{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:30:43Z","timestamp":1792006243119,"version":"4.4.0"},"reference-count":40,"publisher":"National Athletic Trainers' Association","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Context:\u2003<\/jats:title>\n                    <jats:p>Stress fractures are injuries caused by cumulative, repetitive stress that leads to abnormal bone remodeling. Specific populations, including female athletes and endurance athletes, are at higher risk than the general athletic population. Whereas more than 460\u200a000 individuals participate in collegiate athletics in the United States, no large study has been conducted to determine the incidence of stress fractures in collegiate athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:\u2003<\/jats:title>\n                    <jats:p>To assess the incidence of stress fractures in National Collegiate Athletic Association (NCAA) athletes and investigate rates and patterns overall and by sport.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:\u2003<\/jats:title>\n                    <jats:p>Descriptive epidemiology study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:\u2003<\/jats:title>\n                    <jats:p>National Collegiate Athletic Association institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients or Other Participants:\u2003<\/jats:title>\n                    <jats:p>National Collegiate Athletic Association athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s):\u2003<\/jats:title>\n                    <jats:p>Data were analyzed from the NCAA Injury Surveillance Program for the academic years 2004\u20132005 through 2013\u20132014. We calculated rates and rate ratios (RRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:\u2003<\/jats:title>\n                    <jats:p>A total of 671 stress fractures were reported over 11\u200a778\u200a145 athlete-exposures (AEs) for an overall injury rate of 5.70 per 100\u200a000 AEs. The sports with the highest rates of stress fractures were women's cross-country (28.59\/100\u200a000 AEs), women's gymnastics (25.58\/100\u200a000 AEs), and women's outdoor track (22.26\/100\u200a000 AEs). Among sex-comparable sports (baseball\/softball, basketball, cross-country, ice hockey, lacrosse, soccer, swimming and diving, tennis, indoor track, and outdoor track), stress fracture rates were higher in women (9.13\/100\u200a000 AEs) than in men (4.44\/100\u200a000 AEs; RR = 2.06; 95% CI = 1.71, 2.47). Overall, stress fracture rates for these NCAA athletes were higher in the preseason (7.30\/100\u200a000 AEs) than in the regular season (5.12\/100\u200a000 AEs; RR = 1.43; 95% CI = 1.22, 1.67). The metatarsals (n = 254, 37.9%), tibia (n = 147, 21.9%), and lower back\/lumbar spine\/pelvis (n = 81, 12.1%) were the most common locations of injury. Overall, 21.5% (n = 144) of stress fractures were recurrent injuries, and 20.7% (n = 139) were season-ending injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:\u2003<\/jats:title>\n                    <jats:p>Women experienced stress fractures at higher rates than men, more often in the preseason, and predominantly in the foot and lower leg. Researchers should continue to investigate biological and biomechanical risk factors for these injuries as well as prevention interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4085\/1062-6050-52.8.01","type":"journal-article","created":{"date-parts":[[2017,9,22]],"date-time":"2017-09-22T15:42:58Z","timestamp":1506094978000},"page":"966-975","source":"Crossref","is-referenced-by-count":216,"title":["The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004\u20132005 Through 2013\u20132014 Academic Years"],"prefix":"10.4085","volume":"52","author":[{"given":"Katherine H.","family":"Rizzone","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Ackerman","sequence":"first","affiliation":[{"name":"Boston Children's Hospital, Harvard Medical School, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen G.","family":"Roos","sequence":"first","affiliation":[{"name":"Department of Kinesiology, California State University, Long Beach;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Dompier","sequence":"first","affiliation":[{"name":"Department of Athletic Training, Lebanon Valley College, Annville, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary Y.","family":"Kerr","sequence":"first","affiliation":[{"name":"Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b01","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/036354659602400217","article-title":"The incidence and distribution of stress fractures in competitive track and field athletes: a twelve-month prospective study","volume":"24","author":"Bennell","year":"1996","journal-title":"Am J Sports Med"},{"issue":"6","key":"2020060411300568100_i1062-6050-52-10-966-b02","first-page":"948","article-title":"Associations between the female athlete triad and injury among high school runners","volume":"9","author":"Rauh","year":"2014","journal-title":"Int J Sports Phys Ther"},{"issue":"1","key":"2020060411300568100_i1062-6050-52-10-966-b03","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/JSM.0000000000000060","article-title":"Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine","volume":"24","author":"DiFiori","year":"2014","journal-title":"Clin J Sport Med"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b04","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00042752-199510000-00004","article-title":"Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis","volume":"5","author":"Bennell","year":"1995","journal-title":"Clin J Sport Med"},{"issue":"3","key":"2020060411300568100_i1062-6050-52-10-966-b05","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S8756-3282(00)00342-2","article-title":"Stress fractures in military recruits: gender differences in muscle and bone susceptibility