1
|
Wyatt PB, Reiter CR, Satalich JR, O’Neill CN, Edge C, Cyrus JW, O’Connell RS, Vap AR. Effects of Vitamin D Supplementation in Elite Athletes: A Systematic Review. Orthop J Sports Med 2024; 12:23259671231220371. [PMID: 38188620 PMCID: PMC10768611 DOI: 10.1177/23259671231220371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/31/2023] [Indexed: 01/09/2024] Open
Abstract
Background Deficiency in vitamin D has been shown to increase the risk of injury. Purpose To synthesize current placebo-controlled randomized trials investigating the effect of vitamin D supplementation in elite athletes on (1) aerobic capacity; (2) anaerobic measures, such as strength, speed, and anaerobic power; (3) serum biomarkers of inflammation; and (4) bone health. Study Design Systematic review; Level of evidence, 1. Methods A literature search was conducted on November 30, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were randomized, placebo-controlled studies of longer than 2 weeks on subjects with active participation in organized sport. Excluded were nonrandomized controlled trial study designs, vitamin D administration routes other than oral, studies that did not use vitamin D supplementation as the sole intervention, and studies with nonathletic or military populations. Results Out of 2331 initial studies, 14 studies (482 athletes) were included. Of the 3 studies that assessed aerobic capacity, 2 demonstrated significantly greater improvements in maximal oxygen uptake and physical working capacity-170 (P < .05) in supplemented versus nonsupplemented athletes. Measurements of anaerobic power and strength were consistently increased in supplemented groups compared with nonsupplemented groups in 5 out of the 7 studies that assessed this. Of the 6 studies that assessed sprint speed, 4 found no significant difference between supplemented and nonsupplemented groups. Aside from 1 study that found significantly lower interleukin-6 levels in supplemented athletes, measures of other inflammatory cytokines were not affected consistently by supplementation. The 4 studies that assessed markers of bone health were conflicting regarding benefits of supplementation. One study found demonstrated improvements in bone mineral density in response to supplementation (P = .02) compared with control whereas another found no significant difference between supplemented and nonsupplemented groups. However, in 3 other studies, serum biomarkers of bone turnover such as bone-specific alkaline phosphatase, parathyroid hormone, and N-terminal telopeptide appeared to be higher in subjects with lower serum vitamin D levels (P < .05). Conclusion Results of this systematic review indicated that the greatest benefit of vitamin D supplementation in elite athletes may be improving aerobic endurance, anaerobic power, and strength. More research is needed to determine the effect of vitamin D supplementation on bone health and injury risk in this population.
Collapse
Affiliation(s)
- Phillip B. Wyatt
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Charles R. Reiter
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - James R. Satalich
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Conor N. O’Neill
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Carl Edge
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John W. Cyrus
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Robert S. O’Connell
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Alexander R. Vap
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| |
Collapse
|
2
|
Schowalter S, Le B, Creps J, McInnis KC. Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management. Open Access J Sports Med 2022; 13:89-105. [PMID: 36248020 PMCID: PMC9563740 DOI: 10.2147/oajsm.s288882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.
Collapse
Affiliation(s)
- Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Correspondence: Sean Schowalter, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA, Tel +1 617 952 5000, Email
| | - Bryan Le
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - James Creps
- Sports Medicine Service, Boston Red Sox, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Jastifer JR. Contemporary Review: The Foot and Ankle in Long-Distance Running. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221125455. [PMID: 36185350 PMCID: PMC9520164 DOI: 10.1177/24730114221125455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Distance runners represent a unique patient population. The cyclic activity associated with distance running leads to a high incidence of injury. Gait patterns, the extrinsic and intrinsic muscles of the foot and ankle, foot strike pattern, shoe wear considerations, alignment, and orthotics are also all important considerations that must be considered by the treating provider. The purpose of this work is to review relevant functional anatomy, recent studies on gait patterns in running, orthotics, and theory on how the body moves through space during running in order to better equip the clinician to treat long distance runners.
