The Effectiveness of Vitamin D Supplementation on Serum 25(OH)D and its Association with Stress Fractures in High-Risk, Physically Active Adults: A Critically Appraised Topic

Clinical Scenario: In collegiate athletic and military populations alike, the repetitive and intense training increase the risk of experiencing a stress fracture. Stress fractures are an overuse injury resulting from repeated trauma and the body’s inability to remodel the bone efficiently enough to adapt to the stresses placed upon it. This chronic injury represents a significant time loss and financial cost to the individual and organization. Research on these high-risk populations suggests the use of supplemental vitamin D to prevent the occurrence of stress fractures in high-risk adults.

Clinical Question: In high-risk, physically active adults, does the effect of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentration effect the occurrence of stress fractures?

Summary of Key Findings: A search for articles investigating the use of supplemental vitamin D to reduce the occurrence of stress fractures was completed resulting in two studies that met all inclusion criteria and level of evidence requirements. Only one study found a significant correlation between vitamin D supplementation and the reduction of stress fractures. The other study could not find a significant association with the reduction of stress fractures but did find a significant difference in stress fracture rate that was higher in those who did not improve their serum vitamin D levels with supplementation compared to those who did.

Clinical Bottom Line: The findings suggest that clinicians should consider the use of supplemental vitamin D as a protective measure against the occurrence of stress fractures. Future research on the relationship between vitamin D supplementation and the occurrence of stress fractures in athletic and military populations and the effect of diet modifications versus supplementation on the occurrence of stress fractures is warranted.

Strength of Recommendation: Based on the consistent findings across both level 2 articles according to OCEBM Levels of Evidence, a strength of recommendation of B can be suggested in support of vitamin D supplementation for the prevention of stress fractures.