The association between vitamin D status and overuse sport injuries: A systematic review and meta‐analysis

Abstract

Overuse injuries in sports are common and include stress fracture and musculoskeletal inflammation. Vitamin D is important in bone metabolism and exerts anti‐inflammatory effects, and it may be protective against those injuries. The objective was to evaluate the association between vitamin D status and sport injuries. This systematic review was conducted according to the PRISMA statement. We used systematic literature search in PubMed, Embase, Cochrane and Sportdiscus until the 28th of June 2020. We included observational and randomized studies assessing vitamin D status. Sport injuries were defined as stress fractures or musculoskeletal injuries. A meta‐analysis was performed with stress fracture as outcome. In total 16 articles were included, 7 investigating stress fractures, and 9 investigating musculoskeletal injuries. Regarding stress fractures, serum vitamin D levels below 30 ng/mL appeared to be associated with an increased risk of stress fractures, and the meta‐analysis showed increased odds ratio for stress fracture with vitamin D insufficiency. Regarding musculoskeletal injuries only two studies found that low serum vitamin D levels were associated with musculoskeletal injuries. Low serum vitamin D levels are associated with an enhanced risk of stress fractures, while no conclusion can be made regarding musculoskeletal injuries.

Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence

“…In addition, a recent systematic review and meta-analysis of RCTs in postmenopausal women has summarised the effects of vitamin D supplementation (with or without calcium) on measures of muscle strength and mobility. The study suggests that vitamin D supplementation does not affect mobility, though there was a minor improvement in muscle strength after (84).…”

“…Only two studies reported that low serum vitamin D concentrations were associated with musculoskeletal injuries. A heterogeneous definition and reporting of musculoskeletal injuries may have influenced the results ( 84 ).…”

Vitamin D status associates with skeletal muscle loss after anterior cruciate ligament reconstruction

“…Mayo Clinic Laboratories assessed 25(OH)D using gold standard LC-MS/MS methodology. An “optimization” cut point was established at 30 ng/mL (75 nmol/L) based on prior literature indicating optimal health outcomes at this concentration [11, 13, 15, 28]. ELISA was used to assess 1,25-dihydroxy vitamin D (1,25(OH) 2 D; Biovendor R&D RIS024R and RIS021R), free 25(OH)D (Biovendor R&D KAPF1991) and vitamin D binding protein (DBP; R&D Systems DY008B and DY3778B-05) according to the manufacturer’s instructions.…”

“…Mayo Clinic Laboratories assessed 25(OH)D using gold standard LC-MS/MS methodology. An "optimization" cut point was established at 30 ng/mL (75 nmol/L) based on prior literature indicating optimal health outcomes at this concentration [11,13,15,28]. ELISA was used to assess 1,25-dihydroxy vitamin D…”

“…Vitamin D functions primarily through hormone activity by binding to the its nuclear receptor (VDR) and regulating approximately 2000 human genes [10]. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations of ≥30ng/mL (75nmol/L), which is higher than minimum cut points established for deficiency [9], have been associated with reduced risk of stress fractures and sports injury [11,12], greater grip strength [13], and several other health outcomes [14][15][16]. Participants with higher vitamin D status show better muscle strength and recovery [17,18] and supplementation may improve lower body strength in athletes [19].…”