Collapse
Affiliation(s)
- James R. Jastifer
- Department Orthopaedic Surgery, Ascension Borgess Orthopedics, Kalamazoo, MI, USA
- Department of Orthopaedic Surgery, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
| |
Collapse
|
4
|
Ip TST, Fu SC, Ong MTY, Yung PSH. Vitamin D deficiency in athletes: Laboratory, clinical and field integration. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 29:22-29. [PMID: 35847194 PMCID: PMC9256943 DOI: 10.1016/j.asmart.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
Vitamin D deficiency is highly prevalent in athletes. Increased utilisation and storage depletion may be key contributing factor. We found a higher prevalence of vitamin D inadequacy (deficiency/ insufficiency) in power than endurance sport athletes, which may be related to vitamin D utilisation and reserve in skeletal muscles.
Collapse
Affiliation(s)
- Tina Shuk-Tin Ip
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| |
Collapse
|
5
|
Most A, Dörr O, Nef H, Hamm C, Bauer T, Bauer P. Influence of 25-Hydroxy-Vitamin D Insufficiency on Maximal Aerobic Power in Elite Indoor Athletes: A Cross-Sectional Study. SPORTS MEDICINE-OPEN 2021; 7:74. [PMID: 34648100 PMCID: PMC8517059 DOI: 10.1186/s40798-021-00363-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
Background The impact of vitamin D on musculoskeletal health is well-established, although its influence on physical performance is unclear. Therefore, we conducted this study to evaluate the impact of 25-hydroxy-vitamin D (25-OH vitamin D) concentrations with maximal aerobic power of professional indoor athletes.
Results A total of 112 male professional athletes were included in this cross-sectional study, consisting of 88 handball and 24 ice hockey players. The maximal aerobic power was assessed with a standardized cycling ergometer test. Athletes were assigned to two groups according to their 25-OH vitamin D status: insufficient (< 30 ng/mL) and sufficient (≥ 30 ng/mL). Thirty-four players (30.4%) displayed insufficient (21.9 ± 5.9 ng/mL) and 78 (69.6%) sufficient 25-OH vitamin D concentrations (41.6 ± 8.6 ng/mL). Athletes with sufficient levels achieved a higher maximal aerobic power (3.9 ± 0.9 vs. 3.5 ± 0.8 W/kg, p = 0.03) compared to those with insufficient levels. Conclusions There is a high prevalence of 25-OH vitamin D insufficiency in professional indoor athletes, even in summer. Insufficient 25-OH vitamin D concentrations were associated with lower maximal aerobic power in male professional indoor athletes. Further, the 25-OH vitamin D concentration was identified as the only independent predictor of maximal aerobic power in these athletes, highlighting the impact of 25-OH vitamin D on physical performance. Therefore, 25-OH vitamin D concentrations of ≥ 30 ng/mL should be maintained to ensure optimal physical performance in these athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00363-1.
Collapse
Affiliation(s)
- Astrid Most
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Oliver Dörr
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Christian Hamm
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Timm Bauer
- Department of Cardiology, Internal Intensive Care, General Internal Medicine, Sana Klinikum, Offenbach, Germany
| | - Pascal Bauer
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| |
Collapse
|
6
|
Stojanović E, Jakovljević V, Scanlan AT, Dalbo VJ, Radovanović D. Vitamin D 3 supplementation reduces serum markers of bone resorption and muscle damage in female basketball players with vitamin D inadequacy. Eur J Sport Sci 2021; 22:1532-1542. [PMID: 34240659 DOI: 10.1080/17461391.2021.1953153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study aimed to investigate the effect of vitamin D3 supplementation at a dose of 4,000 IU/day for 6 weeks on serum levels of: 25-hydroxyvitamin D [25(OH)D], bone turnover [osteocalcin and carboxy-terminal telopeptides of crosslinks of type I collagen (CTx-I)], and muscle damage [lactate dehydrogenase (LDH) and creatine kinase (CK)] in middle adolescent (15-18 years) and late-adolescent to early adulthood (19-30 years) female basketball players with inadequate vitamin D status. Participants (N=24) were randomly assigned in a double-blind manner into a vitamin D or placebo group. Data were analyzed using separate 2×2x2 mixed ANOVAs with one within-subjects factor (time) and two between-subjects factors (condition and age). When a significant interaction was observed, the intra-group changes were assessed using paired t tests and Hedge's g. Paired t-tests comparing intra-group changes in the vitamin D condition revealed a non-significant large improvement in 25(OH)D (p = 0.06; g = 0.86), non-significant small decreases in CTx-I (p = 0.13; g = -0.22) and CK (p = 0.07; g = -0.26), as well as a significant moderate decrease in LDH (p = 0.004; g = -0.74). Paired t-tests comparing intra-group changes in the placebo condition revealed a significant moderate decline in 25(OH)D (p <0.001; g = -0.77), as well as significant small increases in CTx-I (p = 0.04; g = 0.47) and CK (p = 0.04; g = 0.36). Vitamin D3 supplementation at 4,000 IU/day could be effective in reducing bone resorption and muscle damage in female basketball players with inadequate baseline vitamin D, irrespective of age.
