Best Practice Case Studies-Case 118 Asset 3 Vitamin D Deficiency and Stress Fractures

Pdf Summary

This narrative review examines the relationship between vitamin D (25(OH)D) and stress fractures in athletes, with a focus on prevention and treatment. Stress fractures are common overuse injuries caused by repetitive bone loading and may affect up to 20% of athletes, especially those under 25 and those in sports such as running, basketball, rowing, soccer, aerobics, and ballet. The lower extremity is most often affected, especially the tibia, metatarsals, and pelvis.<br /><br />The review emphasizes that vitamin D deficiency is an important but not sole risk factor. Other major risks include female sex, white ethnicity, older age, low bone density, high training loads, inactivity before training, iron deficiency, menstrual disturbances, smoking, and inadequate calcium or vitamin D intake. In women, the female athlete triad and the broader RED-S syndrome are especially relevant because low energy availability and hormonal disruption increase fracture risk.<br /><br />Vitamin D plays a key role in calcium homeostasis, bone metabolism, muscle function, and overall athletic health. Athletes should be screened for vitamin D status and related markers such as calcium, creatinine, and parathyroid hormone. The authors suggest that serum 25(OH)D levels below about 30 ng/mL are inadequate for bone health, while levels below 40 ng/mL are linked to higher stress fracture prevalence.<br /><br />Prevention strategies include gradual training progression, proper footwear, adequate nutrition, calcium and vitamin D supplementation, and outdoor training when possible. Evidence summarized in the review suggests that daily supplementation with 800 IU vitamin D plus 2000 mg calcium can reduce stress fracture incidence, and some recommendations go up to 2000 IU vitamin D per day. Treatment of existing stress fractures usually involves activity modification, reduced loading, and gradual return to sport, with supplementation used when deficiency is present.<br /><br />Overall, the review concludes that maintaining sufficient vitamin D and calcium status may help reduce stress fracture risk and support recovery in athletes.

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Edition 4th Edition

Related Case 4th Edition, Case 118

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Keywords

vitamin D

stress fractures

athletes

bone health

calcium supplementation

25(OH)D

injury prevention

female athlete triad

RED-S syndrome

overuse injuries

4th Edition

4th Edition, Case 118

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