factors","volume":"27","author":"Beck","year":"2000","journal-title":"Bone"},{"issue":"3","key":"2020060411300568100_i1062-6050-52-10-966-b06","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.bone.2004.05.014","article-title":"Stress fracture injuries in young military men and women","volume":"35","author":"Armstrong","year":"2004","journal-title":"Bone"},{"issue":"suppl 11","key":"2020060411300568100_i1062-6050-52-10-966-b07","doi-asserted-by":"crossref","first-page":"S636","DOI":"10.1249\/MSS.0b013e3181893164","article-title":"Prediction model for stress fracture in young female recruits during basic training","volume":"40","author":"Moran","year":"2008","journal-title":"Med Sci Sports Exerc"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b08","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.pmrj.2010.09.009","article-title":"Overuse injuries in high school runners: lifetime prevalence and prevention strategies","volume":"3","author":"Tenforde","year":"2011","journal-title":"PM R"},{"issue":"1","key":"2020060411300568100_i1062-6050-52-10-966-b09","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1177\/0363546514562739","article-title":"Epidemiology of stress fracture injuries among US high school athletes, 2005\u20132006 through 2012\u20132013","volume":"43","author":"Changstrom","year":"2015","journal-title":"Am J Sports Med"},{"issue":"10","key":"2020060411300568100_i1062-6050-52-10-966-b10","doi-asserted-by":"crossref","first-page":"3123","DOI":"10.1210\/jc.2011-1614","article-title":"Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls","volume":"96","author":"Ackerman","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"8","key":"2020060411300568100_i1062-6050-52-10-966-b11","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1249\/MSS.0000000000000574","article-title":"Cano Sokoloff N, De Nardo Maffazioli G, Clarke HM, Lee H, Misra M. Fractures in relation to menstrual status and bone parameters in young athletes","volume":"47","author":"Ackerman","year":"2015","journal-title":"Med Sci Sports Exerc"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b12","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3928\/01477447-20070401-15","article-title":"Stress fractures in elite cross-country athletes","volume":"30","author":"Laker","year":"2007","journal-title":"Orthopedics"},{"key":"2020060411300568100_i1062-6050-52-10-966-b13","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/B978-0-444-59602-4.00025-3","article-title":"Neuroendocrine mechanisms in athletes","volume":"124","author":"Misra","year":"2014","journal-title":"Handb Clin Neurol"},{"issue":"8","key":"2020060411300568100_i1062-6050-52-10-966-b14","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1177\/0363546513490645","article-title":"Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes","volume":"41","author":"Nattiv","year":"2013","journal-title":"Am J Sports Med"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b15","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1941738111429929","article-title":"A displaced femoral neck stress fracture in an amenorrheic adolescent female runner","volume":"4","author":"Goolby","year":"2012","journal-title":"Sports Health"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b16","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/0363546513520295","article-title":"Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women","volume":"42","author":"Barrack","year":"2014","journal-title":"Am J Sports Med"},{"key":"2020060411300568100_i1062-6050-52-10-966-b17","article-title":"1981-82\u20132012-13 NCAA sports sponsorship and participation rates report","author":"Irick","journal-title":"National Collegiate Athletic Association (NCAA) Web site"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b18","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1177\/036354659402200216","article-title":"Stress fractures of the femoral shaft in athletes\u2013more common than expected: a new clinical test","volume":"22","author":"Johnson","year":"1994","journal-title":"Am J Sports Med"},{"issue":"9","key":"2020060411300568100_i1062-6050-52-10-966-b19","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1249\/mss.0b013e318074e54b","article-title":"Risk factors for stress fracture among young female cross-country runners","volume":"39","author":"Kelsey","year":"2007","journal-title":"Med Sci Sports Exerc"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b20","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4085\/1062-6050-49.3.58","article-title":"National Collegiate Athletic Association Injury Surveillance System: review of methods for 2004\u20132005 through 2013\u20132014 data collection","volume":"49","author":"Kerr","year":"2014","journal-title":"J Athl Train"},{"issue":"7","key":"2020060411300568100_i1062-6050-52-10-966-b21","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1177\/0363546515580790","article-title":"Epidemiology of overuse injuries in collegiate and high school athletics in the United States","volume":"43","author":"Roos","year":"2015","journal-title":"Am J Sports Med"},{"issue":"8","key":"2020060411300568100_i1062-6050-52-10-966-b22","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s40279-014-0194-6","article-title":"What are the main risk factors for running-related injuries?","volume":"44","author":"Saragiotto","year":"2014","journal-title":"Sports Med"},{"issue":"6","key":"2020060411300568100_i1062-6050-52-10-966-b23","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1519\/JSC.0b013e318185f2f0","article-title":"The effects of resistance training on endurance distance running performance among highly trained runners: a systematic review","volume":"22","author":"Yamamoto","year":"2008","journal-title":"J Strength Cond Res"},{"issue":"6","key":"2020060411300568100_i1062-6050-52-10-966-b24","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1007\/s40279-014-0157-y","article-title":"The