Sports Medicine, May 2013
Daniel S. Moran dmoran at sheba.health.gov.il (1) (2) (3)
James P. McClung (4)
Tal Kohen (2)
Harris R. Lieberman (4)
1. Oak Ridge Institute for Science and Education Program, United States Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA
2. Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, 52621, Israel
3. Ariel University, Ariel, Israel
4. Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA
Vitamin D is an essential nutrient obtained from the diet and exposure to sunlight. Roles for vitamin D have been established in the function of the cardiovascular, immune, and musculoskeletal systems. An electronic database search was conducted using EMBASE (1967 to August 2012), MEDLINE (1966 to August 2012), SPORTDiscus™ (1975 to August 2012), and the Scientific Electronic Library Online (SciELO) (1998 to August 2012) with no limits of language of publication. Articles that described vitamin D and performance were considered eligible for this review.
Recent studies suggest that vitamin D maintains physical performance in athletes and other active populations, e.g., maximal oxygen consumption may be related to vitamin D status.
Poor vitamin D status affects muscle strength, and vitamin D may participate in protein synthesis through the actions of the vitamin D receptor in muscle tissue.
Vitamin D may protect against overuse injuries, such as stress fracture, through its well-documented role in calcium metabolism. The objective of this manuscript is to review recent evidence regarding the importance of vitamin D for maintaining physical performance, and includes specific examples of how vitamin D supports the cardiovascular, immune, and musculoskeletal systems.
The opinions or assertions contained herein are the private viewWs of the authors and are not to be construed as official or as reflecting the views of the Army or the Department of Defense. Any citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement of approval of the products or services of these organizations.
Unfortunately the text is behind a pay-wall
Overview Sports and vitamin D which had the following summary May 2013
- Faster reaction time
- Far fewer colds/flues during the winter
- Less sore/tired after a workout
- Fewer micro-cracks and broken bones
- Bones which do break heal much more quickly
- Increased VO2 and exercise endurance Feb 2011
- Indoor athletes especially need vitamin D
- Professional indoor athletes are starting to supplement with vitamin D or use vitamin D beds
- Olympic athletes have used UV/vitamin D since the 1930's
- The biggest gain from the use of vitamin D is by those who exercise less than 2 hours per day.
- Reduced muscle fatigue with 10,000 IU vitamin D daily
- Udowenko M, Trojian T. Vitamin D: extent of deficiency, effect on muscle function, bone health, performance, and injury prevention. Conn Med. 2010;74(8):477–80.
- Hamilton B. Vitamin D: and human skeletal muscle. Scand J Med Sci Sports. 2010;20(2):182–90.
- Cannell JJ, Hollis BW, Zasloff M, et al. Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother. 2008;9:107–18.
- Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
- Cannell JJ, Hollis BW, Sorenson MB, et al. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5):1102–10.
- Halliday TM, Peterson NJ, Thomas JJ, et al. Vitamin D status relative to diet, lifestyle, injury, and illness in college athletes. Med Sci Sports Exerc. 2011;43(2):335–43.
- Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S–88S.
- Matsuoka LY, Ide L, Wortsman J, et al. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab. 1987;64(6):1165–8.
- Parikh SJ, Edelman M, Uwaifo GI, et al. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89(3):1196–9.
- Snijder MB, van Dam RM, Visser M, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population based study in older men and women. J Clin Endocrinol Metab. 2005;90(7):4119–23.
- Webb AR. Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol. 2006;92(1):17–25.
- Houston DK, Cesari M, Ferrucci L, et al. Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2007;62(4):440–6.
- Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89(5):552–72.
- Bartoszewska M, Kamboj M, Patel DR. Vitamin D, muscle function, and exercise performance. Pediatri Clin North Am. 2010;57(3):849–61.
- Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med. 2008;29(6):361–8.
- Hutchinson MS, Grimnes G, Joakimsen RM, et al. Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromso study. Eur J Endocrinol. 2010;162(5):935–42.
