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. 2020 Dec 9;8(12):2325967120966967.
doi: 10.1177/2325967120966967. eCollection 2020 Dec.

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

David Millward  1 , Allison D Root  1 , Jeremy Dubois  1 , Randall P Cohen  1 , Luis Valdivia  1 , Bruce Helming  1 , Justin Kokoskie  1 , Anna L Waterbrook  1 , Stephen Paul  1
Affiliations

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

David Millward et al. Orthop J Sports Med. .

Abstract

Background: Low vitamin D levels along with high-intensity athletic training may put an athlete at increased risk for a stress fracture.

Purpose: To assess whether supplementation with vitamin D is associated with a reduced risk of stress fractures in college athletes. We also assessed differences in vitamin D levels among athletes participating in outdoor versus indoor sports.

Study design: Cohort study; Level of evidence, 2.

Methods: The study participants included 802 National Collegiate Athletic Association Division I intercollegiate athletes (497 men and 305 women) on a sports team for at least 1 semester from 2012 to 2018. All athletes who had a baseline vitamin D level in their medical record were included. Athletes with vitamin D levels <40 ng/mL were given vitamin D supplements. We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to ≥40 ng/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor).

Results: The rate of stress fracture was 12% higher (95% CI, 6-19; P < .001) for those who remained low in vitamin D compared with those who were low at baseline but improved their vitamin D status to ≥40 ng/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P < .001) for those who had low vitamin D levels compared with those who maintained normal levels. The mean baseline vitamin D values were significantly higher for men participating in outdoor sports versus indoor sports. For men, the mean vitamin D level was 5.7 ng/mL higher (95% CI, 0.9-10.5; P = .01) in outdoor athletes. For women, the mean vitamin D level was 3.7 ng/mL higher (95% CI, -0.58 to 8.03; P < .04) for outdoor versus indoor sports.

Conclusion: Study results indicated that correcting low serum vitamin D levels reduces the risk of stress fracture. This study also presented evidence that athletes who participate in indoor sports may be at greater risk for vitamin D deficiency than those who compete in outdoor sports.

Keywords: epidemiology; stress fractures; student-athlete.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Study population flowchart. PPE, preparticipation physical exam.
See this image and copyright information in PMC

References

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