Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA.
Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2023 Jul 22;188(7-8):e1970-e1974. doi: 10.1093/milmed/usac258.
Military trainees are at an increased risk of stress fractures. Vitamin D availability is known to play an important role in both fracture prevention and healing. The purpose of this investigation was to assess 25-hydroxy vitamin D (25(OH)D) levels in soldiers with confirmed lower extremity stress fractures and assess the predictors of fracture location.
Following Institutional Review Board approval, military trainees at a large training base presenting to the orthopedic clinic with a radiographically verified stress fracture were identified. Demographic data and 25(OH)D levels were collected. A descriptive analysis was performed in regard to patient age, body mass index (BMI), and 25(OH)D level. Interactions between variables were assessed using one-way analysis of variance for four fracture location groups (femoral neck, femoral shaft, tibial shaft, and foot and ankle). Bivariate correlations were examined between age, BMI, and vitamin D level.
A total of 155 lower extremity stress fractures were identified in 144 males and 11 females over 30 months. The mean age was 22.7 ± 4.85 years. The majority (60.7%) of fractures were located in the femoral neck. The average 25(OH)D level was 26.8 ± 8.37 ng/mL. Overall, 26% (N = 41) of enrolled patients had normal 25(OH)D levels, 48% (N = 74) had insufficient 25(OH)D levels, and 26% (N = 40) had deficient 25(OH)D levels. Patients with femoral neck fractures and tibial shaft fractures had significantly lower BMI than patients with foot and ankle fractures (23.3 vs. 27.7, P < .001 and 24.2 vs. 27.7, P = .003, respectively). Patients with foot and ankle fractures had significantly lower 25(OH)D levels than patients with femoral shaft fractures (21.1 vs. 30.1, P = .02). There were no significant findings regarding age and fracture location. Age correlated positively (but weakly) with BMI (0.338, P < .001). There was no correlation between age and vitamin D level or BMI and vitamin D level.
Overall, 74% of patients in military training with lower extremity stress fractures had insufficient or deficient levels of 25(OH)D, highlighting a persistent area of concern in this population. Patients with femoral neck and tibial shaft stress fractures had significantly lower BMI than patients with foot and ankle stress fractures. This suggests that in stress fracture-prone patients, BMI may play a role in predicting fracture location.
军事学员面临更高的压力性骨折风险。维生素 D 的可用性被认为在骨折预防和愈合中都起着重要作用。本研究的目的是评估下肢应力性骨折士兵的 25-羟维生素 D（25（OH）D）水平，并评估骨折部位的预测因素。
在获得机构审查委员会批准后，从一家大型培训基地的骨科诊所中确定了出现经影像学证实的应力性骨折的军事学员。收集了人口统计学数据和 25（OH）D 水平。对患者年龄、体重指数（BMI）和 25（OH）D 水平进行了描述性分析。使用单向方差分析评估了四个骨折部位组（股骨颈、股骨干、胫骨骨干和足踝）之间的变量相互作用。检查了年龄、BMI 和维生素 D 水平之间的双变量相关性。
在 30 个月内，共在 144 名男性和 11 名女性中发现了 155 例下肢应力性骨折。平均年龄为 22.7±4.85 岁。大多数（60.7%）骨折位于股骨颈。平均 25（OH）D 水平为 26.8±8.37ng/mL。总体而言，41%（N=41）的入组患者 25（OH）D 水平正常，48%（N=74）的患者 25（OH）D 水平不足，26%（N=40）的患者 25（OH）D 水平不足。与足踝骨折患者相比，股骨颈骨折和胫骨骨干骨折患者的 BMI 明显较低（23.3 与 27.7，P<.001 和 24.2 与 27.7，P=0.003）。与股骨骨干骨折患者相比，足踝骨折患者的 25（OH）D 水平明显较低（21.1 与 30.1，P=0.02）。年龄与骨折部位之间没有明显的相关性。年龄与 BMI 呈正相关（但较弱）（0.338，P<.001）。年龄与维生素 D 水平或 BMI 与维生素 D 水平之间无相关性。
总体而言，下肢应力性骨折的军事学员中，74%的患者 25（OH）D 水平不足或缺乏，这突出了该人群中持续存在的一个令人担忧的问题。与足踝骨折患者相比，股骨颈和胫骨骨干骨折患者的 BMI 明显较低。这表明，在易发生应力性骨折的患者中，BMI 可能在预测骨折部位方面发挥作用。
