Bone stress injuries

Stuart J. Warden, David B. Burr

Research output: Chapter in Book/Report/Conference proceedingChapter


The pathology continuum from stress reaction to stress fracture and complete bone fracture is captured by the term bone stress injury (BSI). The mechanism responsible for BSIs remains theoretical; however, there is consensus that it involves an imbalance between load-induced microdamage formation and its removal. In the scenario of patients taking antiremodeling drugs, BSIs present as atypical femoral (stress) fractures (AFFs) in the subtrochanteric region and diaphysis of the femur. Risk factor identification is important not only for prevention of first-time injury, but also to reduce the risk of recurrence. BSIs present with activity-related pain. At early stages, the pain may be described as a mild diffuse ache occurring after a specific amount of bone loading activity. Numerous classification systems have been reported for grading BSIs to guide management decisions and determine prognosis.

Original languageEnglish (US)
Title of host publicationPrimer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism
Number of pages9
ISBN (Electronic)9781119266594
ISBN (Print)9781119266563
StatePublished - Jan 1 2018


  • Antiremodeling drugs
  • Atypical femoral fractures
  • Bone loading activity
  • Bone stress injury
  • Subtrochanteric region

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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  • Cite this

    Warden, S. J., & Burr, D. B. (2018). Bone stress injuries. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism (pp. 450-458). wiley.