Introduction: Vitamin D is paramount to bone health and little is known about vitamin D's role in the prevention of stress fractures in high-risk athletes. This study consists of a prospective, cross-sectional analysis accompanied by a retrospective review for control comparison of vitamin D3 supplementation in high-risk athletes. Our hypothesis is that supplemental vitamin D3 treatment will decrease the occurrence of stress fractures in highrisk collegiate athletes. Materials and Methods: A total of 118 NCAA Division I athletes were recruited from 6 high-risk collegiate teams. Blood draws in August and February established baseline 25(OH) D levels. Subjects with serum 25(OH)D <30 ng/mL were supplemented with 50,000 IU of vitamin D3/week for 8 weeks. Treated subjects were re-tested to ensure serum 25(OH)D levels rose to sufficient status. All enrolled subjects were monitored for the development of stress fractures. A 5-year retrospective chart review of athletes from the same sports teams was conducted to determine the incidence of any reported stress fractures in the past. Results: Prospective: 112 of the 118 enrolled subjects were tested in August. Sixty-one demonstrated vitamin D sufficiency (40.2 ng/mL ±8.28) and 51 were either insufficient or deficient (22.7 ng/mL ±4.89). Of the 118 enrolled subjects, 104 were tested in February. Fifty-six demonstrated vitamin D sufficiency (40.7 ng/mL ±9.47) and 48 were insufficient or deficient (21.6 ng/mL ±5.87). Two stress fractures were diagnosed amongst our cohort of 118 student athletes (1.69%). Retrospective: 34 stress fractures were diagnosed in 453 subjects from 01/2010-05/2015 (7.51%). Amongst our athletic teams, the cross-country team specifically demonstrated a statistically significant decrease in stress fracture incidence (p<0.05).We also found a statistically significant reduction in stress fracture incidence amongst the current overall cohort compared to our retrospective cohort (p<0.05).
Conclusion:In our population, almost half of the tested athletes proved to be vitamin D deficient. Hypovitaminosis D was prevalent throughout the winter months compared with the summer. With vitamin D3 supplementation, the stress fracture rate in our overall cohort demonstrated a statistically significant decrease from 7.51% to 1.65% (p=0.009).
Open reduction and internal fixation of olecranon stress fractures in competitive baseball players has a high rate of success in returning players to or above their former level of play and allows for good elbow function at an average of 6.2 years postoperatively. However, these patients are at high risk for additional future surgeries on their throwing arm.
The majority of surgical interventions were isolated arthroscopic stabilization procedures, with no statistically significant difference in RTP rates when concomitant arthroscopic procedures or open stabilization procedures were performed. Athletes who returned to play often played in a higher percentage of games after surgery than before the injury, and many played at the same or a higher level after surgery.
Comorbid hypertension, substance use disorders, and thyroid disorders deserve increased clinical surveillance in children and adolescents with ADHD because they may be associated with an increased risk of more than one musculoskeletal injury.
The coexistence of mild primary hyperparathyroidism (PHP) and vitamin D deficiency (VDD) is common and usually presents with hypercalcemia and mild metabolic bone disease. We present a young man with severe PHP and profound VDD who was completely asymptomatic until he sustained an atraumatic hip fracture. His total and ionized serum calcium were normal, intact parathyroid hormone (iPTH) was markedly elevated, and 25-hydroxyvitamin D (25(OH)D) was undetectable. He had highly elevated markers of bone turnover and radiologic evidence of severe bone disease. After removal of a large benign parathyroid adenoma and long-term replacement with calcium and vitamin D, the patient showed marked improvement in bone mineral density (BMD). We also describe detailed follow-up of the gradual changes and near normalization of bone turnover markers and iPTH levels over an 18-month period. This case illustrates that severe PHP can be masked by profound VDD and may remain undetected before the occurrence of a fragility fracture. Key Words: primary hyperparathyroidism, vitamin D deficiency, metabolic bone disease, atraumatic bone fracture (The Endocrinologist 2008;18: 300 -303)
Learning Objectives• Explain the effects of vitamin D deficiency on the clinical picture of hyperparathyroidism.• Summarize the effects of vitamin D repletion on coexistent hyperthyroidism.
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