Restrictive Eating Tendencies And Reduced Sleep Observed In Female Athletes With High-risk Bone Stress Injuries

PURPOSE: To identify differences in associated factors within female athletes participating in land-based sports with a history of bone stress injury (BSI) in high-risk sites (femoral neck, pelvis, sacrum) compared to low-risk sites (metatarsal, tibia, and fibula) and those without prior BSI. METHODS: This cross-sectional study included 15 female athletes with history of high-risk BSI, 15 with low-risk BSI, and 15 with no history of BSI. Survey data regarding prior injuries, menstrual history, eating behaviors using eating disorder examination questionnaire (EDE-Q), weight changes at adult height, and sleep were collected. Dual-energy x-ray absorptiometry (DXA) of lumbar spine, hip and whole body was obtained and standardized to BMD Z-scores. Differences between groups were compared using 1 way ANOVA and post-hoc t-tests with Bonferroni correction. RESULTS: Athletes were young (mean +/- standard deviation: 26.7 yrs+/-4.6 yrs) with healthy body mass index (21.6+/-1.7 kg/m2). Those with a history of high-risk BSI reported more days in the past month where they felt they did not get enough sleep and had lower EDE-Q Shape subscale values compared to athletes with no history of BSI (Table 1). Those with history of high-risk BSI had lower lumbar spine Z-scores and greater changes in weight than those with history of low-risk BSI. Although not meeting threshold of statistical significance, a larger portion of those with history of high-risk BSI experienced primary amenorrhea and/or secondary oligomenorrhea/amenorrhea (63%) compared to those with history of low-risk BSI (33%, p = 0.07) or no BSI history (47%, p = 0.10). CONCLUSION: Female athletes with a history of high-risk BSI are more likely to report restrictive eating tendencies and less sleep compared to female athletes with low-risk or no BSI history. Addressing sleep and optimizing nutrition may be important in reducing potential for high-risk BSI. Table 1 - Factors associated with history of high-risk, low-risk or no prior bone stress injury (BSI) No BSI history Low-risk BSI High-risk BSI Days not enough sleep in 1 month 6.3(5.4) 8.9(4.8) 13.3(8.5)* Total EDE-Q score 0.38(0.34) 0.49(.50) 1.03(1.03) EDE-Q Shape subscale 0.43(.43) 0.76(.78) 1.46(1.28)* Total body Z-score 0.27(0.79) 0.53(0.95) 0.10(0.89) Femoral neck Z-score -0.19(0.71) 0.16(1.19) -0.20(.66) Lumber spine Z-score -0.53(0.82) -0.01(1.15) -1.04(0.76)# Difference of maximum and minimum weight at max height (lbs) 16.8(7.2) 16.9(6.5) 24.9(11.3)# Values are presented as mean(standard deviation) * denotes p < 0.05 compared to no BSI history group # denotes p < 0.05 compared to low-risk group Authors’ views do not reflect the views of the U.S. Army or DoD policy.