Pickleball Bone Fractures up 90x, Primarily in Seniors

The fastest-growing sport in America, especially popular with the older crowd for its low impact and accessibility, has led to an impressive 90-fold increase in fractures over the past 20 years. And players over 60 are bearing the brunt of it. You guessed it: pickleball. The paddle sport played on a badminton-sized court with a whiffle ball-like ball has grown on average over 11% annually with 9 million “core” players in 2022. (Core players are those who play more than eight times a year).

Naturally, as the sport’s popularity skyrockets, associated injuries have also surged.

“Despite its reputation as a low-impact sport, pickleball can pose serious risk for players especially if they have weaker bones from osteoporosis,” said Kurt P. Spindler, M.D., FAAOS, orthopedic surgeon at Cleveland Clinic in Florida in an American Academy of Orthopaedic Surgeons (AAOS) press release.

So, who’s most at risk for hospitalization and surgery?

Demographics Most at Risk for Fractures

While the traditionally “senior sport” is seeing greater diversity in player age in recent years, the study, “Trends in Pickleball- Related Fractures in the United States: An Analysis of the 2002-2022 National Electronic Injury Surveillance System (NEISS) Database,” presented at AAOS’ annual meeting in February 2024 and published online on June 13, 2024 in the National Library of Medicine, found the fractures most observed were of the upper extremity in women over 65 following a fall. This potentially reflects the diminishing bone health of this postmenopausal population.

Despite the female predominance in fractures, men were 2.3 times more likely to be admitted for a fracture, according to the study. This may be a consequence of the anatomic locations and subsequent severity of their fracture which often included lower extremity fractures of the hip, femur and some truncal fractures.

There were significant age differences in men discharged from the emergency room and admitted to the hospital, which was not found in women.

Spindler advised that older players at risk for weakened bones should build bone mass with appropriate nutrients and choose weight-bearing activities to avoid fractures that can lead to hospitalization and surgery.

About the Study

Before 2020, pickleball and its associated injuries had no representation in the sports literature.

“To date, there weren’t any studies with a detailed analysis of pickleball-related fractures,” said Yasmine Ghattas, a fourth-year medical student at the University of Central Florida College of Medicine, who helped author the study. “With paucity in the literature, we wanted to determine the risk factors and prevalence of demographic variables associated with more serious injuries such as fractures since these can lead to hospitalization and surgery.”

The research teams from the University of Central Florida College of Medicine, Cleveland Clinic Florida and Novant Health used the Consumer Product Safety and Commission’s publicly available database, NEISS, to compare a sample of data from 2002 to 2022 to identify pickleball-related fracture trends, mechanisms of injuries, anatomic locations, and gender distributions.

The study was authored by Yasmine S. Ghattas, M.D., Peter Zeblisky, M.D., B.S., Joshua Cassinat, B.S., and Matthew Aceto, B.S. of the University of Central Florida College of Medicine; Kurt P. Spindler, M.D. of Cleveland Clinic Florida; and Lisa K. Cannada, M.D. of Novant Health.