Stress Fractures in Women: Causes and Prevention

by Dr. Marci Goolsby

Stress fractures are a common injury, causing athletes to miss time from exercise and competition. Up to 20 percent of runners have had a stress fracture, and they affect women more than men. There are likely multiple reasons women are more affected, including how women run, how strong their bones are, and the occurrence of something called the Female Athlete Triad.

Female Athlete Triad

The Female Athlete Triad describes the relationship between three health problems:

1. energy deficit (unhealthy eating habits and/or excessive exercise)
2. loss of regular monthly period (amenorrhea or oligomenorrhea)
3. weak bones (osteoporosis)

An energy deficit occurs when one’s nutrition intake does not match up with the energy spent exercising. This can easily occur when one increases their training without appropriately adjusting their nutrition intake, particularly if she has poor nutrition habits. This energy deficit affects the body’s hormone levels. The normal menstrual cycle is disrupted and your periods become spaced out or go away completely. The bones need a healthy diet and normal hormone function to be healthy. Thus, the energy deficit can lead to early osteoporosis (weak bones) and/or stress fractures.

Other causes of stress fractures

The most common mistake women (and men) make is increasing their training by too much, too quickly. Adding jumping or speed training and/or increasing your overall mileage too quickly can lead to stress fractures. Changes in training should be done gradually. It is important to incorporate a good strengthening program into your routine, particularly for the core and hips. This can prevent changes in your running gait that can increase your risk of getting a stress fracture.

Wearing appropriate shoes is important, too. Throw out your shoes that are older than a few months (if running already) or those ones that have been collecting dust on your closet shelf for more than a year. If considering changing to a “minimalist” shoe (they’re not for everyone), make the transition gradual by slowly incorporating their use into your routine.

Keeping your bones strong by avoiding the Female Athlete Triad is important, but getting enough calcium and vitamin D is also vital to bone health. Some people who may not be getting enough sunlight or calcium in their diet may need a supplement.

Overall, to avoid stress fractures, it is important to gradually increase your training, incorporate strength training, and maintain a healthy balance between your nutrition and your exercise.

Marci Goolsby, M.D., is a sports medicine physician in the Women’s Sports Medicine Center at Hospital for Special Surgery. She trained at the University of California Los Angeles, where she served as team physician for the UCLA women’s basketball, volleyball, softball and baseball teams. She has also served as an event physician at marathons and triathlons. Her main areas of clinical and research interest are stress fractures and the Female Athlete Triad. As a prior collegiate basketball player, Dr. Goolsby also has a special interest in the care of basketball players. She is a consulting team physician for the New York Liberty.