Collapse
Affiliation(s)
- Emilija Stojanović
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia.,Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Jakovljević
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia.,Department of Human Pathology, Moscow State Medical University IM Sechenov, Moscow, Russia
| | - Aaron T Scanlan
- Human Exercise and Training Laboratory, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Vincent J Dalbo
- Human Exercise and Training Laboratory, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | | |
Collapse
|
7
|
Bratsman A, Wassef A, Wassef CR, Jayaram P, Mosely JB, Shybut TB. Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II, and III. Orthop J Sports Med 2021; 9:23259671211014496. [PMID: 34291114 PMCID: PMC8274115 DOI: 10.1177/23259671211014496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Bone stress injuries (BSIs) are a major source of functional impairment in athletes of all sports, with many risk factors, including athlete characteristics and type of sport. In National Collegiate Athletic Association (NCAA) athletics, the stratification of programs into divisions with different characteristics and makeup has been identified as increasing the risk for certain kinds of injuries, but there have been no studies on the difference of BSI rates and characteristics between athletes in Division I (DI) and those in Divisions II and III (DII and DIII). Purpose/Hypothesis: To characterize the BSI rates in each division and compare the incidence and characteristics of BSIs within divisions. Our hypothesis was that BSI rates would be higher in DII and DIII athletes as compared with DI athletes. Study Design: Descriptive epidemiology study. Methods: Five years of recorded BSI data in collegiate athletes via the NCAA Injury Surveillance Program were examined for the academic years 2009-2010 to 2013-2014. BSI rates per 100,000 athlete-exposures (AEs) were compared for DI versus DII and DIII athletes using risk ratios and 95% CIs. Time lost to injury, time of season of injury, and class composition of injured athletes were also compared between divisions. Results: Over the 5 years studied, DII and DIII programs reported 252 BSIs more than 1,793,777 AEs (14.05 per 100,000 AEs), and DI programs reported 235 BSIs over 2,022,592 AEs (11.62 per 100,000 AEs). The risk ratio was significant for D1 versus DII and DIII (1.21; 95% CI, 1.01-1.44). There was a significant difference in time lost to injury in DI versus DII and DIII, χ2(5, n = 449) = 16.54; P = .006. When data were stratified by individual sport, there were no significant divisional differences in high-risk sports. Conclusion: In the current study, NCAA DII and DIII athletes had higher rates of BSI than their DI counterparts. As compared with DII and DIII athletes, the DI athletes had a significantly greater proportion of BSIs that did not result in absence from participation in sport.
