Background: Paramilitary recruits undergo repetitive high-intensity physical training, predisposing them to overuse musculoskeletal injuries such as stress fractures. Bone mineral density (BMD) and body mass index (BMI) are key determinants of bone strength, yet limited data exist from Indian paramilitary populations. This study aimed to evaluate BMD status and examine its association with BMI and stress fractures among active recruits. Materials and Methods: A descriptive cross-sectional study was conducted among 200 paramilitary recruits (mean age 26.3 ± 3.88 years). BMD was measured at the calcaneus using a quantitative ultrasound densitometer (CM-300). BMI was calculated using standard anthropometric techniques. Stress fractures were diagnosed based on clinical evaluation, medical record review, and radiographic confirmation when indicated. Dietary pattern, rank, and lifestyle factors were recorded using a structured questionnaire. Associations were analyzed using chi-square tests and correlation statistics, with significance set at P < 0.05. Results: The mean BMD T-score was –0.676 ± 0.572, with 24.5% of participants demonstrating osteopenia. Stress fractures were documented in 16% of recruits. Abnormal BMI (underweight 2.5%, overweight 13%) showed a significant association with osteopenia (P = 0.029). Low BMD was strongly associated with stress fractures, with 78.1% of fracture cases exhibiting osteopenia (P < 0.01). Assistant commandants had a higher prevalence of low BMD compared with constables (35.5% vs. 17.7%, P = 0.005). Vegetarian recruits demonstrated significantly higher osteopenia and stress-fracture rates (P < 0.01). Conclusion: Low BMD and abnormal BMI significantly increase susceptibility to stress fractures among paramilitary recruits. The high prevalence of osteopenia despite intensive physical activity highlights the need for routine BMD screening, BMI-focused conditioning, and structured nutritional interventions to enhance bone health and reduce training-related injuries. Keywords: Bone mineral density, Body mass index, Stress fractures, Paramilitary recruits, Quantitative ultrasound.
Upadhyay et al. (Thu,) studied this question.