Vitamin D metabolites are associated with musculoskeletal injury in young adults:​ a prospective cohort study

Carswell, Alexander T.<sup>1,2</sup>; O'Leary, Thomas J.<sup>3,4</sup>; Swinton, Paul<sup>5</sup>; Jackson, Sarah<sup>3</sup>; Tang, Jonathan CY<sup>1,6</sup>; Oliver, Samuel J.<sup>7</sup>; Izard, Rachel M.<sup>8</sup>; Walsh, Neil P.<sup>9</sup>; Fraser, William D.<sup>1,6</sup>; Greeves, Julie P.<sup>1,3,4</sup>

Affiliations

¹Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK

²School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK

³Army Health and Performance Research, Army HQ, Andover, UK

⁴Division of Surgery and Interventional Science, UCL, London, UK

⁵School of Health Sciences, Robert Gordon University, Aberdeen, UK

⁶Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, UK

⁷College of Human Sciences, Bangor University, Bangor, UK

⁸Defence Science and Technology, Porton Down, Ministry of Defence, Salisbury, UK

⁹Faculty of Science, Liverpool John Moores University, Liverpool, UK

Abstract and keywords

The relationship between vitamin D metabolites and lower body (pelvis and lower limb) overuse injury is unclear. In a prospective cohort study, we investigated the association between vitamin D metabolites and incidence of lower body overuse musculoskeletal and bone stress injury in young adults undergoing initial military training during all seasons. In 1637 men and 530 women (aged 22.6 ± 7.5 years; body mass index [BMI], 24.0 ± 2.6 kg/m⁻²; 94.3% white ethnicity), we measured serum 25-hydroxyvitamin D (25(OH)D) and 24,25-dihydroxyvitamin D (24,25(OH)₂D) by high-performance liquid chromatography tandem mass spectrometry, and 1,25-dihydroxyvitamin D (1,25(OH)₂D) by immunoassay during week 1 of training. We examined whether the relationship between 25(OH)D and 1,25(OH)₂D:24,25(OH)₂D ratio was associated with overuse injury. During 12 weeks of training, 21.0% sustained ≥1 overuse musculoskeletal injury, and 5.6% sustained ≥1 bone stress injury. After controlling for sex, BMI, 2.4 km run time, smoking, bone injury history, and Army training course (Officer, standard, or Infantry), lower body overuse musculoskeletal injury incidence was higher for participants within the second lowest versus highest quartile of 24,25(OH)₂D (odds ratio [OR] = 1.62; 95% confidence interval [CI] 1.13–2.32; p = 0.009) and lowest versus highest cluster of 25(OH)D and 1,25(OH)₂D:24,25(OH)₂D (OR = 6.30; 95% CI 1.89–21.2; p = 0.003). Lower body bone stress injury incidence was higher for participants within the lowest versus highest quartile of 24,25(OH)₂D (OR = 4.02; 95% CI 1.82–8.87; p < 0.001) and lowest versus highest cluster of 25(OH)D and 1,25(OH)₂D:24,25(OH)₂D (OR = 22.08; 95% CI 3.26–149.4; p = 0.001), after controlling for the same covariates. Greater conversion of 25(OH)D to 24,25(OH)₂D, relative to 1,25(OH)₂D (ie, low 1,25(OH)₂D:24,25(OH)₂D), and higher serum 24,25(OH)₂D were associated with a lower incidence of lower body overuse musculoskeletal and bone stress injury. Serum 24,25(OH)₂D may have a role in preventing overuse injury in young adults undertaking arduous physical training.

Keywords: VITAMIN D; INJURY; NUTRITION; EXERCISE; MUSCULOSKELETAL

Links

DOI: 10.1002/jbmr.4890

PubMed: 37526272

WoS: 001087137600008

History

Received: 2023-04-22

Revised: 2023-07-06

Accepted: 2023-07-26

Cited Works (2)

Year	Entry
2011	Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. July 2011;96(7):1911-1930.
2020	Fraser WD, Tang JCY, Dutton JJ, Schoenmakers I. Vitamin D measurement, the debates continue, new analytes have emerged, developments have variable outcomes. Calcif Tiss Int. January 2020;106(1):3-13.