SpringerLink
Log in

Use of bisphosphonates for the treatment of stress fractures in athletes

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

A literature review was performed to investigate the potential role of bisphosphonates for the treatment of stress fractures in athletes. Given the inhibitory action on osteoclast-mediated bone resorption, short-term suppression of bone remodeling using bisphosphonates could potentially treat stress fractures and prevent stress fractures from becoming regular fractures. To date, while there are some animal studies showing the scientific basis of bisphosphonates on stress fractures, there is still no conclusive evidence to prove any effect of bisphosphonates on stress fracture healing in humans. Further well-designed clinical trials should be carried out to establish their usefulness and safety. Until the results are available, it is prudent to limit the use of bisphosphonates for the treatment of stress fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adami S, Bhalla AK, Dorizzi R, Montesanti F, Rosini S, Salvagno G, Lo Cascio V (1987) The acute-phase response after bisphosphonate administration. Calcif Tissue Int 41:326–331

    Article  PubMed  CAS  Google Scholar 

  2. Ali SM, Esteva FJ, Hortobagyi G, Harvey H, Seaman J, Knight R, Costa L, Lipton A (2001) Safety and efficacy of bisphosphonates beyond 24 months in cancer patients. J Clin Oncol 19:3434–3437

    PubMed  CAS  Google Scholar 

  3. Allen MR, Iwata K, Phipps R, Burr DB (2006) Alterations in canine vertebral bone turnover, microdamage accumulation, and biomechanical properties following 1-year treatment with clinical treatment doses of risedronate or alendronate. Bone 39:872–879

    Article  PubMed  CAS  Google Scholar 

  4. Amanat N, Brown R, Bilston LE, Little DG (2005) A single systemic dose of pamidronate improves bone mineral content and accelerates restoration of strength in a rat model of fracture repair. J Orthop Res 23:1029–1034

    Article  PubMed  CAS  Google Scholar 

  5. Amanat N, McDonald M, Godfrey C, Bilston L, Little D (2007) Optimal timing of a single dose of zoledronic acid to increase strength in rat fracture repair. J Bone Miner Res 22:867–876

    Article  PubMed  CAS  Google Scholar 

  6. Barrett JG, Sample SJ, McCarthy J, Kalscheur VL, Muir P, Prokuski L (2007) Effect of short-term treatment with alendronate on ulnar bone adaptation to cyclic fatigue loading in rats. J Orthop Res 25:1070–1077

    Article  PubMed  CAS  Google Scholar 

  7. Bauss F, Schenk RK, Hört S, Müller-Beckmann B, Sponer G (2004) New model for simulation of fracture repair in full-grown beagle dogs: model characterization and results from a long-term study with ibandronate. J Pharmacol Toxicol Methods 50:25–34

    Article  PubMed  CAS  Google Scholar 

  8. Bennell KL, Malcolm SA, Brukner PD, Green RM, Hopper JL, Wark JD, Ebeling PR (1998) A 12-month prospective study of the relationship between stress fractures and bone turnover in athletes. Calcif Tissue Int 63:80–85

    Article  PubMed  CAS  Google Scholar 

  9. Berenson JR, Rosen L, Vescio R, Lau HS, Woo M, Sioufi A, Kowalski MO, Knight RD, Seaman JJ (1997) Pharmacokinetics of pamidronate disodium in patients with cancer with normal or impaired renal function. J Clin Pharmacol 37:285–290

    PubMed  CAS  Google Scholar 

  10. Bilezikian JP (2006) Osteonecrosis of the jaw—do bisphosphonates pose a risk? N Engl J Med 355:2278–2281

    Article  PubMed  CAS  Google Scholar 

  11. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR, FLEX Research Group (2006) Effects of continuing or stop** alendronate after 5 years of treatment: the fracture intervention trial long-term extension (FLEX): a randomized trial. JAMA 296:2927–2938

    Article  PubMed  CAS  Google Scholar 

  12. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR, HORIZON Pivotal Fracture Trial (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822

    Article  PubMed  CAS  Google Scholar 

  13. Body JJ, Mancini I (2002) Bisphosphonates for cancer patients: why, how, and when? Support Care Cancer 10:399–407

    Article  PubMed  CAS  Google Scholar 

  14. Body JJ (2005) Bisphosphonates in metastatic bone disease: renal safety matters. Oncologist 10:1–2

    Article  PubMed  Google Scholar 

  15. Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, Rodriguez-Portales JA, Downs RW, Gupta J, Santora AC, Liberman UA, Alendronate Phase III Osteoporosis Treatment Study Group (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199

