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Tang, Jonathan 
ORCID: https://orcid.org/0000-0001-6305-6333, Jackson, Sarah, Izard, Rachel, Oliver, Samuel, Piec, Isabelle ORCID: https://orcid.org/0000-0002-0648-1330, Washbourne, Christopher, Walsh, Neil, Greeves, Julie and Fraser, William
(2018)
Vitamin D insufficiency and elevated vitamin D metabolite ratios (VMR) are associated with increased risk of injuries: Results from the British Army Lower Limb Iinjury Pprevention (ALLIP) study.
Journal of Bone and Mineral Research, 59.
ISSN 0884-0431
Abstract
Introduction: British Army recruits suffer from musculoskeletal injuries (MSI) during initial training. Up to 10% suffer skeletal stress fracture (SFx) resulting in lost training days and medical attrition. There is evidence to suggest that vitamin D deficiency is prevalent in the army. Our aim was to determine vitamin D metabolites (VDM) in recruits upon starting training, and health outcomes after a 14-week training programme. Methods: 940 of 2252 healthy army recruits, age 18–32 yrs were included in the analysis (ClinicalTrials.gov ID: NCT02416895). Excluded were those who took calcium/vitamin D supplements and with prior injuries. Serum 25OHD/24,25(OH)2D, 1,25(OH)2D and PTH were tested across all seasons. The co-primary endpoints were incidence of SFx, MSI, infections and days lost in rehabilitation (DLR) in relation to VDM. Results: 38% of participants identified as vitamin D insufficient (25OHD<50 nmol/L) were associated with increased risk(OR): SFx(1.03), medial tibial stress syndrome (MTSS)(1.26), upper limb trauma (1.02), respiratory infections (1.13); and highly significant risk of upper limb overuse injuries(3.18) and subsequent DLR(3.49). 25OHD:24,25(OH)2D VMR was significantly increased at 25OHD<50 nmol/L (P<0.001). There was no significant relationship between 1,25(OH)2D and 25OHD, the distribution of 1,25(OH)2D:24,25(OH)2D VMR showed an exponential negative correlation with 25OHD (y=1525.8×−0.983, r2Exp =0.582, P<0.001). PTH was significantly higher (P>0.001) in subjects with high 1,25(OH)2D:24,25(OH)2D VMR and low 25OHD than those at the opposite. Cosinor-fit curves revealed circannual rhythm on all VDM and VMR except for 1,25(OH)2D. Baseline BMD was not associated with any health outcomes. Conclusion: Vitamin D insufficiency is strongly associated with training-related injuries and lengthened rehabilitation. By using VMR models we demonstrated possible underlying mechanisms preceding the accelerated injury.
| Item Type: | Article |
|---|---|
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 16 Sep 2022 09:38 |
| Last Modified: | 19 Oct 2023 03:25 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/88373 |
| DOI: | 10.1530/ENDOABS.59.OC1.2 |
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