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Osteoporosis International
Published in: Osteoporosis International 1/2016

01-01-2016 | Original Article

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

Authors: T. Davey, S. A. Lanham-New, A. M. Shaw, B. Hale, R. Cobley, J. L. Berry, M. Roch, A. J. Allsopp, J. L. Fallowfield

Published in: Osteoporosis International | Issue 1/2016

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Abstract

Summary

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 (χ2 (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.
Literature
1.
Pepper M, Akuthota V, McCarty EC (2006) The pathophysiology of stress fractures. Clin Sports Med 25(1):1–16, vii PubMedCrossRef
2.
Burr DB (2011) Why bones bend but don't break. J Musculoskelet Neuronal Interact 11(4):270–285PubMed
3.
Wright LA, Demicheli V, Gillespie WJ, Jefferson TO (1998) Morbidity surveillance in the British Army--the first 12 months. J R Army Med Corps 144(1):11–17PubMedCrossRef
4.
Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. Institute of Medicine, Washington
5.
DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6 Suppl):1689S–1696SPubMed
6.
Kauppi M, Impivaara O, Maki J, Heliovaara M, Marniemi J, Montonen J, Jula A (2009) Vitamin D status and common risk factors for bone fragility as determinants of quantitative ultrasound variables in a nationally representative population sample. Bone 45(1):119–124PubMedCrossRef
7.
Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, Mahonen A, Alen M, Halleen J, Vaananen K, Lamberg-Allardt C (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78(3):485–492PubMed
8.
Valimaki VV, Alfthan H, Lehmuskallio E, Loyttyniemi E, Sahi T, Stenman UH, Suominen H, Valimaki MJ (2004) Vitamin D status as a determinant of peak bone mass in young Finnish men. J Clin Endocrinol Metab 89(1):76–80PubMedCrossRef
9.
Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293(18):2257–2264PubMedCrossRef
10.
Beck TJ, Ruff CB, Mourtada FA, Shaffer RA, Maxwell-Williams K, Kao GL, Sartoris DJ, Brodine S (1996) Dual-energy X-ray absorptiometry derived structural geometry for stress fracture prediction in male U.S. Marine Corps recruits. J Bone Miner Res 11(5):645–653. doi:10.​1002/​jbmr.​5650110512 PubMedCrossRef
11.
Pouilles JM, Bernard J, Tremollieres F, Louvet JP, Ribot C (1989) Femoral bone density in young male adults with stress fractures. Bone 10(2):105–108PubMedCrossRef
12.
Valimaki VV, Alfthan H, Lehmuskallio E, Loyttyniemi E, Sahi T, Suominen H, Valimaki MJ (2005) Risk factors for clinical stress fractures in male military recruits: a prospective cohort study. Bone 37(2):267–273PubMedCrossRef
13.
Davey T, Lanham-New SA, Allsopp AJ, Taylor P, Cooper C, Fallowfield JL (2012) Lumbar spine and hip bone mineral density are important risk factors for stress fracture in Royal Marine recruits. Osteoporos Int 23(Suppl 5):S521–S611
14.
Givon U, Friedman E, Reiner A, Vered I, Finestone A, Shemer J (2000) Stress fractures in the Israeli defense forces from 1995 to 1996. Clin Orthop Relat Res 373:227–232PubMedCrossRef
15.
Burgi AA, Gorham ED, Garland CF, Mohr SB, Garland FC, Zeng K, Thompson K, Lappe JM (2011) High serum 25-hydroxyvitamin D is associated with a low incidence of stress fractures. J Bone Miner Res 26(10):2371–2377PubMedCrossRef
16.
Ruohola JP, Laaksi I, Ylikomi T, Haataja R, Mattila VM, Sahi T, Tuohimaa P, Pihlajamaki H (2006) Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res 21(9):1483–1488PubMedCrossRef
17.
18.
Lappe JM, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K (2008) Calcium and vitamin D supplementation decreases incidence of stress fractures in female Navy recruits. J Bone Miner Res 23(5):741–749PubMedCrossRef
19.
Harkness L, Cromer B (2005) Low levels of 25-hydroxy vitamin D are associated with elevated parathyroid hormone in healthy adolescent females. Osteoporos Int 16(1):109–113PubMedCrossRef
20.
Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B (1989) Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 321(26):1777–1783PubMedCrossRef
21.
22.
Evans RK, Antczak AJ, Lester M, Yanovich R, Israeli E, Moran DS (2008) Effects of a 4-month recruit training program on markers of bone metabolism. Med Sci Sports Exerc 40(11 Suppl):S660–S670PubMedCrossRef
23.
24.
Ross RA, Allsopp AJ (2002) Stress fractures in Royal Marines recruits. Mil Med 167(7):560–565PubMed
25.
Moran DS, Heled Y, Arbel Y, Israeli E, Finestone A, Evans RK, Yanovich R (2012) Dietary intake and stress fractures among elite male combat recruits. J Int Soc Sports Nutr 9(1):6PubMedPubMedCentralCrossRef
26.
Beck TJ, Ruff CB, Shaffer RA, Betsinger K, Trone DW, Brodine SK (2000) Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors. Bone 27(3):437–444PubMedCrossRef
27.
Jones BH, Bovee MW, Harris JM 3rd, Cowan DN (1993) Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med 21(5):705–710PubMedCrossRef
28.
29.
Zittermann A (2003) Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr 89(5):552–572PubMedCrossRef
30.
Committee on Medical Aspects of Food Policy (1998) Report on health and social subjects. No 49. Nutrition and bone health: with particular reference to calcium and vitamin D. HMSO, London
31.
Swan G (2004) Findings from the latest National Diet and Nutrition Survey. Proc Nutr Soc 63(4):505–512PubMedCrossRef
32.
Guillemant J, Le HT, Maria A, Allemandou A, Peres G, Guillemant S (2001) Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int 12(10):875–879PubMedCrossRef
33.
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7(5):439–443PubMedCrossRef
34.
Vieth R, Ladak Y, Walfish PG (2003) Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88(1):185–191PubMedCrossRef
35.
Shaffer RA, Brodine SK, Almeida SA, Williams KM, Ronaghy S (1999) Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program. Am J Epidemiol 149(3):236–242PubMedCrossRef
36.
Giladi M, Milgrom C, Simkin A, Danon Y (1991) Stress fractures. Identifiable risk factors. Am J Sports Med 19(6):647–652PubMedCrossRef
Metadata
Title
Low serum 25-hydroxyvitamin D is associated with increased risk of stress fracture during Royal Marine recruit training
Authors
T. Davey
S. A. Lanham-New
A. M. Shaw
B. Hale
R. Cobley
J. L. Berry
M. Roch
A. J. Allsopp
J. L. Fallowfield
Publication date
01-01-2016
Publisher
Springer London
Published in
Osteoporosis International / Issue 1/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-015-3228-5

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