Association of Vitamin D With Stress Fractures: A Retrospective Cohort Study

Miller, Jason R.; Dunn, Karl W.; Ciliberti, Louis J.; Patel, Rikhil D.; Swanson, Brock A.

doi:10.1053/j.jfas.2015.08.002

Cited by 48 publications

(34 citation statements)

References 15 publications

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“…For example, the Endocrine Society recommends 1500–2000 IU/d of vitamin D for most individuals with higher intakes recommended for individuals at risk for vitamin D deficiency [ 30 ]. While the RDA of 600 IU/d supports circulating 25(OH)D 3 concentrations of 20 ng/ml (sufficient to prevent clinical rickets) such circulating concentrations may not provide further health benefits including reduced risk of certain cancers [ 31 , 32 , 33 ] and prevention of stress fractures [ 34 ]. Heaney suggests the optimal concentration of 25(OH)D 3 should be at least 30 ng/ml and further stresses that maintaining circulating concentrations of 25(OH)D 3 in the range of 30–50 ng/ml may produce added health benefits [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Sun exposure in pigs increases the vitamin D nutritional quality of pork

et al. 2017

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There is a high prevalence of vitamin D insufficiency and deficiency worldwide likely because of both limited sun-exposure and inadequate dietary intake. Meat, including pork, is not typically considered a dietary source of vitamin D, possibly because of management practices that raise pigs in confinement. This experiment determined the vitamin D content of loin and subcutaneous adipose tissue in sun-exposed finisher pigs. Two separate groups of pigs were used. The first group (28 white Landrace-Duroc) was assigned at random to either sunlight exposure (SUN) in spring and summer or confinement per standard practice (Control). The second (24 Yorkshire-Duroc-Landrace) underwent the same exposure protocol but was exposed in summer and fall or assigned to control (Control). A subsample of five SUN and four Control pigs, matched for weight and body condition score, was selected for slaughter from each group. Pigs (n = 10 SUN, n = 8 Control) had blood drawn for analysis of 25(OH)D3 concentration before/after sun exposure or control, and tissue samples were taken at slaughter for analysis of tissue vitamin D3 and 25(OH)D3 concentration. Three random samples from a single loin chop and surrounding adipose were collected and analyzed. Serum concentrations of 25(OH)D3 did not differ (P≥0.376) between treatments prior to sun exposure in either group, but was increased (time*treatment interaction, P<0.001) with SUN exposure. Total vitamin D content (D3 plus 25(OH)D3) of loin tissue was increased (P < 0.001) with sun exposure and averaged 0.997±0.094 μg/100g and 0.348±0.027 μg/100g for sun and control pigs, respectively. While exposure to sunlight increased (P = 0.003) tissue content of 25(OH) D in subcutaneous adipose tissue, vitamin D3 content was similar between treatments (P = 0.56). Sunlight exposure in pigs increased the vitamin D content of loin, and may provide an additional source of dietary vitamin D.

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Section: Discussionmentioning

confidence: 99%

Sun exposure in pigs increases the vitamin D nutritional quality of pork

et al. 2017

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“…Although a small-scale association study, these data provide some indication of potential dietary risk factors for stress fracture injury. Miller et al (2016) also demonstrated an increased risk of stress fracture in athletes with low vitamin D status, as assessed by circulating 25(OH)D 3 . Similarly, other groups have shown a link between calcium intake and both bone mineral density (Myburgh et al, 1990) and stress fracture risk (Nieves et al, 2010) in athletes.…”

Section: Nutrition To Prevent and Treat Bone Injuriesmentioning

confidence: 91%

Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes

Sale

Baar³

et al. 2019

International Journal of Sport Nutrition and Exercise Metabolism

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Injuries are an inevitable consequence of athletic performance with most athletes sustaining one or more during their athletic careers. As many as one in 12 athletes incur an injury during international competitions, many of which result in time lost from training and competition. Injuries to skeletal muscle account for over 40% of all injuries, with the lower leg being the predominant site of injury. Other common injuries include fractures, especially stress fractures in athletes with low energy availability, and injuries to tendons and ligaments, especially those involved in high-impact sports, such as jumping. Given the high prevalence of injury, it is not surprising that there has been a great deal of interest in factors that may reduce the risk of injury, or decrease the recovery time if an injury should occur: One of the main variables explored is nutrition. This review investigates the evidence around various nutrition strategies, including macro- and micronutrients, as well as total energy intake, to reduce the risk of injury and improve recovery time, focusing upon injuries to skeletal muscle, bone, tendons, and ligaments.

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“…A direct relationship between serum vitamin D levels and musculoskeletal outcomes is relatively clear [69] and makes sense given the important role for vitamin D in calcium and phosphorus metabolism. Miller et al [74] examined the vitamin D concentrations in 53 patients with radiographically confirmed stress fractures, with 44 of these patients having serum vitamin D levels of less than 40 ng·mL −1 . Similarly, Maroon et al [75] showed that vitamin D levels were significantly lower in professional American Football players having suffered at least one bone fracture when compared to those players with no fractures.…”

Section: Specific Nutritional Issues For the Athletementioning

confidence: 99%

Nutrition and Athlete Bone Health

Sale

Elliott‐Sale

2019

Sports Med

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Athletes should pay more attention to their bone health, whether this relates to their longer-term bone health (e.g. risk of osteopenia and osteoporosis) or their shorter-term risk of bony injuries. Perhaps the easiest way to do this would be to modify their training loads, although this advice rarely seems popular with coaches and athletes for obvious reasons. As such, other possibilities to support the athletes' bone health need to be explored. Given that bone is a nutritionally modified tissue and diet has a significant influence on bone health across the lifespan, diet and nutritional composition seem like obvious candidates for manipulation. The nutritional requirements to support the skeleton during growth and development and during ageing are unlikely to be notably different between athletes and the general population, although there are some considerations of specific relevance, including energy availability, low carbohydrate availability, protein intake, vitamin D intake and dermal calcium and sodium losses. Energy availability is important for optimising bone health in the athlete, although normative energy balance targets are highly unrealistic for many athletes. The level of energy availability beyond which there is no negative effect for the bone needs to be established. On the balance of the available evidence it would seem unlikely that higher animal protein intakes, in the amounts recommended to athletes, are harmful to bone health, particularly with adequate calcium intake. Dermal calcium losses might be an important consideration for endurance athletes, particularly during long training sessions or events. In these situations, some consideration should be given to pre-exercise calcium feeding. The avoidance of vitamin D deficiency and insufficiency is important for the athlete to protect their bone health. There remains a lack of information relating to the longer-term effects of different dietary and nutritional practices on bone health in athletes, something that needs to be addressed before specific guidance can be provided.

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Association of Vitamin D With Stress Fractures: A Retrospective Cohort Study

Cited by 48 publications

References 15 publications

Sun exposure in pigs increases the vitamin D nutritional quality of pork

Sun exposure in pigs increases the vitamin D nutritional quality of pork

Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes

Nutrition and Athlete Bone Health

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