Supplementary information files for Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

Supplementary information for article Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers <br> Objectives: The aims of this study were to determine whether lumbar areal bone mineral density differed between cricket fast bowlers with and without lumbar stress fracture, and whether bone mineral density trajectories differed between groups during rehabilitation. Design: Cross-sectional and cohort. Methods: 29 elite male fast bowlers received a post-season anteroposterior lumbar dual-energy X-ray absorptiometry scan and a lumbar magnetic resonance imaging scan to determine stress fracture status. Participants were invited for three additional scans across the 59 weeks post baseline or diagnosis of injury. Bone mineral density was measured at L1 – L4 and ipsilateral and contralateral L3 and L4 sites. Independent-sample t-tests determined baseline differences in bone mineral density and multilevel models were used to examine differences in bone mineral density trajectories over time between injured and uninjured participants. Results: 17 participants with lumbar stress fracture had lower baseline bone mineral density at L1 – L4 (7.6 %, p = 0.034) and contralateral sites (8.8–10.4 %, p = 0.038–0.058) than uninjured participants. Bone mineral density at all sites decreased 1.9–3.0 % by 20–24 weeks before increasing to above baseline levels by 52 weeks post injury. Conclusions: Injured fast bowlers had lower lumbar bone mineral density at diagnosis that decreased following injury and did not return to baseline until up to a year post-diagnosis. Localised maladaptation of bone mineral density may contribute to lumbar stress fracture. Bone mineral density loss following injury may increase risk of recurrence, therefore fast bowlers require careful management when returning to play. <br> <br>