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. 2021 Dec 31;19(1):422.
doi: 10.3390/ijerph19010422.

Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review

Grace M Lennox  1 , Patrick M Wood  1 , Ben Schram  1   2 , Elisa F D Canetti  1   2 , Vini Simas  2 , Rodney Pope  1   2   3 , Robin Orr  1   2
Affiliations

Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review

Grace M Lennox et al. Int J Environ Res Public Health. .

Abstract

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

Keywords: air-force; army; bone; defence; navy; recruits; stress fracture; trainees.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases and registers only [34].
See this image and copyright information in PMC

References

    1. Dixon S., Nunns M., House C., Rice H., Mostazir M., Stiles V., Davey T., Fallowfield J., Allsopp A. Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits. J. Sci. Med. Sport. 2019;22:135–139. doi: 10.1016/j.jsams.2018.06.015. - DOI - PubMed
    1. Armstrong D.W., 3rd, Rue J.P., Wilckens J.H., Frassica F.J. Stress fracture injury in young military men and women. Bone. 2004;35:806–816. doi: 10.1016/j.bone.2004.05.014. - DOI - PubMed
    1. Knapik J., Montain S.J., McGraw S., Grier T., Ely M., Jones B.H. Stress fracture risk factors in basic combat training. Int. J. Sports Med. 2012;33:940–946. doi: 10.1055/s-0032-1311583. - DOI - PubMed
    1. Jones B.H., Thacker S.B., Gilchrist J.C., Kimsey D.J., Sosin D.M. Prevention of Lower Extremity Stress Fractures in Athletes and Soldiers: A Systematic Review. Epidemiol. Rev. 2002;24:228–247. doi: 10.1093/epirev/mxf011. - DOI - PubMed
    1. Patel D.S., Roth M., Kapil N. Stress fractures: Diagnosis, treatment, and prevention. Am. Fam. Physician. 2011;83:39–46. - PubMed

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