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Calcif Tissue Int. 2019 Apr 22. doi: 10.1007/s00223-019-00548-7. [Epub ahead of print]

Regional Changes in Density and Microarchitecture in the Ultradistal Tibia of Female Recruits After U.S. Army Basic Combat Training.

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Department of Defense Biotechnology High Performance Computing Software Applications Institute, Fort Detrick, MD, USA.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA.
Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.
Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
Department of Defense Biotechnology High Performance Computing Software Applications Institute, Fort Detrick, MD, USA.


Musculoskeletal injuries, such as stress fracture, are responsible for over 10-million lost-duty days among U.S. Army Soldiers. During Basic Combat Training (BCT), an 8- to 10-week program that transforms civilians into Soldiers, women are four times more likely than men to sustain a stress fracture. In this work, we performed high-resolution peripheral quantitative computed tomography scans on the ultradistal tibia of 90 female recruits [age = 21.5 ± 3.3 (mean ± standard deviation) years] before the start of BCT and after 8 weeks into BCT. Then, we divided the scanned bone volume into four sectors-lateral, posterior, medial, and anterior-and computed the bone density and microarchitectural parameters in each of the four sectors pre- and post-BCT. We used linear mixed models to estimate the mean difference for bone density and microarchitectural parameters, while controlling for age, race, and pre-BCT body mass index. Our results revealed that the total volumetric bone mineral density, trabecular volumetric bone mineral density, and trabecular thickness increased (p < 0.05) in each of the four sectors. In addition, cortical thickness and trabecular bone volume/total volume increased in both medial and posterior sectors (p < 0.05). Overall, six and five out of nine parameters improved in the medial and posterior sectors, respectively, after BCT. In conclusion, the heightened physical activity during BCT led to the most beneficial bone adaptation in the medial and posterior sectors of the ultradistal tibia, which is indicative of higher loading in these sectors during activities performed in the course of BCT.


Bone; Bone adaptation; Exercise; High-resolution peripheral quantitative computed tomography; Stress fracture in women


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