Collapse
Affiliation(s)
- Andrew Bratsman
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Audrey Wassef
- Department of Orthopedic Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christina R Wassef
- Department of Orthopedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
| | - Prathap Jayaram
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - J Bruce Mosely
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Theodore B Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
8
|
Yoon S, Kwon O, Kim J. Vitamin D in athletes: focus on physical performance and musculoskeletal injuries. Phys Act Nutr 2021; 25:20-25. [PMID: 34315203 PMCID: PMC8342187 DOI: 10.20463/pan.2021.0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The aim of this review was to discuss the effects of vitamin D on physical performance and musculoskeletal injuries in athletes and provide information on the field applications of vitamin D. METHODS A systematic review was conducted to identify studies on vitamin D in athletes that assessed serum vitamin D levels, vitamin D and physical performance, vitamin D and musculoskeletal injuries, and practical guidelines for supplementation of vitamin D. RESULTS Several studies reported that a high proportion of athletes had vitamin D insufficiency or deficiency. Low serum levels of vitamin D in athletes were more pronounced in winter than in other seasons, and indoor athletes had lower serum vitamin D levels than outdoor athletes. Low vitamin D levels have been demonstrated to have negative effects on muscle strength, power, and endurance; increase stress fractures and other musculoskeletal injuries; and affect acute muscle injuries and inflammation following high-intensity exercises. Therefore, periodic assessment and monitoring of vitamin D levels are necessary in athletes; the recommended serum level of 25(OH)D is > 32 ng/mL and the preferred level is > 40 ng/mL (-1). In those with low levels of vitamin D, exposure to sunlight and an improved diet or supplements may be helpful. Particularly, 2000-6000 IU of supplemental vitamin D3 can be consumed daily. CONCLUSION Vitamin D is a potential nutritional factor that can significantly affect physical performance and musculoskeletal injuries in athletes. The importance and role of vitamin D in athletes should be emphasized, and the current levels of vitamin D should be assessed. Therefore, it is essential to periodically evaluate and monitor serum vitamin D levels in athletes.
Collapse
Affiliation(s)
- Sewoon Yoon
- Division of Sports Science, College of Health Science, University of Suwon, Hwaseong, Republic of Korea
| | - Ohkyu Kwon
- Department of Physical Education, College of Education, Daegu Catholic University, Gyeongsan, Republic of Korea
| | - Jooyoung Kim
- Office of Academic Affairs, Konkuk University, Chungju, Republic of Korea
| |
Collapse
|
9
|
Hamstra-Wright KL, Huxel Bliven KC, Napier C. Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach. Front Sports Act Living 2021; 3:665683. [PMID: 34124660 PMCID: PMC8192811 DOI: 10.3389/fspor.2021.665683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/14/2021] [Indexed: 01/09/2023] Open
Abstract
Bone stress injuries (BSIs) are a common orthopedic injury with short-term, and potentially long-term, effects. Training load capacity, influenced by risk factors, plays a critical role in the occurrence of BSIs. Many factors determine how one's body responds to repetitive loads that have the potential to increase the risk of a BSI. As a scientific community, we have identified numerous isolated BSI risk factors. However, we have not adequately analyzed the integrative, holistic, and cumulative nature of the risk factors, which is essential to determine an individual's specific capacity. In this narrative review, we advocate for a personalized approach to monitor training load so that individuals can optimize their health and performance. We define “cumulative risk profile” as a subjective clinical determination of the number of risk factors with thoughtful consideration of their interaction and propose that athletes have their own cumulative risk profile that influences their capacity to withstand specific training loads. In our narrative review, we outline BSI risk factors, discuss the relationship between BSIs and training load, highlight the importance of individualizing training load, and emphasize the use of a holistic assessment as a training load guide.
Collapse
Affiliation(s)
- Karrie L Hamstra-Wright
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Kellie C Huxel Bliven
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Christopher Napier
- Menrva Research Group, Faculty of Applied Science, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
10
|
Knechtle B, Jastrzębski Z, Hill L, Nikolaidis PT. Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:223. [PMID: 33804459 PMCID: PMC7999420 DOI: 10.3390/medicina57030223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/13/2023]
Abstract
There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete's lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.
