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Athletes may need to maintain higher vitamin D levels to reduce their risk of stress fractures, according to new research.

A study published in the Journal of Foot & Ankle Surgery suggests that active individuals who participate in higher impact activities, such as running, face an increased risk of stress fractures when they have low levels of vitamin D in the body.

Vitamin D is known to be essential for bone health, with low levels potentially leading to osteoporosis, osteomalacia, decreased bone mineral density, and risk of acute fracture. The nutrient is obtained in the diet and through the skin when exposed to the sun´s rays.

Researchers in Pennsylvania examined the serum concentrations of vitamin D in patients with confirmed stress fractures.

“By assessing the average serum vitamin D concentrations of people with stress fractures and comparing these with the current guidelines, we wanted to encourage a discussion regarding whether a higher concentration of serum vitamin D should be recommended for active individuals,” explained lead investigator Dr. Jason R. Miller, Fellowship Director of the Pennsylvania Intensive Lower Extremity Fellowship, foot and ankle surgeon from Premier Orthopedics and Sports Medicine, in Malvern, Pennsylvania, and Fellow Member of the American College of Foot and Ankle Surgeons.

The findings of the study showed an association between stress fracture and vitamin D level. Using the standards recommended by the Vitamin D Council (sufficient range 40 to 80 ng/mL), more than 80% of the patients were classified as having insufficient or deficient vitamin D levels. According to the standards set by the Endocrine Society (sufficient range 30 to 100 ng/mL), over 50% had insufficient levels.

“Based on these findings, we recommend a serum vitamin D level of at least 40 ng/mL to protect against stress fractures, especially for active individuals who enjoy participating in higher impact activities,” Dr. Miller said. “This correlates with an earlier study of 600 female Navy recruits who were found to have a twofold greater risk of stress fractures of the tibia and fibula with a vitamin D level of less than 20 ng/mL compared with females with concentrations above 40 ng/mL.

However, Dr. Miller also noted that vitamin D is not the only predictor of a stress fracture and said: “We recommend that individuals who regularly exercise or enjoy participating in higher impact activities should be advised on proper and gradual training regimens to reduce the risk of developing a stress fracture.”

The researchers also said that a larger and prospective investigation is warranted to further understand the effect of vitamin D level and stress fracture prevention in active individuals.