Higher BEDA-Q Score Is Associated With Increased Number Of Stress Fractures In Female Athletes

Stress fractures (i.e., grade 4/4 BSI) are common overuse injuries in individuals who engage in repetitive, high-impact activities. Factors such as disordered eating (DE) and eating disorders (ED) may contribute to higher stress fracture risk by adversely impacting bone health. The Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) is used to distinguish between female athletes with and without EDs, with a score ≥ 0.27 classifying a respondent as “At Risk”. However, a potential association between BEDA-Q score and number of stress fractures in female athletes is underexplored. PURPOSE: To investigate the relationship between BEDA-Q score and stress fractures, and among those with an “At Risk” BEDA-Q score, the relationship between BEDA-Q score and the number of historical stress fractures. METHODS: 781 female athletes (ages 14-25 yrs) who reported training ≥10 hrs per week completed an online survey about athletic health and wellness, including the BEDA-Q. Historical stress fractures (diagnosed via radiographs, MRI, bone scan, and/or CT) were self-reported. Linear regression models were used to evaluate the relationship between BEDA-Q score and stress fracture. R2 and p-values are reported with ɑ set a priori to 0.05. RESULTS: Athletes were young (mean age: 19.9 ± 3.3 yrs) with normal body mass index (BMI) (mean BMI: 22.9 ± 3.7 kg/m2). There were no differences in age, height, or BMI of athletes classified as “At Risk” (n = 296) vs “Not at Risk” (n = 485) by BEDA-Q. 256 (32.8%) female athletes reported sustaining ≥1 stress fractures and 98 (12.5%) reported sustaining ≥2 stress fractures. BEDA-Q score was not significantly associated with number of stress fractures (p = 0.20). Additionally, BEDA-Q scores of athletes classified as “Not at Risk” were not correlated with number of stress fractures (p = 0.99). However, BEDA-Q scores of athletes classified as “At Risk” were positively correlated with number of stress fractures (R2 = 0.12, p = 0.006). CONCLUSIONS: Our findings reveal that among those at risk for ED, increased BEDA-Q score is associated with greater likelihood of having more stress fractures. Health practitioners should consider interpreting BEDA-Q scores on a continuum that may indicate patient risk of multiple stress fractures, in addition to using the questionnaire as a classification tool for ED and DE.