Multidisciplinary Approaches to Predicting, Preventing, and Managing Bone Stress Injuries in Elite Endurance Athletes

Bone stress injuries (BSIs), including stress reactions and complete stress fractures, are a major challenge in elite endurance sport. Distance runners, triathletes, race walkers, and other endurance athletes are exposed to repetitive, high-volume loading, while low energy availability, endocrine dysfunction, biomechanical factors, training-load errors, and inadequate recovery may further compromise skeletal health. Although BSIs are extensively studied, they continue to interrupt training and competition, impair athletic careers, and contribute to longer-term musculoskeletal and bone-health consequences. Current research also raises important questions about how these interacting risk factors can be identified early and how injury risk can be assessed accurately at the individual level.Recent studies have improved understanding of the contributions of Relative Energy Deficiency in Sport (REDs), menstrual and hormonal disturbances, bone turnover, running biomechanics, imaging findings, and external training load. Advances in MRI, DXA, high-resolution peripheral quantitative computed tomography, wearable sensors, biomarkers, and artificial intelligence have created new opportunities for screening and risk prediction. However, the evidence remains heterogeneous, and many proposed tools lack prospective validation, clinical integration, or applicability across different endurance disciplines, sexes, ages, and performance levels. Prevention and rehabilitation strategies also vary considerably, highlighting the need for better multidisciplinary frameworks that connect biological, mechanical, nutritional, clinical, and training-related information.This Research Topic aims to advance the prediction, prevention, diagnosis, and management of BSIs in elite endurance athletes by integrating perspectives from sports medicine, biomechanics, nutrition, endocrinology, rehabilitation, training science, and data science. It will examine how interacting risk factors influence skeletal loading and bone health, evaluate emerging screening and monitoring approaches, and identify evidence-based strategies for individualized care, return to sport, and long-term injury prevention. To gather further insights in the multidisciplinary investigation of BSIs across elite endurance sports, we welcome articles addressing, but not limited to, the following themes:o Risk prediction, screening, and early detection of BSIso Biomarkers, bone turnover, and skeletal-health assessmento Imaging approaches, including DXA, MRI, and high-resolution peripheral quantitative computed tomographyo Biomechanical contributors, including gait, ground reaction forces, footwear, and running surfaceso Relative Energy Deficiency in Sport, low energy availability, nutrition, and endocrine healtho Menstrual function, sex-specific risk factors, and hormonal influences on bone healtho Training-load monitoring, periodization, recovery, and injury-risk managemento Wearable technologies, artificial intelligence, machine learning, and individualized prediction modelso Diagnostic pathways and clinical decision-makingo Treatment and rehabilitation strategies for different BSI locations and severitieso Return-to-training and return-to-competition protocolso Multidisciplinary models of care for elite endurance athleteso Differences across endurance disciplines, age groups, and athlete populationso Long-term skeletal health and recurrent injury prevention Topic editors: Michael Fredericson, Angela Ryck Source: https://www.frontiersin.org/research-topics/84111/multidisciplinary-approaches-to-predicting-preventing-and-managing-bone-stress-injuries-in-elite-endurance-athletes