Recurrent stress fractures in runners warrant assessment for relative energy deficiency, potential eating disorders, undernourishment, endocrinologist consultation, and vitamin D levels.

“you find out they had three other stress fractures right so this is their third stress fracture yeah at the first visit you have to have a conversation about um relative energy deficiency right why why are you not healing do we we need you to see an endocrinologist vitamin D find out yeah you see this a lot in I I've seen this at least anecdotally so much in female Runners who are basically being put into Eating Disorders by you know running coaches right right so yeah they're they're way under nourished right it's a we call it the female triad and it's a risk of osteoporosis stress fractures and menstrual abnormalities okay”