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Original article
Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis Alexis A Wright,1 Jeffrey B Taylor,1 Kevin R Ford,1 Lindsey Siska,2 James M Smoliga1 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjsports-2015-094828). 1
Department of Physical Therapy, High Point University, High Point, North Carolina, USA 2 Department of Exercise Science, High Point University, High Point, North Carolina, USA Correspondence to Dr Alexis A Wright, High Point University, 833 Montlieu Ave, Drawer 67, High Point, NC 27262, USA;
[email protected] Accepted 26 June 2015 Published Online First 17 July 2015
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. Purpose We systematically reviewed and critiqued the evidence regarding risk factors associated with increased risk of lower extremity stress fractures in runners. Study design 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
