title: Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis.
abstract: BACKGROUND
  Stress fractures are common overuse injuries with up to 95% occurring in the lower extremities. Among runners, stress fractures account for 15-20% of all musculoskeletal injuries.
  
  
  OBJECTIVE
  We systematically reviewed and critiqued the evidence regarding risk factors associated with increased risk of lower extremity stress fractures in runners.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic, computerised literature search of Medline, Embase, PubMed, SPORTDiscus, and CINAHL databases (from database inception through 9 January 2014) using keywords related to risk factors and stress fractures. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the search and reporting phases of the study. Inverse variance meta-analyses, using a random effects model were used to summarise ORs.
  
  
  RESULTS
  8 articles met the inclusion criteria; 7 were considered low risk. 4 articles qualified for meta-analysis. Results of the meta-analysis identified previous history of stress fracture and female sex as the primary risk factors for future stress fracture with a pooled OR of 4.99 (95% CI 2.91 to 8.56; p<0.001; I(2)=0%) and 2.31 (95% CI 1.24 to 4.29; p<0.01; I(2)=0%), respectively.
  
  
  CONCLUSIONS
  Currently, only previous history of stress fracture and female sex are risk factors for lower extremity stress fractures strongly supported by the data.
authors.affiliation: Department of Physical Therapy, High Point University, High Point, North Carolina, USA.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: Department of Physical Therapy, High Point University, High Point, North Carolina, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Taylor
authors.affiliation: Department of Physical Therapy, High Point University, High Point, North Carolina, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ford
authors.affiliation: Department of Exercise Science, High Point University, High Point, North Carolina, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Siska
authors.affiliation: Department of Physical Therapy, High Point University, High Point, North Carolina, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Smoliga
mesh_terms: D012090:Cumulative Trauma Disorders / Q000209:etiology; D004033:Diet Fads; D005260:Female; D015775:Fractures, Stress / Q000209:etiology*; D006801:Humans; D007869:Leg Injuries / Q000209:etiology*; D008297:Male; D009752:Nutritional Status; D012307:Risk Factors; D012420:Running / Q000293:injuries*; D012775:Shoes / Q000009:adverse effects
keywords: Lowever extremity; Risk factor; Running; Stress fracture