- Melamed ML, Michos ED, Post W, et al. 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168(15):1629–37.
- Verstuyf A, Carmeliet G, Bouillon R, et al. Vitamin D: a pleiotropic hormone. Kidney Int. 2010;78(2):140–5.
- Ceglia L. Vitamin D and skeletal muscle tissue and function. Mol Aspects Med. 2008;29(6):407–14.
- Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Larsen PR, Kronenberg HM, Melmed S, et al., editors. Williams textbook of endocrinology. 10th ed. Philadelphia: Saunders; 2003. p. 1317–20.
- McClung JP, Karl JP. Vitamin D and stress fracture: the contribution of vitamin D receptor gene polymorphisms. Nutr Rev. 2010;68(6):365–9.
- Norman AW. Intestinal calcium absorption: a vitamin D-hormone-mediated adaptive response. Am J Clin Nutr. 1990;51:290–300.
- Fleet JC, Eksir F, Hance KW, et al. Vitamin D-inducible calcium transport and gene expression in three Caco-2 cell lines. Am J Physiol Gastrointest Liver Physiol. 2002;283:G618–25.
- Heaney RP. Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr. 2008;88(2):S541–4.
- Larson-Meyer DE, Willis KS. Vitamin D and athletes. Curr Sports Med Rep. 2010;9(4):220–6.
- Need AG, Horowitz M, Morris HA, et al. Vitamin D status: effects on parathyroid hormone and 1,25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr. 2000;71:1577–81.
- Cranney A, Weiler HA, O’Donnell S, et al. Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr. 2008;88(2):S513–9.
- Pfeifer M, Begerow B, Minne HW. Vitamin D and muscle function. Osteoporos Int. 2002;13(3):187–94.
- Hopkinson NS, Li KW, Kehoe A, et al. Vitamin D receptor genotypes influence quadriceps strength in chronic obstructive pulmonary disease. Am J Clin Nutr. 2008;87:385–90.
- Berchtold M, Brinkmeirer H, Muntener M. Calcium ion in skeletal muscle: its crucial role for muscle function, plasticity, and disease. Physiol Rev. 2000;80:1215–65.
- Berg U, Gustafsson T, Sundberg C, et al. Interstitial IGF-1 in exercising skeletal muscle in women. Eur J Endocrinol. 2007;157:427–35.
- Baxter RC. Insulin-like growth factor (IGF)-binding proteins: interactions with IGF’s and intrinsic bioactivities. Am J Physiol Endocrinol Metab. 2000;278:E967–76.
- Peng L, Malloy P, Feldman D. Identification of a functional vitamin d response element in the human insulin-like growth factor binding protein-3 promoter. Mol Endocrinol. 2004;18:1109–19.
- Liao L, Chen X, Wang S, et al. Steroid receptor coactivator 3 maintains circulating insulin-like growth factor 1 (IGF-1) by controlling IGF-binding protein 3 expression. Mol Cell Biol. 2008;28:2460–9.
- Malabanan A, Veronikis I, Holick M. Redefining vitamin D insufficiency. Lancet. 1998;351:805–6.
- Dawson-Hughes B, Heaney R, Holick M, et al. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–6.
- Bischoff-Ferrari H, Giovannucci E, Willett W, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18–28.
- Bischoff-Ferrari H, Dawson-Hughes B. Where do we stand on vitamin D? Bone. 2007;41:S13–9.
- Hansen K, Jones A, Lindstrom M, et al. Vitamin D insufficiency: disease or no disease? J Bone Miner Res. 2008;23:1052–60.
- Holick M. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79:362–71.
- Binkley N, Novotny R, Krueger D, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007;92:2130–5.
- Nowson CA, Margerison C. Vitamin D intake and vitamin D status of Australians. Med J Aust. 2002;177:149–52.
- Gordon C, DePeter K, Feldman H, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–7.
- Hashemipour S, Larijani B, Adibi H, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Publ Health. 2004;4:38–44.
- Andersen R, Molgaard C, Skovgaard L, et al. Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr. 2005;59(4):533–41.
