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Need for Routine Vitamin D Screening in Military Personnel – Sept 2016

Military Medicine Vol 181 Issue 9, September 2016, pp. 1163-1164
COL Albert F. DiNicola , MC USAR (Ret.)*; Peter J. DiNicola , BS†; Lucia Sanchez *
DOI: http://dx.doi.org/10.7205/MILMED-D-16-00115
*Pinnacle Medical Group, 8110 Mango Avenue, Fontana, CA 92335.
†University of California, Riverside, 900 University Avenue, Riverside, CA 92521.


Dear Editor:
Vitamin D is a necessary component in repairing bone damage, decreasing predisposition to bone injury, and strengthening the immune system. Vitamin D deficiency plays a key role in the etiology of bone pathologies such as rickets, osteoporosis, and osteomalacia. In military personnel, as noted by the Deployment Health Clinical Center, low vitamin D blood levels have been associated with musculoskeletal injuries and stress fractures as well as implicated in increased susceptibility to chronic musculoskeletal pain, autoimmune disease, cancer, immune system dysfunction, diabetes, and post-traumatic stress disorder–mild traumatic brain injury symptoms.

Deployed Operation Iraqi Freedom/Operation Enduring Freedom military personnel have a predisposition to low vitamin D levels as a result of
(lack of sun exposure due to uniform sleeve worn down,

  • shade-cover-seeking behaviors,
  • nighttime operational requirements
  • use of sunblock, and
  • lack of fortified dairy products in MREs (Meals Ready to Eat).

Heavy field loads, carried by Service Members and weighing 60–100 plus pounds, also increase the risk of musculoskeletal injuries.

The intent in our study is to demonstrate the suboptimal blood vitamin D levels in apparently well-appearing adolescents and thus support the need for the military to routinely screen for and treat vitamin D deficiency and insufficiency so as to optimize bone health, reduce the risk of musculoskeletal injuries, and enhance immune system function. In our study, 120 adolescents were randomly screened during routine adolescent well checks for vitamin D deficiency (25-hydroxy blood vitamin D levels 0–19.9 ng/mL) and vitamin D insufficiency (25-hydroxy blood vitamin D levels 20.0–29.9 ng/mL). Age ranges were 11–18 years with a mean age of 14.6 years with 53% males (63/120) and 47% females (57/120). Ethnicities, in this predominantly low middle-income class population, were 95% Hispanic, 4% Caucasian, and 1% Middle Eastern with vitamin D levels obtained from May 2015 to February 2016.

Results were as follows: total number of patients with vitamin D deficiency and insufficiency 80% (95/120), total number with vitamin D deficiency 32% (38/120), total number with vitamin D insufficiency 48% (57/120), total number of males with vitamin D insufficiency 56% (35/63) and deficiency 17% (11/63), and total number of females with vitamin D insufficiency 39% (22/57) and deficiency 47% (27/57). The average 25-hydroxy vitamin D deficiency and insufficiency levels were 14.7 ng/mL and 23.4 ng/mL, respectively. Our results demonstrate a high incidence of vitamin D deficiency and insufficiency levels in both adolescent males and females with the percentage of vitamin D deficiency and insufficiency in females (86%, 49/57) greater than in males (73%, 46/63).

In conclusion, more studies are needed to determine the prevalence of suboptimal vitamin D levels among military personnel and the general population, and possible links to other medical conditions, such as nonhealing fractures, chronic pain, anxiety, depression, and post-traumatic stress disorder–mild traumatic brain injury. Mandatory vitamin D levels should be routinely obtained on all military personnel especially those in pre- and postdeployment mobilization phases. Obtaining blood vitamin D levels are widely available, rapid, inexpensive, and reliable.


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