3 A recent study among the Royal Marines during commando training found that, on average, the rehabilitation time for stress fractures ranged from 12 to 21 weeks depending on the site of fracture. A previous MSMR article estimated that there were 31,349 incident stress fractures diagnosed (a rate of 3.2 per 1,000 person-years) among active component service members from 2004 through 2010. 1–3 Injuries, including stress fractures, are a major public health concern among the military because of their high prevalence, the associated lost working time, and the cost of treatment. The physical activity can potentially result in overuse injuries because the repetitive force exerted by the musculoskeletal system may cause cumulative microtraumatic damage leading to strains, sprains, and stress fractures. Armed Forces participate in intense physical activity when training and performing their job responsibilities. These stress fracture injuries may contribute to lost duty days and reduce deployment readiness because of physical limitation. This study suggests that receiving NSAIDs may increase the risk for stress fracture among active component service members. What Is the Impact on Readiness and Force Health Protection? Among cases, the odds of a delayed healing diagnosis among NSAID recipients were 1.4 times that of nonrecipients. Prior NSAID receipt was associated with a 70% increased incidence of stress fracture. This is the first MSMR report on the association between prior NSAID receipt and incident stress fracture diagnosis in service members. These findings may have significant implications for military readiness because NSAIDs are used extensively and stress fractures are already a major contributor to the burden of health care encounters and lost duty time. Among stress fracture cases, prior receipt of NSAIDs was associated with increased diagnosis of delayed healing (adjusted odds ratio=1.41 95% CI: 1.12–1.77 p=.004). Prior receipt of NSAIDs was associated with an increased incidence of stress fractures (adjusted incidence rate ratio=1.70 95% confidence interval :1.58–1.82 p<.0001). A subset of cases were evaluated for delayed healing diagnoses within 90 days following incident case diagnosis using International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. A total of 7,036 cases of stress fracture and 28,141 matched controls were identified between June 2014 and Dec. The current study evaluated the relative risk of stress fractures in active duty service members with and without previous receipt of NSAIDs. Previous studies have suggested that the use of nonsteroidal anti inflammatory drugs (NSAIDs) is associated with an increased risk of stress fractures due to their inhibitory effect on bone formation. Medical Surveillance Monthly Report Abstract
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