Vitamin D and the Risk of Stress Fractures in Athletes and Military Personnel: A Systematic Review and Meta-analysis
Abstract
BACKGROUND: Stress fractures are common overuse injuries in military personnel and athletes. Although a low vitamin D level is a proposed risk factor, the evidence is conflicting, and the specific risk in athletes has not been systematically synthesized.
PURPOSE: To assess the association between vitamin D status and the risk of stress fractures in military personnel and athletes.
STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3.
METHODS: Major databases were systematically searched through April 16, 2025 for studies that quantitatively measured serum levels of 25-hydroxyvitamin D in military or athlete populations with a stress fracture group and a control group. Data were pooled using a random-effects model to calculate the mean difference (MD) and 95% confidence interval (CI). Subgroup analyses were conducted based on population type (military vs athlete), sex, and vitamin D status. Meta-regression was also performed to investigate sources of heterogeneity.
RESULTS: A total of 15 studies (4183 participants) were included. Overall, patients with stress fractures had significantly lower vitamin D levels compared to controls (MD, -5.82 nmol/L [95% CI, -10.35 to -1.29]). The association was also significant for military personnel (MD, -7.33 nmol/L [95% CI, -11.77 to -2.89]) and male participants (MD, -9.14 nmol/L [95% CI, -14.23 to -4.06]). Subgroup analyses of female participants and athletes did not detect a statistically significant difference in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,183 participants or records.
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