{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:59:04Z","timestamp":1790420344069,"version":"4.1.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Low vitamin D levels along with high-intensity athletic training may put an athlete at increased risk for a stress fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To assess whether supplementation with vitamin D is associated with a reduced risk of stress fractures in college athletes. We also assessed differences in vitamin D levels among athletes participating in outdoor versus indoor sports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The study participants included 802 National Collegiate Athletic Association Division I intercollegiate athletes (497 men and 305 women) on a sports team for at least 1 semester from 2012 to 2018. All athletes who had a baseline vitamin D level in their medical record were included. Athletes with vitamin D levels &lt;40 ng\/mL were given vitamin D supplements. We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to \u226540 ng\/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The rate of stress fracture was 12% higher (95% CI, 6-19; P &lt; .001) for those who remained low in vitamin D compared with those who were low at baseline\u00a0but improved their vitamin D status to \u226540 ng\/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P &lt; .001) for those who had low vitamin D levels compared with those who maintained normal levels. The mean baseline vitamin D values were significantly higher for men participating in outdoor sports versus indoor sports. For men, the mean vitamin D level was 5.7 ng\/mL higher (95% CI, 0.9-10.5; P = .01) in outdoor athletes. For women, the mean vitamin D level was 3.7 ng\/mL higher (95% CI,\u00a0\u20130.58 to 8.03; P &lt; .04) for outdoor versus indoor sports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Study results indicated that correcting low serum vitamin D levels reduces the risk of stress fracture. This study also presented evidence that athletes who participate in indoor sports may be at greater risk for vitamin D deficiency than those who compete in outdoor sports.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2325967120966967","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T13:50:11Z","timestamp":1607608211000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":28,"title":["Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes"],"prefix":"10.1177","volume":"8","author":[{"given":"David","family":"Millward","sequence":"first","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison D.","family":"Root","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Dubois","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall P.","family":"Cohen","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Valdivia","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Helming","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Kokoskie","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Waterbrook","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Paul","sequence":"additional","affiliation":[{"name":"University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"bibr1-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.2019.1632158"},{"key":"bibr2-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513475787"},{"key":"bibr3-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(05)70016-8"},{"key":"bibr4-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.451"},{"key":"bibr5-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181930c2b"},{"key":"bibr6-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-014-0267-6"},{"key":"bibr7-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1177\/1941738116677732"},{"key":"bibr8-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/85.1.6"},{"key":"bibr9-2325967120966967","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01160308"},{"key":"bibr10-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2003.10719287"},{"key":"bibr11-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/135.11.2739S"},{"key":"bibr12-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra070553"},{"key":"bibr13-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514567297"},{"key":"bibr14-2325967120966967","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2015.08.002"},{"key":"bibr15-2325967120966967","unstructured":"National Collegiate Athletic Association. 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