Collapse
Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zürich, Switzerland
| | - Zbigniew Jastrzębski
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, 80-336 Gdańsk, Poland;
| | - Lee Hill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada;
| | - Pantelis T. Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece;
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
| |
Collapse
|
11
|
Abstract
Hintergrund Die labordiagnostische Untersuchung stellt eine wichtige Möglichkeit zur Beurteilung und Optimierung der Leistungs- und Regenerationsfähigkeit professioneller Athleten dar. Ferner ist sie für die Prävention, Diagnostik und Rehabilitation von Verletzungen und Überbelastungen von Bedeutung. Fragestellung Ziel dieser Arbeit ist die Darstellung muskuloskelettaler laborchemischer Parameter, die relevante Erkenntnisse für die medizinische Betreuung von Leistungssportlern liefern. Material und Methoden Literaturrecherche und narratives Review. Ergebnisse Die Bestimmung des Vitamin-D-, Calcium- und Knochenstoffwechsels stellt die laborchemische Basisdiagnostik im Rahmen der Beurteilung des Skelettstatus mit zusätzlichem präventivem Nutzen bezüglich muskuloskelettaler Verletzungen dar. Ferner können muskuläre Serummarker, z. B. Laktatdehydrogenase (LDH), Kreatinkinase (CK), Myoglobin und Aspartat-Aminotransferase (ASAT), helfen, eine metabolische Adaptation an das physische Training festzustellen und Aussagen über die muskuläre Arbeitslast und mögliche Schädigungen zu gewinnen. Die Energieverfügbarkeit kann durch eine entsprechende Bilanzierung sowie die laborchemische Bestimmung der Makro- und Mikronährstoffe eingeschätzt und optimiert werden. Schlussfolgerungen Die labordiagnostische Untersuchung besitzt in der Betreuung von Athleten eine sportartenübergreifende klinische Relevanz. Sie dient der Erreichung einer höchstmöglichen Leistungsfähigkeit sowie optimalen Prävention von Knochen- und Muskelverletzungen, wobei sämtliche Mangelzustände (z. B. Vitamin D) ausgeglichen werden sollten. Durch eine Periodisierung der laborchemischen Untersuchungen, mit zumindest zwei Labordiagnostiken im Jahr, und Aufstellung individueller Variabilitäts- und Referenzbereiche kann ferner eine bessere Beurteilbarkeit erreicht werden.
Collapse
|
12
|
Grant WB, Lahore H, Rockwell MS. The Benefits of Vitamin D Supplementation for Athletes: Better Performance and Reduced Risk of COVID-19. Nutrients 2020; 12:E3741. [PMID: 33291720 PMCID: PMC7761895 DOI: 10.3390/nu12123741] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is having major economic and personal consequences for collegiate and professional sports. Sporting events have been canceled or postponed, and even when baseball and basketball seasons resumed in the United States recently, no fans were in attendance. As play resumed, several players developed COVID-19, disrupting some of the schedules. A hypothesis now under scientific consideration is that taking vitamin supplements to raise serum 25-hydroxyvitamin D [25(OH)D] concentrations could quickly reduce the risk and/or severity of COVID-19. Several mechanisms have been identified through which vitamin D could reduce the risks of infection and severity, death, and long-haul effects of COVID-19: (1) inducing production of cathelicidin and defensins to reduce the survival and replication of the SARS-CoV-2 virus; (2) reducing inflammation and the production of proinflammatory cytokines and risk of the "cytokine storm" that damages the epithelial layer of the lungs, heart, vascular system, and other organs; and (3) increasing production of angiotensin-converting enzyme 2, thus limiting the amount of angiotensin II available to the virus to cause damage. Clinical trials have confirmed that vitamin D supplementation reduces risk of acute respiratory tract infections, and approximately 30 observational studies have shown that incidence, severity, and death from COVID-19 are inversely correlated with serum 25(OH)D concentrations. Vitamin D supplementation is already familiar to many athletes and sports teams because it improves athletic performance and increases playing longevity. Thus, athletes should consider vitamin D supplementation to serve as an additional means by which to reduce risk of COVID-19 and its consequences.
Collapse
Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
| | - Henry Lahore
- VitaminDWiki, 2289 Highland Loop, Port Townsend, WA 98368, USA;
| | - Michelle S. Rockwell
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA
| |
Collapse
|