    Article  PubMed  CAS  Google Scholar 

  16. Bransford R, Goergens E, Briody J, Amanat N, Cree A, Little D (2007) Effect of zoledronic acid in an L6–L7 rabbit spine fusion model. Eur Spine J 16:557–562

    Article  PubMed  Google Scholar 

  17. Burr DB, Milgrom C, Boyd RD, Higgins WL, Robin G, Radin EL (1990) Experimental stress fractures of the tibia. Biological and mechanical aetiology in rabbits. J Bone Joint Surg Br 72:370–375

    PubMed  CAS  Google Scholar 

  18. Burr DB, Forwood MR, Fyhrie DP, Martin RB, Schaffler MB, Turner CH (1997) Bone microdamage and skeletal fragility in osteoporotic and stress fractures. J Bone Miner Res 12:6–15

    Article  PubMed  CAS  Google Scholar 

  19. Burr DB (2001) Pharmaceutical treatments that may prevent or delay the onset of stress fractures. In: Burr DB, Milgrom C (eds) Muscloskeletal fatigue and stress fractures. CRC Press, Boca Raton, pp 259–270

    Google Scholar 

  20. Cao Y, Mori S, Mashiba T, Westmore MS, Ma L, Sato M, Akiyama T, Shi L, Komatsubara S, Miyamoto K, Norimatsu H (2002) Raloxifene, estrogen, and alendronate affect the processes of fracture repair differently in ovariectomized rats. J Bone Miner Res 17:2237–2246

    Article  PubMed  CAS  Google Scholar 

  21. Eisman JA, Civitelli R, Adami S, Czerwinski E, Recknor C, Prince R, Reginster JY, Zaidi M, Felsenberg D, Hughes C, Mairon N, Masanauskaite D, Reid DM, Delmas PD, Recker RR (2008) Efficacy and tolerability of intravenous ibandronate injections in postmenopausal osteoporosis: 2-year results from the DIVA Study. J Rheumatol 35:488–497

    PubMed  CAS  Google Scholar 

  22. Ezra A, Golomb G (2000) Administration routes and delivery systems of bisphosphonates for the treatment of bone resorption. Adv Drug Deliv Rev 42:175–195

    Article  PubMed  CAS  Google Scholar 

  23. Felix R, Bettex JD, Fleisch H (1981) Effect of diphosphonates on the synthesis of prostaglandins in cultured calvaria cells. Calcif Tissue Int 33:549–552

    Article  PubMed  CAS  Google Scholar 

  24. Flinn SD (2002) Changes in stress fracture distribution and current treatment. Curr Sports Med Rep 1:272–277

    PubMed  Google Scholar 

  25. Flora L, Hassing GS, Cloyd GG, Bevan JA, Parfitt AM, Villanueva AR (1981) The long-term skeletal effects of EHDP in dogs. Metab Bone Dis Relat Res 3:289–300

    Article  PubMed  CAS  Google Scholar 

  26. Fournier P, Boissier S, Filleur S, Guglielmi J, Cabon F, Colombel M, Clézardin P (2002) Bisphosphonates inhibit angiogenesis in vitro and testosterone-stimulated vascular regrowth in the ventral prostate in castrated rats. Cancer Res 62:6538–6544

    PubMed  CAS  Google Scholar 

  27. Gehrmann RM, Renard RL (2006) Current concepts review: Stress fractures of the foot. Foot Ankle Int 27:750–757

    PubMed  Google Scholar 

  28. Hame SL, LaFemina JM, McAllister DR, Schaadt GW, Dorey FJ (2004) Fractures in the collegiate athlete. Am J Sports Med 32:446–451

    Article  PubMed  Google Scholar 

  29. Hausman MR, Schaffler MB, Majeska RJ (2001) Prevention of fracture healing in rats by an inhibitor of angiogenesis. Bone 29:560–564

