Stress fracture in a young or athletic person
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
First stress fracture
Laboratory tests
- 25-hydroxyvitamin D
- PTH (with serum calcium, if 25-hydroxyvitamin D is low or calcium intake doubtful)if needednon-French guidelineThe female athlete triad consensus recommends measuring 25-hydroxyvitamin D and PTH and adjusting intake: a raised PTH with normal vitamin D and serum calcium suggests inadequate calcium intake [2].
- Total testosterone (man, if weight loss, dietary restriction or reduced libido)if needednon-French guidelineLow testosterone is, in men, the equivalent of menstrual disorders among the major indicators of energy deficiency (RED-S) [2].
- Woman with irregular or absent periods: amenorrhoea work-up (see the page "Secondary amenorrhoea").
Also consider
- Eating disorder suspected? For an eating disorder, see the page "Anorexia nervosa".
- Older person, fracture without exertion? Fracture due to bone insufficiency (pelvis, sacrum, femoral neck): this calls for the work-up of a bone-weakening disease, see the page "Osteoporosis".
Do not order
Recurrent stress fractures
Laboratory tests
- 25-hydroxyvitamin D
- Serum calciumif needednon-French guidelineA 2022 review reports, as an expert proposal, basic biochemical tests for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- Serum albuminif needednon-French guidelineA 2022 review reports, as an expert proposal, basic biochemical tests for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- Serum phosphate (in case of recurrent fractures)if needednon-French guidelineA 2022 review reports, as an expert proposal, basic biochemical tests for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- Serum creatinine with eGFR (in case of recurrent fractures)if needednon-French guidelineA 2022 review reports, as an expert proposal, basic biochemical tests for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- TSH (in case of recurrent fractures)if needednon-French guidelineA 2022 review reports, as an expert proposal, thyroid tests for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- PTH (on the same sample as the serum calcium)if needednon-French guidelineThe Triad Coalition recommends measuring 25-hydroxyvitamin D and PTH to adjust calcium and vitamin D intake [2].
24-hour urine collection
- Urinary calciumif needednon-French guidelineA 2022 review reports, as an expert proposal, a 24-hour urinary calcium for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
- 24-hour urinary creatinineif needednon-French guidelineA 2022 review reports, as an expert proposal, a 24-hour urinary calcium for recurrent stress fractures [3]. The American Family Physician review (2011) proposes no laboratory tests in this situation [4].
Do not order
- Bone turnover markers (CTX, etc.): no difference between people with and without stress fracture [3].
Sources (6)
- Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741-9.
- Williams NI, De Souza MJ, Misra M, et al. 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 2: Clinical Guidelines for Screening, Diagnosis, Treatment, and Return to Play for Adolescents and Adults. Sports Med. 2026;56(2):375-427.
- da Rocha Lemos Costa TM, Borba VZC, Correa RGP, Moreira CA. Stress fractures. Arch Endocrinol Metab. 2022;66(5):765-73.
- Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011;83(1):39-46.
- Schroeder JD, Trigg SD, Capo Dosal GE. Bone Stress Injuries: Diagnosis and Management. Am Fam Physician. 2024;110(6):592-600.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1139 (25-OH-vitamine D) et 0983 (parathormone).