2015 ISAKOS Biennial Congress ePoster #603

Increasing Rates of Stress Fracture in Pediatric and Overall Populations

Benjamin Streufert, BS, Durham, NC UNITED STATES
Kathryne Judith Stabile, MD, MS, Lititz, PA UNITED STATES
Jonathan Godin, MD, MBA, Edwards, CO UNITED STATES
Richard C. Mather, MD, Durham, NC UNITED STATES

Duke University Medical Center, Durham, NC, USA

FDA Status Not Applicable

Summary: A retrospective database review of 20 million nationwide private insurance claimants from 2007 to 2011 identified increasing rates of stress fractures and examined associated diagnoses, imaging trends, and later diagnoses, demonstrating the challenges of effectively diagnosing and treating stress fractures and raising questions about the impact of this disease on active individuals.

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Abstract:

Introduction

Stress fractures cause significant morbidity in active individuals and present diagnostic and treatment challenges. Previous studies have examined the association of stress fractures with activity level, gender, and associated conditions such as eating disorders, but recent epidemiological trends are not well described. Additionally, it is not well known whether an increasing emphasis on youth athletics has affected the rates of stress fracture in the pediatric population. The purpose of this study is to examine recent trends in diagnosis of stress fracture in both overall and pediatric populations.

Methods

Persons diagnosed with stress fractures between 2007 and 2011 were identified by ICD-9 diagnosis codes in private insurance claims via the PearlDiver Database (PearlDiver Technologies, Fort Wayne, IN). This national database contains all orthopaedic claims for over 20 million patients, and 2 million patients under 20 years of age. Anatomic location of stress fracture was separately examined for the tibia and fibula, metatarsal, femoral neck, femoral shaft, and pelvis. Demographics of patients diagnosed with stress fracture were examined. Incidence of diagnosis was calculated per 10,000 insured claimants in each age group, gender, and region per year. Diagnoses associated with stress fracture were examined by ICD-9 diagnosis codes. Imaging trends were identified by CPT procedural codes in the three months prior to diagnosis. Diagnosis of fracture was examined by ICD-9 diagnosis codes after initial diagnosis of stress fracture at the same anatomic location.

Results

Between 2007 and 2011, 70,590 persons were diagnosed with stress fracture, with 16,212 of those under age 20. In the period studied, the incidence of stress fracture diagnosis rose 41% from 6.08 to 8.58 per 10,000 person-years (p<0.001) in the total population. In those under age 20, the incidence of diagnosis was considerably higher, and additionally rose 37% from 25.12 to 34.32 per 10,000 person-years (p<0.001). Of all stress fractures, 46% were located in the metatarsals, 24% in the tibia or fibula, 3% in the femoral neck, shaft, or pelvis, and the remainder in other anatomic locations. Females represented 69% of all diagnosed, and 57% of those diagnosed under the age of 20 years. Eating disorder diagnoses were present in less than 1% diagnosed with stress fracture. In the three months prior to diagnosis, 10.5% underwent magnetic resonance imaging, and 1.4% received computerized tomography scans of the affected location. Diagnosis of fracture was common in the period after stress fracture diagnosis, occurring in 13% of tibia/fibula, 18% of metatarsal, and 30% of femoral neck stress fractures.

Discussion

AND CONCLUSIONS: The rate of stress fracture diagnosis is increasing in both absolute number and incidence, and holds for both overall and pediatric populations. The reason for the dramatically higher incidence in younger person is likely multifactorial, owing perhaps to changing activity patterns and diagnostic techniques. The high rates of future fracture diagnoses may reflect different diagnostic considerations or progression to more severe pathology. The findings of this study deserve further examination to fully understand this challenging pathology and its impact on the health of active individuals.