    Article  PubMed  CAS  Google Scholar 

  30. Jackson G (2005) Safety and compliance of intravenous and oral dosing regimens. Oncologist 10:313–314

    Article  PubMed  Google Scholar 

  31. Kaeding CC (2006) Stress fractures. Clin Sports Med 25:15–16

    Article  Google Scholar 

  32. Koester MC, Spindler KP (2006) Pharmacologic agents in fracture healing. Clin Sports Med 25:63–73

    Article  PubMed  Google Scholar 

  33. Korpelainen R, Orava S, Karpakka J, Siira P, Hulkko A (2001) Risk factors for recurrent stress fractures in athletes. Am J Sports Med 29:304–310

    PubMed  CAS  Google Scholar 

  34. Kurth AH, Eberhardt C, Müller S, Steinacker M, Schwarz M, Bauss F (2005) The bisphosphonate ibandronate improves implant integration in osteopenic ovariectomized rats. Bone 37:204–210

    Article  PubMed  CAS  Google Scholar 

  35. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 87:2155–2159

    Article  PubMed  Google Scholar 

  36. Lenart BA, Lorich DG, Lane JM (2008) Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 358:1304–1306

    Article  PubMed  CAS  Google Scholar 

  37. Li C, Mori S, Li J, Kaji Y, Akiyama T, Kawanishi J, Norimatsu H (2001) Long-term effect of incadronate disodium (YM–175) on fracture healing of femoral shaft in growing rats. J Bone Miner Res 16:429–436

    Article  PubMed  CAS  Google Scholar 

  38. Lin JH (1996) Bisphosphonates: a review of their pharmacokinetic properties. Bone 18:75–85

    Article  PubMed  CAS  Google Scholar 

  39. Little DG, Cornell MS, Hile MS, Briody J, Cowell CT, Bilston L (2001) Effect of pamidronate on distraction osteogenesis and fixator-related osteoporosis. Injury 32:SD14–SD20

    Article  PubMed  Google Scholar 

  40. Little DG, Smith NC, Williams PR, Briody JN, Bilston LE, Smith EJ, Gardiner EM, Cowell CT (2003) Zoledronic acid prevents osteopenia and increases bone strength in a rabbit model of distraction osteogenesis. J Bone Miner Res 18:1300–1307

    Article  PubMed  CAS  Google Scholar 

  41. Little DG, Peat RA, Mcevoy A, Williams PR, Smith EJ, Baldock PA (2003) Zoledronic acid treatment results in retention of femoral head structure after traumatic osteonecrosis in young Wistar rats. J Bone Miner Res 18:2016–2022

    Article  PubMed  CAS  Google Scholar 

  42. Little DG, McDonald M, Bransford R, Godfrey CB, Amanat N (2005) Manipulation of the anabolic and catabolic responses with OP-1 and zoledronic acid in a rat critical defect model. J Bone Miner Res 20:2044–2052

    Article  PubMed  CAS  Google Scholar 

  43. Macarol V, Fraunfelder FT (1994) Pamidronate disodium and possible ocular adverse drug reactions. Am J Ophthalmol 118:220–224

    PubMed  CAS  Google Scholar 

  44. Martin B (1995) Mathematical model for repair of fatigue damage and stress fracture in osteonal bone. J Orthop Res 13:309–316

    Article  PubMed  CAS  Google Scholar 

  45. Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117

    Article  PubMed  Google Scholar 

  46. Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB (2000) Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 15:613–620

    Article  PubMed  CAS  Google Scholar 

  47. Mashiba T, Turner CH, Hirano T, Forwood MR, Johnston CC, Burr DB (2001) Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 28:524–531

    Article  PubMed  CAS  Google Scholar 

  48. Milgrom C, Simkin A, Eldad A, Nyska M, Finestone A (2000) Using bone’s adaptation ability to lower the incidence of stress fractures. Am J Sports Med 28:245–251

    PubMed  CAS  Google Scholar 

  49. Milgrom C, Finestone A, Sharkey N, Hamel A, Mandes V, Burr D, Arndt A, Ekenman I (2002) Metatarsal strains are sufficient to cause fatigue fracture during cyclic overloading. Foot Ankle Int 23:230–235

    PubMed  CAS  Google Scholar 

  50. Milgrom C, Finestone A, Novack V, Pereg D, Goldich Y, Kreiss Y, Zimlichman E, Kaufman S, Liebergall M, Burr D et al (2004) The effect of prophylactic treatment with risedronate on stress fracture incidence among infantry recruits. Bone 35:418–424

