Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms

Background: Although the exact cause of medial tibial stress syndrome is unclear, changes in bone metabolism are likely to be involved. Hypothesis: Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms; these changes are reversible and are not inherited. Study Design: Prospective cohort study. Methods: Bone mineral density in 14 adult male athletes with long-standing medial tibial stress syndrome was measured when they were symptomatic and after recovery (mean follow-up, 5.7 years). Repeat measurements were also made prospectively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes. Results: Bone mineral density was 9% +/- 11% higher in the proximal tibia but 11% +/- 12% lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects. It increased by 19% +/- 11% in the region of pain after recovery from symptoms and, at follow-up, was no lower than in nonathlete control subjects. Conclusion: Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms. (C) 2003 American Orthopaedic Society for Sports Medicine.