Individuals who participate in higher impact activities may require higher vitamin D levels to reduce their risk of stress fractures, a new study in The Journal of Foot & Ankle Surgery reported. 

Vitamin D is critical for bone development and remodeling to ensure appropriate bone mass density. Deficient levels can result in osteoporosis, osteomalacia, decreased bone mineral density, and risk of acute fracture. 

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Researchers analyzed the serum concentration of 25(OH)D in patients with confirmed stress fractures to see whether a higher concentration of serum vitamin D should be recommended for those who are more active. They reviewed medical records of patients who experienced lower extremity pain, with a suspected stress fracture, from August 2011 to July 2014.  After an initial x-ray of the affected extremity, patients were sent for an MRI if no acute fracture was seen but concern for the presence of a stress fracture remained based on physical exam findings. Musculoskeletal radiologists reviewed the MRI scans and study investigators confirmed the diagnosis after reviewing the images.

Serum vitamin D levels were recorded within 3 months of diagnosis for 53 of the patients. The results indicated that over 80% of these patients would have been categorized as having insufficient or deficient vitamin D levels according to the standards recommended by the Vitamin D Council (40–80ng/mL). Based off the standards recommended by the Endocrine Society (30–100ng/mL), over 50% were considered to have insufficient levels. 

Jason R. Miller, DPM, FACFAS, Fellowship Director of the Pennsylvania Intensive Lower Extremity Fellowship, and foot and ankle surgeon from Premier Orthopedics and Sports Medicine, and coauthors recommend a “serum vitamin D level of ≥40ng/mL to protect against stress fractures, especially for active individuals who enjoy participating in higher impact activities.” Study findings support a previous study (n=600) of  female Navy recruits who were found to have double the risk of stress fractures of the tibia and fibula when vitamin D levels were <20ng/mL compared to females with levels >40ng/mL.

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