Vitamin D and Health

Table 16: RCTs on effects of vitamin D supplementation on stress fracture reduction in adults < 50y
Study/country Population Intervention & duration Mean baseline & post
intervention 25(OH)D (nmol/L)
Results
Lappe et al (2008)
USA
Female Navy recruits (n=5201)
Median age 19 y (17-35y)
1. 20 µg vitamin D & 2000 mg Ca
2. Placebo
Duration: 8 weeks
Not reported.
Supplemented group had 20% lower incidence of
stress fracture than control group (5.3% vs 6.6%)
RR = 0.80 (95% CI, 0.64-0.99) (p < 0.0026)
Per protocol analysis: 21% fewer fractures in
supplemented vs control gp (6.8% vs 8.6%).
Table 17: Meta-analysis of observational studies on association between serum 25(OH)D concentration and stress fractures in adults < 50y
Study Methods Results Conclusions
Dao et al (2014)
Serum 25-Hydroxyvitamin D
levels and stress fractures in
military personnel: a
systematic review and metaanalysis
Selection criteria:
Inclusion: Any type of study examining association
between stress fractures and serum 25(OH)D
concentration; participants aged ≥ 18 y; participants
involved in any branch of a country’s military force
(i.e. army, navy, air force, marine corps); and studies
published in the English.
Exclusion: Case reports and series (< 10 participants);
review articles; guidelines; basic science and animal
studies; conference abstracts; studies of athletes.
Outcome measure
Stress fractures
8 studies (n=2634; age, 18-30y): 5 prospective cohort studies, 2 nested casecontrol
studies; 1 case-control study.
Overall mean serum 25(OH)D concentration significantly lower for stress fracture
cases than controls: MD, -6.1 nmol/L (95% CI, -10.1 to -2.1; p = 0.003) with
between study heterogeneity (I 2 =53%).
At time of diagnosis (3 case-control studies):
25(OH)D concentration significantly lower in stress fracture cases compared with
controls: MD, -5.6 nmol/L (95% CI, -9.7 to -1.6; p=0.007) with moderate between
study heterogeneity (I 2 = 42%)
At time of entry to basic training (5 studies):
Pooled MD of serum 25(OH)D between stress fracture cases and controls: -6.6
nmol/L (95% CI, -14.5 to 1.3; p = 0.10) (I 2 = 65%)
Results suggest some
association between serum
25(OH)D concentration
and lower extremity stress
fractures in military
personnel.
Table 18: Cohort studies (not included in above meta-analysis) on association between serum 25(OH)D concentration and stress fractures in adults < 50y
Study/Country Population Follow-up
Mean baseline 25(OH)D
concentration (nmol/L) (SD)
Results
Comments
Davey et al (2016)
UK
Male RM recruits on a RM training
programme (n=1,082)
Age (mean): 20 y
32 weeks With fracture: 64.2 (28.2)
Without fracture : 69.6 (29.3)
25(OH)D < 50 nmol/L v > 50 nmol/L)
OR = 1.6 ( 95% CI, 1.0-2.6)
Further studies into the effects
of stress fracture risk are
warranted.
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