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Citation
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Bulathsinhala L, Hughes JM, McKinnon CJ, Kardouni JR, Guerriere KI, Popp KL, Matheny RW, Bouxsein ML. J. Bone Miner. Res. 2017; 32(7): 1546-1553. |
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Affiliation
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Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Department of Orthopedic Surgery, Harvard Medical School, Boston MA, USA. |
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Abstract
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Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in White and Hispanic Soldiers compared to Black soldiers. However, these studies did not account for the large ethnic diversity in the U.S. Military.
PURPOSE: We aimed to identify differences in SF risk among racial/ethnic groups within the U.S. Army.
METHODS: A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex.
RESULTS: We identified 21,549 SF cases in 1,299,332 Soldiers (over 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1,000 person-years (7.47 and 2.05 per 1,000 person years in women and men, respectively). Using Non-Hispanic Blacks as the referent group, Non-Hispanic White women had the highest risk of SF, with a 92% higher risk of SF than Non-Hispanic Black women [1.92 (1.81-2.03)], followed by American Indian/Native Alaskan women [1.72 (1.44-1.79)], Hispanic women [1.65 (1.53-1.79)] and Asian women [1.32 (1.16-1.49)]. Similarly, Non-Hispanic White men had the highest risk of SF, with a 59% higher risk of SF than Non-Hispanic Black men [1.59 (1.50-1.68))], followed by Hispanic men [1.19 (1.10-1.29)].
CONCLUSION: When examining the total U.S. Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with Non-Hispanic White Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Language: en |