- Rockell J, Green T, Skeaff C, et al. Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5–15 y. J Nutr. 2005;135:2602–8.
- Hannan MT, Litman HJ, Araujo AB, et al. Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Met. 2008;93:40–6.
- Fonseca V, Tongia R, El-Hazmi M, et al. Exposure to sunlight and vitamin D deficiency in Saudi Arabian women. Postgrad Med J. 1984;60:589–91.
- Hatun S, Islam O, Cizmecioglu F, et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr. 2005;135:218–22.
- Allali F, El Aichaoui S, Saoud B, et al. The impact of clothing style on bone mineral density among post menopausal women in Morocco: a case-control study. Biomed Central Publ Health. 2006;6:1–6.
- Zadshir A, Tareen N, Pan D, et al. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis. 2005;15(4 Suppl 5):S97–S101.
- Van Demark RE 3rd, Allard B, Van Demark RE Jr. Nonunion of a distal tibial stress fracture associated with vitamin D deficiency: a case report. S D Med. 2010;63(3):87–93.
- Glerup H, Mikkelsen K, Poulsen L, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Intl. 2000;66:419–24.
- Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003;18(2):343–51.
- Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80(3):752–8.
- Wicherts IS, van Schoor NM, Boeke AJ, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;92(6):2058–65.
- Bartali B, Frongillo EA, Guralnik JM, et al. Serum micronutrient concentrations and decline in physical function among older persons. JAMA. 2008;299(3):308–15.
- Ardestani A, Parker B, Mathur S, et al. Relation of vitamin D level to maximal oxygen uptake in adults. Am J Cardiol. 2011;107(8):1246–9.
- Giovannucci E, Liu Y, Hollis BW, et al. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174–80.
- Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168:1340–9.
- Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007;167:1730–7.
- Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007;167:1159–65.
- Gouni-Berthold I, Krone W, Berthold HK. Vitamin D and cardiovascular disease. Curr Vasc Pharmacol. 2009;7:414–22.
- Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J. 1973;85:546–62.
- Lyerly GW, Sui X, Lavie CJ, et al. The association between cardiorespiratory fitness and risk of all-cause mortality among women with impaired fasting glucose or undiagnosed diabetes mellitus. Mayo Clin Proc. 2009;84:780–6.
- Mowry DA, Costello MM, Heelan KA. Association among cardiorespiratory fitness, body fat, and bone marker measurements in healthy young females. J Am Osteopath Assoc. 2009;109:534–9.
- Lovell G, Vitamin D. Status of females in an elite gymnastics program. Clinical J Sport Med. 2008;18:159–61.
- Gannagé-Yared MH, Chemali R, Sfeir C, et al. Dietary calcium and vitamin D intake in an adult Middle Eastern population: food sources and relation to lifestyle and PTH. Int J Vitam Nutr Res. 2005;75(4):281–9.
- Glerup H, Mikkelsen K, Poulsen L, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66:419–24.
- Bischoff-Ferrari HA, Borchers M, Gudat F, et al. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res. 2004;19:265–9.
- Maimoun L, Manetta J, Couret I, et al. The intensity level of physical exercise and the bone metabolism response. Int J Sports Med. 2006;27(2):105–11.
- Bischoff-Ferrari HA. Vitamin D and fracture prevention. Endocrinol Metab Clin North Am. 2010;39(2):347–53.
- Mingrone G, Greco A, Castagneto M, et al. A woman who left her wheelchair. Lancet. 1999;353:806.
- Prabhala A, Garg R, Dandona P. Severe myopathy associated with vitamin D deficiency in Western New York. Arch Intern Med. 2000;160:1199–203.
- Wang Y, Deluca HF. Is the vitamin D receptor found in muscle? Endocrinology. 2011;152(2):354–63.
- Marantes I, Achenbach SJ, Atkinson EJ, et al. Is vitamin D a determinant of muscle mass and strength? J Bone Miner Res. 2011;26(12):2860–71.
