1. Why is the incidence of stress fractures in military basic training greater for women than for men?

  2. What is the relationship of genetics and body composition to bone density and the incidence of stress fractures in women?

  3. What are the effects of diet, physical activity, contraceptive use, and other lifestyle factors (smoking and alcohol) on the accrual of peak bone mineral content, incidence of stress fractures, and development of osteoporosis in military women?

  4. How do caloric restriction and disordered eating patterns affect hormonal balance and the accrual and maintenance of peak bone mineral content?

  5. How can the military best ensure that the dietary intakes of active-duty military women in training and throughout their military careers do not contribute to an increased incidence of stress fractures and osteoporosis?


In considering the questions posed by the military (and as a follow-on activity to the subcommittee's earlier report, Assessing Readiness in Military Women [IOM, 1998]), the subcommittee consulted with a liaison panel comprising military researchers and health care personnel. A workshop was held in December 1997 to bring together additional military personnel in the areas of training, physical fitness, and military nutrition, as well as civilian researchers and practitioners in the areas of physical fitness and performance, endocrinology, bone mineral assessment, and sports medicine. A focused literature review culled from workshop presentations and selected military and civilian research on the pathophysiology and epidemiology of stress fractures is included in this report.


This report responds to the five task questions by evaluating the relevant information provided to the subcommittee at the workshop and subsequent deliberations in executive session, which form the basis for the subcommittee's conclusions and recommendations. Chapter 1 reviews the essential concepts of bone health, Chapter 2 reviews the risk factors for stress fracture, and Chapter 3 examines the effects of energy intake, physical activity, and hormonal factors on bone health. In Chapter 4, the subcommittee provides its responses to the task questions; these responses form the basis for the subcommittee's conclusions, recommendations, and suggestions for additional research. The appendixes contain the agenda and speakers' abstracts from the workshop Reducing Stress Fracture Among Physically Active Young Servicemembers , which was held on December 10, 1997 (Appendix A); summary tables of the most recent (1985) Military Recommended Dietary Allowances (Appendix B) and the Food and Nutrition Board's 1997 Recommended Intakes summary table for Calcium and Related Nutrients (Appendix C); and biographical sketches of the subcommittee members (Appendix D).

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