Emerging Options for Biologic Enhancement of Stress Fracture Healing in Athletes

Timothy L. Miller, MD; Christopher C. Kaeding, MD; Scott A. Rodeo, MD


J Am Acad Orthop Surg. 2020;28(1):1-9. 

In This Article

Using a Holistic Approach

Because the shortest time to union and return to full activity are the goals of treating stress fractures in elite athletes, the traditional treatment strategy of immobilization and extended rest from sports participation is often impractical or unacceptable. Multiple biologic and mechanical factors influence a bone's ability to remodel as well as heal a bony stress injury. Optimal treatment requires taking a holistic approach to athletes presenting with this injury. Maximizing an athlete's biologic capacity to repair damaged bone requires assessment of the athlete's nutritional, hormonal, and emotional status as well as their biomechanics, bone mineral density, and medication usage.[2] Athletes at greatest risk for recurrent or severe stress fractures are those presenting with the female athlete triad (low-energy availability, menstrual dysfunction, and decreased bone mineral density) and relative energy deficiency in sport. A team approach to treatment that includes nutrition counseling, sports psychology evaluation, endocrinology assessment, and biomechanical analysis is necessary in these high-risk athletes.