- McGrath JJ, Feron FP, Burne TH, et al. Vitamin D3-implications for brain development. J Steroid Biochem Mol Biol. 2004;89–90(1–5):557–60.
- Eyles DW, Smith S, Kinobe R, et al. Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat. 2005;29(1):21–30.
- Dhesi JK, Jackson SH, Bearne LM, et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004;33(6):589–95.
- Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am J Physiol Renal Physiol. 2005;289(1):F8–28.
- Andersen NE, Karl JP, Cable SJ, et al. Vitamin D status in female military personnel during combat training. J Int Soc Sports Nutr. 2010;7:38.
- Ruohola J, Laaksi I, Ylikomi T, et al. Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res. 2006;21:1483–8.
- Lappe J, Cullen D, Haynatzki G, et al. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23:741–9.
- Court-Brown CM. Fractures of the tibia and fibula. In: Bucholz RW, Heckman JD, editors. Rockwood and Green’s fractures in adults. 5th ed, vol. 2. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1939–2000.
- Trafton PG. Tibial shaft fractures. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, editors. Skeletal trauma. 3rd ed. Philadelphia: Elsevier Saunders; 2003. p. 2131–255.
- Moran DS, Finestone A, Arbel Y, et al. Simplified model to predict stress fracture in young elite combat recruits. J Strength Cond Res. 2012;26:2585–92.
- Daffner RH, Pavlov H. Stress fractures: current concepts. AJR. 1992;159:245–52.
- Devas MB. Stress fractures of the tibia in athletes or “shin soreness”. J Bone Joint Surg Br. 1958;40B(2):227–39.
- Moran DS, Evans R, Arbel Y, et al. Physical and psychological stressors linked with stress fractures in recruit training. Scand J Med Sci Sports. 2011. doi:10.1111/j.1600-0838.2011.01420.x.
- Hoffman JR, Chapnik L, Shamiss A, et al. The effect of strength and endurance on the incidence of lower extremity overuse injuries during military training. Mil Med. 1999;164:153–6.
- Devas MB. Stress fractures. London: Churchill Livingstone; 1975.
- Jones BH, Thacker SB, Gilchrist J, et al. Prevention of lower extremity stress fractures in athletes and soldiers: a systematic review. Epidemiol Rev. 2002;24:228–47.
- Friedl KE, Evans RK, Moran DS. Stress fracture and military medical readiness: bridging basic and applied research. Med Sci Sports Exerc. 2008;40(11 Suppl):S609–22.
- Willis KS, Vitamin D. Status and immune system biomarkers in athletes. Laramie: University of Wyoming; 2008. p. 85.
- Laaksi I, Ruohola JP, Tuohimaa P, et al. An association of serum vitamin D concentrations <40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr. 2007;86:714–7.
- Cox AJ, Gleeson M, Pyne DB, et al. Clinical and laboratory evaluation of upper respiratory symptoms on elite athletes. Clin J Sport Med. 2008;18(5):438–45.
- Reis JP, Mühlen D, Miller ER III, et al. Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics. 2009;124(3):e371–9.
- Allen R, Cureton T. Effects of ultraviolet radiation on physical fitness. Arch Phys Med. 1945;26:641–4.
- Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142–52.
- Lehmann G. Significance of certain wave lengths for increased efficacy of ultraviolet irradiation (in German). Strahlentherapie. 1954;95(3):447–53.
- McKinney K, Breitkopft CR, Berenson AB. Association of race, body fat, and season with vitamin D status among young women: a cross sectional study. Clin Endocrinol. 2008;69:535–41.
- Erikssen J, Rodahl K. Seasonal variation in work performance and heart rate response to exercise: a study of 1,835 middle-aged men. Eur J Appl Physiol Occup Physiol. 1979;42:133–40.
- Svedenhag J, Sjodin B. Physiological characteristics of elite male runners in and off-season. Can J Appl Sport Sci. 1985;10(3):127–33.
