Does tibial bone mineral status quality differ between medial tibial stress syndrome symptomatic and asymptomatic long-distance runners?

Background Although the exact cause of medial tibial stress syndrome is unclear, changes in bone metabolism are likely to be involved. Hypothesis Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms; these changes are reversible and are not inherited. Study Design Prospective cohort study. Methods Bone mineral density in 14 adult male athletes with long-standing medial tibial stress syndrome was measured when they were symptomatic and after recovery (mean follow-up, 5.7 years). Repeat measurements were also made prospectively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes. Results Bone mineral density was 9% ± 11% higher in the proximal tibia but 11% ± 12% lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects. It increased by 19% ± 11% in the region of pain after recovery from symptoms and, at follow-up, was no lower than in nonathlete control subjects. Conclusion Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms.

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Abnormally Decreased Regional Bone Density in Athletes with Medial Tibial Stress Syndrome

The American Journal of Sports Medicine ◽

10.1177/03635465010290060701 ◽

2001 ◽

Vol 29 (6) ◽

pp. 712-715 ◽

Cited By ~ 55

Author(s):

Håkan I. Magnusson ◽

Nils E. Westlin ◽

Fredrik Nyqvist ◽

Per Gärdsell ◽

Ego Seeman ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

The Body ◽

Medial Tibial Stress Syndrome ◽

Mineral Density ◽

Male Athletes ◽

Tibial Bone ◽

Control Subjects ◽

Stress Syndrome ◽

Regional Bone Mineral Density

Medial tibial stress syndrome, a common condition of uncertain origin found in athletes, is characterized by pain in the distal posteromedial aspect of the tibia during exercise, with or without increased scintigraphic uptake in the affected region. To determine whether medial tibial stress syndrome with increased scintigraphic uptake is associated with a change in tibial bone mineral density confined to the site of the increased uptake, we measured bone mineral density (in grams per square centimeter) in 18 adult male athletes with long-standing medial tibial stress syndrome and compared the measurements with those of 16 age-and sex-matched control subjects and with those of 18 athletes without medial tibial stress syndrome who had a comparable training regimen. Tibial bone mineral density in the region corresponding to the pain was 15% ± 9% lower in the patients than in control subjects and 23% ± 8% lower than in the athletic control subjects (both significant differences). Bone mineral densities in most other regions of the body were higher than in the control subjects but lower than in the athletic controls at the corresponding sites. In summary, medial tibial stress syndrome is associated with low regional bone mineral density.

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