The Effect of Vitamin D Supplementation on Serum 25(OH)D and its Association with Stress Fractures in High-Risk, Physically Active Adults: A Critically Appraised Topic

Clinical Scenario: In collegiate athletic and military populations alike, the repetitive and intense training increase the risk of experiencing a stress fracture, representing a significant time loss and financial cost. Research suggests the use of supplemental vitamin D to prevent the occurrence of stress fractures in high-risk adults. Clinical Question: In high risk, physically active adults, does the effect of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentration effect the occurrence of stress fractures? Clinical Bottom Line: The findings suggest that clinicians should consider the use of supplemental vitamin D as a protective measure against the occurrence of stress fractures. Future research on the relationship between vitamin D supplementation and the occurrence of stress fractures in athletic and military populations and the effect of diet modifications versus supplementation on the occurrence of stress fractures is warranted. Strength of Recommendation: Based on the consistent findings across both level 2 articles according to OCEBM Levels of Evidence, a strength of recommendation of B can be suggested in support of vitamin D supplementation for the prevention of stress fractures.