- Svartberg J, Jorde R, Sundsfjord J, et al. Seasonal variation of testosterone and waist to hip ratio in men: the Tromso study. J Clin Endocrinol Metab. 2003;88(7):3099–104.
- Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293:2257–64.
- Izaks GJ. Fracture prevention with vitamin D supplementation: considering the inconsistent results. BMC Musculoskelet Disord. 2007;8:26.
- Tenforde AS, Sayres LC, Sainani KL, et al. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PM R. 2010;2(10):945–9.
- Valimaki VV, Alfthan H, Lehmuskallio E, et al. Vitamin D status as a determinant of peak bone mass in young Finnish men. J Clin Endocrinol Metab. 2004;89(1):76–80.
- Priemel M, von Domarus C, Klatte TO, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010;25(2):305–12.
- El-Hajj G, Nabulsi M, Tamim H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405–12.
- Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004;116:634–9.
- Givon U, Friedman E, Reiner A, et al. Stress fractures in the Israeli defense forces from 1995 to 1996. Clin Orthop Relat Res. 2000;373:227–32.
- Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington: National Academy Press; 1997.
- Ruffing J, Cosman F, Zion M, et al. Determinants of bone mass and bone size in a large cohort of physically active young adult men. Nutr Metab (Lond). 2006;3:14.
- Turkbey EB, Jorgensen NW, Johnson WC, et al. Physical activity and physiological cardiac remodelling in a community setting: the Multi-Ethnic Study of Atherosclerosis (MESA). Heart. 2010;96:42–8.
- Haggmark T, Eriksson E. Hypotrophy of the soleus muscle in man after Achilles tendon rupture. Discussion of findings obtained by computed tomography and morphologic studies. Am J Sports Med. 1979;7:121–6.
- Whaley MH, Kampert JB, Kohl HW III, et al. Physical fitness and clustering of risk factors associated with the metabolic syndrome. Med Sci Sports Exerc. 1999;31:287–93.
- Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect. 2007;135(7):1095–6.
- Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006;134:1129–40.
- Sabetta JR, DePetrillo P, Cipriani RJ, et al. Serum 25-hydroxyvitamin D and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One. 2010;5(6):e11088.
- Ross AC, Taylor CL, Yaktine AL, et al. editors. Dietary reference intakes for calcium and vitamin D. Washington (DC): Food and Nutrition Board, Institutes of Medicine; 2010. p. 483.
- Lenville J. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008;88(Suppl):582S–6S.
- Barrueto F Jr, Wang-Flores HH, Howland MA, et al. Acute vitamin D intoxication in a child. Pediatrics. 2005;116:e453–6.
- Klontz KC, Acheson DW. Dietary supplement-induced vitamin D intoxication. N Engl J Med. 2007;357:308–9.
- Kobylinski S, Häfer B, Kohde G. Correlative pathologic studies on the role of vitamin D in vascular calcinosis in childhood (In German). Zentralbl Allg Pathol. 1984;129:137–47.
- Bolland MJ, Grey A, Avenell A, et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011;342:d2040.
- Zittermann A, Pilz S, Börgmann J, et al. Calcium supplementation and vitamin D: a trigger for adverse cardiovascular events? Future Cardiol. 2011;7(6):725–7.
- Tryfonidou MA, Oosterlaken-Dijksterhuis MA, Mol JA, et al. 24-Hydroxylase: potential key regulator in hypervitaminosis D3 in growing dogs. Am J Physiol Endocrinol Metab. 2003;284:E505–13.
- Harmeyer J, Schlumbohm C. Effects of pharmacological doses of vitaminD3 on mineral balance and profiles of plasma vitaminD3 metabolites in horses. J Steroid Biochem Mol Biol. 2004;89–90:595–600.
- Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53–8.
- Zittermann A, Grant WB. 25-hydroxyvitamin D levels and all-cause mortality. Arch Intern Med. 2009;169:1075–6.
- Bischoff-Ferrari HA, Willett WC, Oray EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367:40–9.
- Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Altern Med Rev. 2008;13:6–20.