    Article  PubMed  CAS  Google Scholar 

  51. Miltner O, Niedhart C, Piroth W, Weber M, Siebert CH (2003) Transient osteoporosis of the navicular bone in a runner. Arch Orthop Trauma Surg 123:505–508

    Article  PubMed  CAS  Google Scholar 

  52. Minsker DH, Manson JM, Peter CP (1993) Effects of the bisphosphonate, alendronate, on parturition in the rat. Toxicol Appl Pharmacol 121:217–223

    Article  PubMed  CAS  Google Scholar 

  53. Murguia MJ, Vailas A, Mandelbaum B, Norton J, Hodgdon J, Goforth H, Riedy M (1988) Elevated plasma hydroxyproline. A possible risk factor associated with connective tissue injuries during overuse. Am J Sports Med 16:660–664

    Article  PubMed  CAS  Google Scholar 

  54. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90:1294–1301

    Article  PubMed  CAS  Google Scholar 

  55. Ott SM (2001) Fractures after long-term alendronate therapy. J Clin Endocrinol Metab 86:1835–1836

    Article  PubMed  CAS  Google Scholar 

  56. Parker L (1999) I.v. devices and related infections: causes and complications. Br J Nurs 8:1491–1498

    PubMed  CAS  Google Scholar 

  57. Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A (1999) Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology 60:68–73

    Article  PubMed  CAS  Google Scholar 

  58. Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P (2007) A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther 29:1548–1558

    Article  PubMed  CAS  Google Scholar 

  59. Pepper M, Akuthota V, McCarty EC (2006) The pathophysiology of stress fractures. Clin Sports Med 25:1–16

    Article  PubMed  Google Scholar 

  60. Ramachandran M, Ward K, Brown RR, Munns CF, Cowell CT, Little DG (2007) Intravenous BP therapy for traumatic osteonecrosis of the femoral head in adolescents. J Bone Joint Surg Am 89:1727–1734

    Article  PubMed  Google Scholar 

  61. Ringe JD, Dorst A, Faber H (2005) Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate. Osteoporos Int 16:2063–2068

    Article  PubMed  CAS  Google Scholar 

  62. Ringe JD, Body JJ (2007) A review of bone pain relief with ibandronate and other bisphosphonates in disorders of increased bone turnover. Clin Exp Rheumatol 25:766–774

    PubMed  CAS  Google Scholar 

  63. Russell RG, Watts NB, Ebetino FH, Rogers MJ (2008) Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 19:733–759

    Article  PubMed  CAS  Google Scholar 

  64. Saito M, Mori S, Mashiba T, Komatsubara S, Marumo K (2008) Collagen maturity, glycation induced-pentosidine, and mineralization are increased following 3-year treatment with incadronate in dogs. Osteoporos Int 19:1343–1354

    Article  PubMed  CAS  Google Scholar 

  65. Santini D, Vincenzi B, Galluzzo S, Battistoni F, Rocci L, Venditti O, Schiavon G, Angeletti S, Uzzalli F, Caraglia M, Dicuonzo G, Tonini G (2007) Repeated intermittent low-dose therapy with zoledronic acid induces an early, sustained, and long-lasting decrease of peripheral vascular endothelial growth factor levels in cancer patients. Clin Cancer Res 13:4482–4486

    Article  PubMed  CAS  Google Scholar 

  66. Shaffer SW, Uhl TL (2006) Preventing and treating lower extremity stress reactions and fractures in adults. J Athl Train 41:466–469

    PubMed  Google Scholar 

  67. Shane E, Goldring S, Christakos S, Drezner M, Eisman J, Silverman S, Pendrys D (2006) Osteonecrosis of the jaw: more research needed. J Bone Miner Res 21:1503–1505

    Article  PubMed  Google Scholar 

  68. Siegmund T, Allen MR, Burr DB (2008) Failure of mineralized collagen fibrils: modeling the role of collagen cross-linking. J Biomech 41:1427–1435

    Article  PubMed  Google Scholar 

  69. Siris ES (1993) Bisphosphonates and iritis. Lancet 341:436–437

    Article  PubMed  CAS  Google Scholar 

  70. Smith EJ, Little DG, Briody JN, McEvoy A, Smith NC, Eisman JA, Gardiner EM (2005) Transient disturbance in physeal morphology is associated with long-term effects of nitrogen-containing bisphosphonates in growing rabbits. J Bone Miner Res 20:1731–1741

