Association Between Vitamin D and Musculoskeletal Injuries: A Systematic Review

Abstract

It is generally accepted that the maintenance of the health of the musculoskeletal system is highly dependent on vitamin D. However, the relationship between vitamin D levels and the incidence of musculoskeletal injuries is still uncertain. This systematic review aimed to summarize the available information on the association between vitamin D levels and musculoskeletal injuries. Seven electronic databases were searched using Boolean operators to link MeSH (Medical Subject Headings) terms and free text phrases. This improved the sensitivity and specificity of the search results. Studies investigating the association between vitamin D status and musculoskeletal damage were included. Twelve studies met the inclusion criteria. The majority of studies reported an increased prevalence amongst individuals with low vitamin D levels and musculoskeletal symptoms or injury. This underlines the important role of vitamin D screening and supplementation. Some studies have associated certain vitamin D metabolites with injury occurrence, suggesting that levels and balance of these metabolites may influence injury risk. However, there have been conflicting results on the effect of vitamin D supplementation on muscle function and exercise-induced muscle injury, with some studies failing to find any significant changes. Consistent evidence has demonstrated the benefits of vitamin D supplementation in reducing the incidence of stress fractures in athletes. One study suggests that genetic variations may influence how vitamin D is related to musculoskeletal health. The reviewed studies revealed a complex relationship between the vitamin D status and musculoskeletal injuries. While low vitamin D levels were consistently observed, the effects of supplementation on various musculoskeletal outcomes varied. These findings emphasize the need for further research to better understand the underlying mechanisms and to develop targeted interventions for specific populations, considering factors such as vitamin D metabolites, supplementation dosage, and genetic variations.

Keywords: athletic performance; muscle function; musculoskeletal injuries; stress fractures; supplementation; vitamin d.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol representation of the study inclusion process for the review

Figure 2. Bias assessment using the ROBINS-I tool

Figure 3. Bias assessment using the AXIS tool

Figure 4. Bias assessment using the RoB 2.0 tool