Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men.
Low vitamin D level may predict rickets, osteomalacia, or osteoporosis. We examined serum 25(OH)D concentration as a predisposing factor for bone stress fracture in 756 military recruits. The average serum 25(OH)D concentration was significantly lower in the group with fracture, suggesting a relationship between vitamin D and fatigue bone stress fracture.


BACKGROUND
Low vitamin D level may predict rickets, osteomalacia, or osteoporosis. Fatigue bone stress fracture is one of the most frequently seen types of overuse injuries in athletes and military recruits. An association was recently shown between vitamin D and BMC. A correlation has also been found between low femoral BMD and stress fractures. We measured serum 25(OH)D concentration in a population sample of military recruits to determine if vitamin D is a predisposing factor for fatigue bone stress fracture.


METHODS
We prospectively followed 800 randomly selected, healthy Finnish military recruits with a mean age of 19 years for developing stress fractures in homogenous circumstances. Blood for serum 25(OH)D concentration was drawn at entry into military service, and the weight, height, body mass index (BMI), muscle strength, and 12-minute running were measured for all subjects. Serum 25(OH)D concentrations were measured with enzyme immunoassay. At end of the 90-day follow-up, 756 subjects completed the study. Subjects without fracture constituted controls.


RESULTS
Twenty-two recruits with stress fracture were identified (2.9%), the incidence being 11.6 (95% CI: 6.8-16.5) per 100 person-years. In the final multivariate analysis, the significant risk factor for stress fracture in conscripts was a below median serum 25(OH)D level (75.8 nM), OR being 3.6 (95% CI: 1.2-11.1). No significant associations between BMI (p = 0.255), age (p = 0.216), or smoking (p = 0.851) and bone stress fracture were found in this study population.


CONCLUSIONS
A lower level of serum 25(OH)D concentration may be a generally predisposing element for bone stress fractures. Considering the obvious need of additional vitamin D in prevention of stress fractures, the effects of vitamin D fortification of foods and supplementation will be subjects of interest for future research.
Ruohola
Juha-Petri
JP
Research Institute of Military Medicine, Helsinki, Finland. j-p.ruohola@pp.inet.fi
Laaksi
Ilkka
I
Ylikomi
Timo
T
Haataja
Riina
R
Mattila
Ville M
VM
Sahi
Timo
T
Tuohimaa
Pentti
P
Pihlajamäki
Harri
H
D000293:Adolescent; D000328:Adult; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002112:Calcifediol / Q000097:blood*; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009132:Muscles / Q000502:physiology; D011446:Prospective Studies; D013223:Statistics as Topic; D013314:Stress, Mechanical; D013718:Tensile Strength
D002112:Calcifediol