    Article  PubMed  CAS  Google Scholar 

  71. Stewart GW, Brunet ME, Manning MR, Davis FA (2005) Treatment of stress fractures in athletes with intravenous pamidronate. Clin J Sport Med 15:92–94

    Article  PubMed  Google Scholar 

  72. Taki M, Iwata O, Shiono M, Kimura M, Takagishi K (2007) Extracorporeal shock wave therapy for resistant stress fracture in athletes: a report of 5 cases. Am J Sports Med 35:1188–1192

    Article  PubMed  Google Scholar 

  73. Thiébaud D, Sauty A, Burckhardt P, Leuenberger P, Sitzler L, Green JR, Kandra A, Zieschang J, Ibarra de Palacios P (1997) An in vitro and in vivo study of cytokines in the acute-phase response associated with bisphosphonates. Calcif Tissue Int 61:386–392

    Article  PubMed  Google Scholar 

  74. Thompson K, Rogers MJ (2004) Statins prevent bisphosphonate-induced gamma, delta-T-cell proliferation and activation in vitro. J Bone Miner Res 19:278–288

    Article  PubMed  CAS  Google Scholar 

  75. Tonino RP, Meunier PJ, Emkey R, Rodriguez-Portales JA, Menkes CJ, Wasnich RD, Bone HG, Santora AC, Wu M, Desai R, Ross PD (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group. J Clin Endocrinol Metab 85:3109–3115

    Article  PubMed  CAS  Google Scholar 

  76. Tonino RP (2001) Safety of long-term alendronate. J Clin Endocrinol Metab 86:1835–1836

    Article  CAS  Google Scholar 

  77. van Meerten EL, Kroon HM, Papapoulos SE (1992) Epi- and metaphyseal changes in children caused by administration of bisphophonates. Radiology 184:249–254

    Google Scholar 

  78. Ward K, Cowell CT, Little DG (2005) Quantification of metaphyseal modeling in children treated with bisphosphonates. Bone 36:999–1002

    Article  PubMed  CAS  Google Scholar 

  79. Välimäki VV, Alfthan H, Lehmuskallio E, Löyttyniemi E, Sahi T, Suominen H, Välimäki MJ (2005) Risk factors for clinical stress fractures in male military recruits: a prospective cohort study. Bone 37:267–273

    Article  PubMed  Google Scholar 

  80. Weinstein RS, Chen JR, Powers CC, Stewart SA, Landes RD, Bellido T, Jilka RL, Parfitt AM, Manolagas SC (2002) Promotion of osteoclast survival and antagonism of bisphosphonate-induced osteoclast apoptosis by glucocorticoids. J Clin Invest 109:1041–1048

    PubMed  CAS  Google Scholar 

  81. Whyte MP, Wenkert D, Clements KL, McAlister WH, Mumm S (2003) Bisphosphonate-induced osteopetrosis. N Engl J Med 349:457–463

    Article  PubMed  CAS  Google Scholar 

  82. Woo SB, Hellstein JW, Kalmar JR (2006) Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761

    PubMed  CAS  Google Scholar 

  83. Wood J, Bonjean K, Ruetz S, Bellahcène A, Devy L, Foidart JM, Castronovo V, Green JR (2002) Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther 302:1055–1061

    Article  PubMed  CAS  Google Scholar 

  84. Wysowski DK, Chang J (2005) Alendronate and risedronate: reports of severe bone, joint, and muscle pain. Arch Intern Med 165:346–347

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, P.O. Box 4014, Ullevaal Stadion, 0806, Oslo, Norway

    Yosuke Shima & Junji Iwasa

  2. Orthopedic Center, Ullevaal University Hospital, 0407, Oslo, Norway

    Lars Engebretsen

  3. Faculty of Medicine, University of Oslo, 0407, Oslo, Norway

    Lars Engebretsen

  4. Department of Orthopedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan

    Yosuke Shima, Katsuhiko Kitaoka & Katsuro Tomita

Authors
  1. Yosuke Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Engebretsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junji Iwasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katsuhiko Kitaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katsuro Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Engebretsen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shima, Y., Engebretsen, L., Iwasa, J. et al. Use of bisphosphonates for the treatment of stress fractures in athletes. Knee Surg Sports Traumatol Arthrosc 17, 542–550 (2009). https://doi.org/10.1007/s00167-008-0673-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-008-0673-0

Keywords

Search

Navigation