Bone Stress Injuries in Basic Military Training and Investigation of the Possible Role of Recombinant Parathyroid Hormone (1-34) in their Treatment

Eastman, Katharine Genevieve (2024) Bone Stress Injuries in Basic Military Training and Investigation of the Possible Role of Recombinant Parathyroid Hormone (1-34) in their Treatment. Doctoral thesis, University of East Anglia.

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Abstract

Trainees in basic military training are susceptible to lower body bone stress injuries (BSIs). Current treatment is conservative and average healing times exceed 80 days. Improved treatment is required to accelerate healing and protect against re-injury. This thesis presents four studies that explored the risk factors for BSIs in infantry trainees, and the efficacy of recombinant parathyroid hormone (PTH(1-34)) for their treatment.

1. A prospective cohort study did not identify predictive intrinsic risk factors for lower body BSI in men during Infantry basic military training. ‘Elite’ Infantry were 9-times more likely than ‘non-elite’ to suffer a BSI (OR 9.3 [95%CI: 2.6 to 33.4], P≤0.001).
2. A meta-analysis found PTH(1-34) improved functional outcomes across a range of fracture types (MD −1.59, 95%CI: −1.97 to −1.21, P≤0.00001) but did not affect fracture healing rate (OR 0.96, 95%CI: 0.57 to 1.61, P=0.87) or reduce pain (MD −4.55, 95%CI: −7.47 to −1.63, P=0.002).
3. The pharmacokinetic response, to a single injection of PTH(1-34) persisted for up to 240 min with a significantly higher AUC for PTH(1-34) in males (AUC difference estimate 8306.6 pmol/mL, 95%CI: 1668.8 to 14944.0 P=0.016) than females. Adjusted calcium (P=0.0079) and cAMP (P=0.0071) were higher in males than females.
4. A clinical trial comparing daily PTH(1-34) to standard care (n=34 males, 1 female) did not demonstrate improved radiological healing at 8-weeks post randomisation (adjusted OR: 0.590, 95%CI: 0.071 to 4.350; P=0.829)) or time to complete radiological healing (adjusted difference: -1.022, 95%CI: -3.553 to 1.510; P=0.411) for lower body BSI in Infantry trainees.

Bone stress injury risk in ‘elite’ male trainees was more likely affected by training load. PTH(1-34) did not accelerate BSI healing in young healthy adults, but sex differences in response to PTH(1-34) suggest sensitivity to PTH(1-34) differs between males and females. Further research on the utility of PTH(1-34) in BSIs in a larger sample of males and females is warranted.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 19 Dec 2024 08:42
Last Modified: 19 Dec 2024 08:42
URI: https://ueaeprints.uea.ac.uk/id/eprint/98030
DOI:

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