Calcium and vitamin D supplementation and bone health in Marine recruits: Effect of season

Gaffney‐Stomberg, Erin; Nakayama, Anna; Guerriere, Katelyn I.; Lutz, Laura J.; Walker, Leila A.; Staab, Jeffery S.; Scott, James N.; Gasier, Heath G.; McClung, James P.

doi:10.1016/j.bone.2019.03.021

Cited by 34 publications

(42 citation statements)

References 24 publications

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“…Skeletal injuries are indicative of the high mechanical stresses of military activities, but decreased bone formation and increased bone resorption with low energy availability could decrease mechanical strength of bone and increase the propagation of microcracks with repeated loading. The evidence for low energy availability in basic military training is mixed, and bone adapts favorably in response to 8-13 weeks basic military training programmes at appendicular sites (122)(123)(124)(125)(126). Increased incidence of stress fractures (25,99,(127)(128)(129) and musculoskeletal injuries (130), and lower bone mass (131), are seen in servicewomen with menstrual disturbances (oligomenorrhoea, amenorrhoea, or delayed menarche), although these findings are not supported by all studies (24,(132)(133)(134)(135)(136).…”

Section: Bonementioning

confidence: 99%

Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military

2020

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Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and REDS , but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.

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Section: Bonementioning

confidence: 99%

Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military

2020

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“…Subjects participated in this study after providing voluntary written informed consent. Data presented in this manuscript are from a randomized, double‐blind, placebo‐controlled study designed to evaluate the effect of a calcium and vitamin D‐fortified food product on bone health during training …”

Section: Methodsmentioning

confidence: 99%

Effects of vitamin D supplementation on salivary immune responses during Marine Corps basic training

Scott

Kazman

Palmer

et al. 2019

Scandinavian Med Sci Sports

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Vitamin D's role in regulating immune responses may increase during periods of elevated psychological and physiological stress. Due to the high demands placed on US Marine Corps recruits undergoing 12 weeks of basic military training, we hypothesized that vitamin D status would be related to markers of innate mucosal immunity, and daily vitamin D supplementation would augment immune responses during training. Males (n = 75) and females (n = 74) entering recruit basic training during the summer and winter volunteered to participate in a randomized, double‐blind, placebo‐controlled study. Subjects received either 1000 IU vitamin D3 + 2000 mg calcium/d (n = 73) or placebo (n = 76) for 12 weeks. Saliva samples were collected pre‐training, during (weeks 4 and 8), and post‐training (week 12) in order to determine salivary SIgA and cathelicidin (indices of mucosal immunity) and α‐amylase (indicator of stress). Initial (baseline) and post‐training serum 25(OH)D levels were measured. Results were as follows: serum 25(OH)D levels were 37% higher in recruits entering training in summer compared with winter. A positive relationship was observed between baseline 25(OH)D levels and SIgA secretion rates (‐SR). When stress levels were high during summer training, baseline 25(OH)D levels contributed to an increase in salivary secretory immunoglobulin A secretion rates (SIgA‐SR) and cathelicidin‐SR, the latter only in males. Vitamin D supplementation contributed to the changes in SIgA‐SR and cathelicidin‐SR, specifically SIgA‐SR was higher in the treatment group. These data highlight the importance of vitamin D and mucosal immune responses during arduous basic military training when stress levels are increased.

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“…25(OH)D and calcium are essential for bone health [175]. It is known that athletes with a lower 25(OH)D concentration had a higher risk of a stress fracture [68] and a higher 25(OH)D concentration was associated with a reduced risk for a stress fracture [83].…”

Section: (Oh)d Supplementation As a Preventive Measurementioning

confidence: 99%

“…Due to its effect on the calcium metabolism, the supply of 25(OH)D should have a beneficial effect on damage caused by overuse such as stress fractures [20]. The supplementation of 25(OH)D can reduce both markers of bone formation and resorption and the decline of 25(OH)D [175]. Especially runners who have already had a stress fracture are at high risk of low bone density [179].…”

Section: (Oh)d Supplementation As a Preventive Measurementioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

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Calcium and vitamin D supplementation and bone health in Marine recruits: Effect of season

Cited by 34 publications

References 24 publications

Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military

Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military

Effects of vitamin D supplementation on salivary immune responses during Marine Corps basic training

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

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