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Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis
  1. Alexis A Wright1,
  2. Jeffrey B Taylor1,
  3. Kevin R Ford1,
  4. Lindsey Siska2,
  5. James M Smoliga1
  1. 1Department of Physical Therapy, High Point University, High Point, North Carolina, USA
  2. 2Department of Exercise Science, High Point University, High Point, North Carolina, USA
  1. Correspondence to Dr Alexis A Wright, High Point University, 833 Montlieu Ave, Drawer 67, High Point, NC 27262, USA; awright{at}


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<0.001; I2=0%) and 2.31 (95% CI 1.24 to 4.29; p<0.01; I2=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.

  • Risk factor
  • Running
  • Lowever extremity
  • Stress fracture

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