Endocrine Abstracts

Background: Bone stress injuries are typically overuse injuries associated with repetitive loading of bone and inadequate recovery. A continuum of bone stress injury from periosteal reaction to cortical fracture exists. Intrinsic and extrinsic recognised risk factors have been encapsulated within broader working consensus statements e.g. Relative Energy Deficiency in Sport (RED-S). There is uncertainty as to the appropriate metabolic work-up for such patients.

Objectives: To ascertain the prevalence of metabolic disorders and assess current management of patients with bony stress injuries referred to a secondary/tertiary care sports exercise medicine (SEM) service.

Methods: Retrospective analysis of patient records (n=41) attending between February 2016-December 2017. Patients with a working diagnosis stress injury and subsequent MRI confirmation were identified. Data analysis was performed in-line with the RED-S consensus paper.

Results: 70.7% were female. The commonest associated sport was running (61%). Stress injuries were located in the tibia (51%), metatarsal (22%), femoral neck (10%) and pelvis (5%). Vitamin D results were normal in 37%. Concentrations ranged from <30 (22%) to >75 mmol/L (29.3%). One abnormal calcium concentration (high) and three abnormal TFTs were identified (subclinical hypothyroidism). 88% had blood tests, and 10% were referred for DXA scanning. 7% were referred to endocrinology.

Discussion: Most patients had no evidence of an underlying metabolic condition. We would advocate that patients are referred to SEM for initial assessment. Patients with endocrine abnormalities can then be discussed/referred to endocrinology.

Conclusion: Through collaboration between SEM and endocrinology we have utilised the analysis to develop a trust-wide clinical pathway. This demonstrates the utility of SEM within the NHS whilst ensuring that endocrine services referrals are used where there is a true clinical benefit. Implementation of this will enable prospective data collection across specialties to ensure compliance with best evidence - thus improving healthcare resource utilisation and morbidity.