title: Risk factors for stress fracture in female endurance athletes: a cross-sectional study.
abstract: OBJECTIVE
  To identify psychological and physiological correlates of stress fracture in female endurance athletes.
  
  
  METHODS
  A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit.
  
  
  METHODS
  Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ&sup2;, analysis of variance and Mann-Whitney U tests.
  
  
  RESULTS
  Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively).
  
  
  CONCLUSIONS
  Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk.
authors.affiliation: Centre for Global Health and Human Development,  Loughborough University, SSEHS, Loughborough, Leicestershire,  UK.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Duckham
authors.forename: Nicholas
authors.initials: N
authors.lastname: Peirce
authors.forename: Caroline
authors.initials: C
authors.lastname: Meyer
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Summers
authors.forename: Noël
authors.initials: N
authors.lastname: Cameron
authors.forename: Katherine
authors.initials: K
authors.lastname: Brooke-Wavell