Vitamin D and the Risk of Stress Fractures in Athletes and Military Personnel: A Systematic Review and Meta-analysis
Moraes BF, Leitão CVFS, Rodrigues VMS, Dressler HB, Paixão JC, da Silva ABN, de Oliveira GM, Medina G, Mansur NSB, Lintz F, Zambelli R, Souza MLAT
The American journal of sports medicine · 0 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2026-06-01 · Am J Sports Med · vol. 54 · número 11 · págs. 2854–2863
- Editorial
- SAGE Publishing
- Citado
- 1 cita · más que el 88% de estudios similares · 2.3× el promedio de su campo
- Referencias
- 47 trabajos
- Acceso
- De pago
- Áreas de investigación
- Vitamin D Research Studies · Lower Extremity Biomechanics and Pathologies · Bone health and osteoporosis research
- Palabras clave
- vitamin D, stress fractures, 25-hydroxyvitamin D, serum vitamin D levels, military personnel, athletes, overuse injuries, vitamin D deficiency, sex differences
- MeSH
- humans, vitamin d deficiency, fractures, stress, vitamin d, risk factors, military personnel, female, male, athletes
12 autores
- Bernardo de Faria Moraes🇧🇷Universidade Federal de Minas Gerais
- Carla Leitão🇧🇷Universidade Federal de Minas Gerais
- Vitor Rodrigues🇧🇷Universidade Federal do Piauí
- Hugo Bertani Dressler🇧🇷Mater Dei Hospital
- João Corrêa Paixão
- Ana Beatriz Nardelli da Silva🇧🇷Universidade Federal do Pará
- Gabriel Moraes de Oliveira🇺🇸🇧🇷Harvard University; Massachusetts General Hospital; Universidade Federal de São Paulo
- Giovanna Medina🇺🇸Harvard University; Massachusetts General Hospital
- Nacime Salomão Barbachan Mansur🇺🇸🇧🇷Duke University; Universidade Federal de São Paulo
- Francois Lintz🇫🇷Fondation Ramsay Santé
- Roberto Zambelli
- Matheus Levy Almeida Taveira de Souza🇧🇷🇪🇸 · autor de correspondenciaMater Dei Hospital; Universitat de Barcelona
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Stress fractures are common overuse injuries in military personnel and athletes. Although a low vitamin D level is a proposed risk factor, the evidence is conflicting, and the specific risk in athletes has not been systematically synthesized.
Purpose
To assess the association between vitamin D status and the risk of stress fractures in military personnel and athletes.
Study design
Systematic review and meta-analysis; Level of evidence, 3.
Methods
Major databases were systematically searched through April 16, 2025 for studies that quantitatively measured serum levels of 25-hydroxyvitamin D in military or athlete populations with a stress fracture group and a control group. Data were pooled using a random-effects model to calculate the mean difference (MD) and 95% confidence interval (CI). Subgroup analyses were conducted based on population type (military vs athlete), sex, and vitamin D status. Meta-regression was also performed to investigate sources of heterogeneity.
Results
A total of 15 studies (4183 participants) were included. Overall, patients with stress fractures had significantly lower vitamin D levels compared to controls (MD, -5.82 nmol/L [95% CI, -10.35 to -1.29]). The association was also significant for military personnel (MD, -7.33 nmol/L [95% CI, -11.77 to -2.89]) and male participants (MD, -9.14 nmol/L [95% CI, -14.23 to -4.06]). Subgroup analyses of female participants and athletes did not detect a statistically significant difference in vitamin D levels. Meta-regression identified baseline vitamin D status as a significant moderator, explaining over half of the between-study heterogeneity (R2 = 53.8%). The subgroup analysis based on baseline vitamin D status revealed that the association between lower vitamin D levels and stress fractures was present only in the subgroup in which control participants were already vitamin D sufficient (MD, -13.53 nmol/L [95% CI, -20.57 to -6.49]).
Conclusion
A lower serum vitamin D level was associated with an increased risk of stress fractures, particularly in military personnel and male participants. The absence of a significant association in athletes and female participants warrants further investigation. These findings suggest that vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels.
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