effect of strength training on performance in endurance athletes","volume":"44","author":"Beattie","year":"2014","journal-title":"Sports Med"},{"issue":"1","key":"2020060411300568100_i1062-6050-52-10-966-b25","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1519\/JSC.0b013e3182a1f44c","article-title":"Effects of plyometric training on endurance and explosive strength performance in competitive middle- and long-distance runners","volume":"28","author":"Ramirez-Campillo","year":"2014","journal-title":"J Strength Cond Res"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b26","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0278-5919(05)70016-8","article-title":"Epidemiology and site specificity of stress fractures","volume":"16","author":"Bennell","year":"1997","journal-title":"Clin Sports Med"},{"issue":"1","key":"2020060411300568100_i1062-6050-52-10-966-b27","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1152\/physrev.2001.81.1.419","article-title":"Sex steroids and bone","volume":"81","author":"Compston","year":"2001","journal-title":"Physiol Rev"},{"issue":"4","key":"2020060411300568100_i1062-6050-52-10-966-b28","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1136\/bjsports-2013-093218","article-title":"2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013","volume":"48","author":"DeSouza","year":"2014","journal-title":"Br J Sports Med"},{"issue":"7","key":"2020060411300568100_i1062-6050-52-10-966-b29","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1136\/bjsports-2014-094559","article-title":"RED-S CAT: Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool (CAT)","volume":"49","author":"Mountjoy","year":"2015","journal-title":"Br J Sports Med"},{"issue":"6","key":"2020060411300568100_i1062-6050-52-10-966-b30","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1177\/0363546515572142","article-title":"Identifying sex-specific risk factors for low bone mineral density in adolescent runners","volume":"43","author":"Tenforde","year":"2015","journal-title":"Am J Sports Med"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b31","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s40279-015-0411-y","article-title":"Parallels with the female athlete triad in male athletes","volume":"46","author":"Tenforde","year":"2015","journal-title":"Sports Med"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b32","first-page":"311","article-title":"Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives","volume":"42","author":"Hootman","year":"2007","journal-title":"J Athl Train"},{"issue":"11","key":"2020060411300568100_i1062-6050-52-10-966-b33","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1177\/0363546515599631","article-title":"Epidemiology of hamstring strains in 25 NCAA sports in the 2009-2010 to 2013-2014 academic years","volume":"43","author":"Dalton","year":"2015","journal-title":"Am J Sports Med"},{"issue":"3","key":"2020060411300568100_i1062-6050-52-10-966-b34","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/036354659001800310","article-title":"Stress fractures in figure skaters","volume":"18","author":"Pecina","year":"1990","journal-title":"Am J Sports Med"},{"issue":"3","key":"2020060411300568100_i1062-6050-52-10-966-b35","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1519\/JSC.0b013e3181c7c2eb","article-title":"Correlations between injury, training intensity, and physical and mental exhaustion among college athletes","volume":"24","author":"Vetter","year":"2010","journal-title":"J Strength Cond Res"},{"issue":"3","key":"2020060411300568100_i1062-6050-52-10-966-b36","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/00042752-200405000-00002","article-title":"Preparticipation evaluation: an evidence-based review","volume":"14","author":"Wingfield","year":"2014","journal-title":"Clin J Sport Med"},{"issue":"7","key":"2020060411300568100_i1062-6050-52-10-966-b37","first-page":"35","article-title":"Frequency of preparticipation sports examinations in secondary school athletes: are the University Interscholastic League guidelines appropriate?","volume":"81","author":"Risser","year":"1985","journal-title":"Tex Med"},{"issue":"5","key":"2020060411300568100_i1062-6050-52-10-966-b38","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/01.jsm.0000179136.69598.37","article-title":"Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities","volume":"15","author":"Rumball","year":"2005","journal-title":"Clin J Sport Med"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b39","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/JSM.0b013e3182425aee","article-title":"Female athlete triad screening in National Collegiate Athletic Association Division I athletes: is the preparticipation evaluation form effective?","volume":"22","author":"Mencias","year":"2012","journal-title":"Clin J Sport Med"},{"issue":"2","key":"2020060411300568100_i1062-6050-52-10-966-b40","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1111\/sms.12493","article-title":"A multi-state framework for the analysis of subsequent injury (M-FASIS)","volume":"26","author":"Shrier","year":"2016","journal-title":"Scand J Med Sci Sports"}],"container-title":["Journal of Athletic Training"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/jat\/article-pdf\/52\/10\/966\/1457945\/1062-6050-52_8_01.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/jat\/article-pdf\/52\/10\/966\/1457945\/1062-6050-52_8_01.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T14:57:03Z","timestamp":1749653823000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/52\/10\/article-p966.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,1]]},"references-count":40,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2017,10,1]]}},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-52.8.01","relation":{},"ISSN":["1062-6050"],"issn-type":[{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2017,10,1]]}}}