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Increased stress fractures during military training if low vitamin D (now in UK as well as US) – Jan 2016

Low serum 25-hydroxyvitamin D is associated with increased risk of stress fracture during Royal Marine recruit training.

Osteoporos Int. 2016 Jan;27(1):171-9. doi: 10.1007/s00198-015-3228-5. Epub 2015 Jul 10.
Davey T1, Lanham-New SA2, Shaw AM3, Hale B4, Cobley R3, Berry JL5, Roch M6, Allsopp AJ3, Fallowfield JL3.

Publisher wants $40 for the PDF

1Environmental Medicine and Science, Institute of Naval Medicine, Cresent Road, Alverstoke, Gosport, PO12 2DL, UK. trish at trishdavey.co.uk.
2Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
3Environmental Medicine and Science, Institute of Naval Medicine, Cresent Road, Alverstoke, Gosport, PO12 2DL, UK.
4University of Chichester, College Lane, Chichester, West Sussex, PO19 6PE, UK.
5Specialist Assay Laboratory, Clinical Biomechemistry, Manchester Royal Infirmary, Manchester, M13 9WL, UK.
6Clinical Laboratory Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.

The aim of this study was to investigate vitamin D status and stress fracture risk during Royal Marine military training. Poor vitamin D status was associated with an increased risk of stress fracture. Vitamin D supplementation may help to reduce stress fracture risk in male military recruits with low vitamin D status.
INTRODUCTION:
Stress fracture is a common overuse injury in military recruits, including Royal Marine (RM) training in the UK. RM training is recognised as one of the most arduous basic training programmes in the world. Associations have been reported between serum 25-hydroxyvitamin D (25(OH)D) and risk of stress fracture, but the threshold of 25(OH)D for this effect remains unclear. We aimed to determine if serum 25(OH)D concentrations were associated with stress fracture risk during RM training.
METHODS:
We prospectively followed 1082 RM recruits (males aged 16-32 years) through the 32-week RM training programme. Troops started training between September and July. Height, body weight and aerobic fitness were assessed at week 1. Venous blood samples were drawn at weeks 1, 15 and 32. Serum samples were analysed for 25(OH)D and parathyroid hormone (PTH).
RESULTS:
Seventy-eight recruits (7.2 %) suffered a total of 92 stress fractures. Recruits with a baseline serum 25(OH)D concentration below 50 nmol L(-1) had a higher incidence of stress fracture than recruits with 25(OH)D concentration above this threshold ( (2) (1) = 3.564, p = 0.042; odds ratio 1.6 (95 % confidence interval (CI) 1.0-2.6)). Baseline serum 25(OH)D varied from 47.0 ± 23.7 nmol L(-1) in February, to 97.3 ± 24.6 nmol L(-1) in July (overall mean 69.2 ± 29.2 nmol L(-1), n = 1016). There were weak inverse correlations between serum 25(OH)D and PTH concentrations at week 15 (r = -0.209, p < 0.001) and week 32 (r = -0.214, p < 0.001), but not at baseline.
CONCLUSION:
Baseline serum 25(OH)D concentration below 50 nmol L(-1) was associated with an increased risk of stress fracture. Further studies into the effects of vitamin D supplementation on stress fracture risk are certainly warranted.

PMID: 26159112 DOI: 10.1007/s00198-015-3228-5

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