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Kids, Bones, and Stress Fractures
Stress fractures are fractures of the bones that occur from repeated submaximal
loading. They are also called fatigue or insufficiency fractures, bone
contusions, or stress injuries and they occur in adolescents more than
ever. In part, this is because young people have increased their participation
in and their intensity level of impact sports. Additionally, we are now
better at diagnosing stress fractures using highly accurate MRI exams for
people with unexplained pain. MRI testing, unlike x-rays, reveals the interior
of bones and the increased reaction that occurs when bones are injured.
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Increased signal in MRI images
indicative of bone injury
of the
femoral condyle (Figures 1a, 1b),
and
bone injury
in the foot (Figure 1c).
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Prevention of stress fractures is targeted in two areas: nutrition and
physical activity. To maximize peak bone mass, children must consume
a minimum of 1000 mg of calcium per day (preferably 1500 mg).
Calcium-rich foods include milk, cheese, yogurt, almonds, and spinach.
Physical activity helps build bone mass, but sudden increases in the
intensity, duration, or frequency of training can actually induce stress
fractures. Sports participation in adolescents greater than 16 hours
per week is associated with a higher incidence of fractures. To avoid
stress fractures and other such bone injuries caused by overuse, we encourage
kids to modify sports impact levels, wear athletic shoes with excellent
shock absorption, run on shock absorbing surfaces, and maintain consistent
exercise patterns and fitness levels.
Some Bone Mass Facts:
- With good nutrition and exercise, bone mass increases through
childhood and plateaus between the ages of 20 and 30. The majority of
bone mass is accumulated before the age of 15. Significant deficits are
often realized around the age of 50, when the rate of bone mass loss
exceeds the rate of bone mass accumulation.
- 20 – 40% of bone mass
can be influenced by calcium intake, physical activity, hormones, and
body mass.
- 60 – 80% of bone mass
may be genetically determined.
Thin, premenstrual or ammenorheic, hyper-athletic girls with low calcium
intake are obvious candidates for stress fractures. Menstrual irregularities
reflect low serum estrogen levels. Estrogen is a key hormone in bone
deposition and maintenance. Only upon the onset of menstruation does
significant mineral get deposited to form more bone.
- Normal appearing
boys and girls who do not consume adequate calcium may not develop
stress fractures, but are decreasing their calcium deposits to the
body’s
bone bank, and are thus at higher risk for developing osteoporosis
later in life.
- Direct sunlight is required to convert the
passive form of vitamin D to the active form required for calcium utilization
by bone.
The message is clear: At least 1500 mg of calcium, 400 IU of vitamin
D, 30 minutes of direct sunshine without sunscreen, and 60 minutes of
daily weight-bearing and resistance exercise is recommended to build
bone mass and decrease fracture risk. The young increase bone mass; adults
can prevent loss. Feed your children milk and other calcium and vitamin
D rich foods, and encourage daily exercise and a significant amount of
sunlight exposure. For children of all ages, treat yourself the same
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Stone Clinic Podcast
The Stone Clinic is now broadcasting podcasts and RSS feeds. Podcasts
are audio files that users can subscribe to and download free of
charge to store on their computers or portable audio devices for listening
at their leisure.
The Knee Joint: Meniscus
Description:
Kevin R. Stone, M.D., discusses the meniscus: what it is, why it
is important, and what to do if you injure it. Followed by a
patient Q&A. 12:19 minutes/11.3MB |
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Tissue Transplantation: Safety
Description:
Dr. Kevin Stone is interviewed by Molly McCrae of CBS News 5 regarding
the safety, risks, and benefits of using donated tissue for transplantation
in Orthopaedics. 8:21 minutes/11.5MB |
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Top Questions About the Knee, Part I
Description:
Kevin R. Stone, M.D., discusses the top questions patients ask
about the knee joint: Part 1 of a 2 part series. 9:37 minutes/13.2MB |
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Top Questions About the Knee, Part II
Description:
Kevin R. Stone, M.D., discusses the top questions patients ask
about the knee joint: Part 2 of a 2 part series. 7:47 minutes/7.2MB |
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The Ankle
Description:
Kevin R. Stone, M.D., discusses the ankle, common ankle injuries,
treatments, and rehabilitation. Followed by a patient Q&A.
9:29 minutes/8.7MB |
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The Clavicle
Description:
Kevin R. Stone, M.D., discusses the clavicle, common clavicle injuries,
and treatment options. 4:27 minutes/4MB |
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Lower Back Pain
Description:
Kevin R. Stone, M.D., talks about some
common low back problems that we see, particularly in our rowers
and our cyclists. 4:58 minutes/4.5MB |
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Physical Therapy
Description:
Kevin R. Stone, M.D., in San Francisco talks about the importance
of physical therapy. 4.33 minutes/4.5MB |
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Anterior Cruciate Ligament Injuries
Description:
Kevin R. Stone, M.D., talks about current thoughts on reconstruction
of the Anterior Cruciate Ligament (ACL), and discusses future
developments. 6.4 minutes/4.6MB |
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