Carswell Alexander T, O'Leary Thomas J, Swinton Paul, Jackson Sarah, Tang Jonathan Cy, Oliver Samuel J, Izard Rachel M, Walsh Neil P, Fraser William D, Greeves Julie P
Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
J Bone Miner Res. 2023 Oct;38(10):1453-1464. doi: 10.1002/jbmr.4890. Epub 2023 Aug 30.
The relationship between vitamin D metabolites and lower body (pelvis and lower limb) overuse injury is unclear. In a prospective cohort study, we investigated the association between vitamin D metabolites and incidence of lower body overuse musculoskeletal and bone stress injury in young adults undergoing initial military training during all seasons. In 1637 men and 530 women (aged 22.6 ± 7.5 years; body mass index [BMI], 24.0 ± 2.6 kg/m ; 94.3% white ethnicity), we measured serum 25-hydroxyvitamin D (25(OH)D) and 24,25-dihydroxyvitamin D (24,25(OH) D) by high-performance liquid chromatography tandem mass spectrometry, and 1,25-dihydroxyvitamin D (1,25(OH) D) by immunoassay during week 1 of training. We examined whether the relationship between 25(OH)D and 1,25(OH) D:24,25(OH) D ratio was associated with overuse injury. During 12 weeks of training, 21.0% sustained ≥1 overuse musculoskeletal injury, and 5.6% sustained ≥1 bone stress injury. After controlling for sex, BMI, 2.4 km run time, smoking, bone injury history, and Army training course (Officer, standard, or Infantry), lower body overuse musculoskeletal injury incidence was higher for participants within the second lowest versus highest quartile of 24,25(OH) D (odds ratio [OR] = 1.62; 95% confidence interval [CI] 1.13-2.32; p = 0.009) and lowest versus highest cluster of 25(OH)D and 1,25(OH) D:24,25(OH) D (OR = 6.30; 95% CI 1.89-21.2; p = 0.003). Lower body bone stress injury incidence was higher for participants within the lowest versus highest quartile of 24,25(OH) D (OR = 4.02; 95% CI 1.82-8.87; p < 0.001) and lowest versus highest cluster of 25(OH)D and 1,25(OH) D:24,25(OH) D (OR = 22.08; 95% CI 3.26-149.4; p = 0.001), after controlling for the same covariates. Greater conversion of 25(OH)D to 24,25(OH) D, relative to 1,25(OH) D (ie, low 1,25(OH) D:24,25(OH) D), and higher serum 24,25(OH) D were associated with a lower incidence of lower body overuse musculoskeletal and bone stress injury. Serum 24,25(OH) D may have a role in preventing overuse injury in young adults undertaking arduous physical training. © 2023 Crown copyright and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.
维生素D代谢物与下半身（骨盆和下肢）过度使用损伤之间的关系尚不清楚。在一项前瞻性队列研究中，我们调查了在所有季节接受初始军事训练的年轻人中，维生素D代谢物与下半身过度使用性肌肉骨骼和骨应力损伤发生率之间的关联。在1637名男性和530名女性（年龄22.6±7.5岁；体重指数[BMI]为24.0±2.6kg/m²；94.3%为白人）中，我们在训练第1周时通过高效液相色谱串联质谱法测量血清25-羟基维生素D（25(OH)D）和24,25-二羟基维生素D（24,25(OH)₂D），并通过免疫测定法测量1,25-二羟基维生素D（1,25(OH)₂D）。我们研究了25(OH)D与1,25(OH)₂D:24,25(OH)₂D比值之间的关系是否与过度使用损伤有关。在12周的训练期间，21.0%的人遭受了≥1次过度使用性肌肉骨骼损伤，5.6%的人遭受了≥1次骨应力损伤。在控制了性别、BMI、2.4公里跑步时间、吸烟、骨损伤史和陆军训练课程（军官、标准或步兵）后，24,25(OH)₂D处于第二低四分位数与最高四分位数之间的参与者，其下半身过度使用性肌肉骨骼损伤发生率高于最高四分位数的参与者（比值比[OR]=1.62；95%置信区间[CI]为1.13 - 2.32；p=0.009），以及25(OH)D和1,25(OH)₂D:24,25(OH)₂D处于最低组与最高组之间的参与者（OR=6.30；95%CI为1.89 - 21.2；p=0.003）。在控制相同协变量后，24,25(OH)₂D处于最低四分位数与最高四分位数之间的参与者，其下半身骨应力损伤发生率高于最高四分位数的参与者（OR=4.02；95%CI为1.82 - 8.87；p<0.001），以及25(OH)D和1,25(OH)₂D:24,25(OH)₂D处于最低组与最高组之间的参与者（OR=22.08；95%CI为3.26 - 149.4；p=0.001）。相对于1,25(OH)₂D，25(OH)D向24,25(OH)₂D的转化率更高（即1,25(OH)₂D:24,25(OH)₂D较低）以及血清24,25(OH)₂D水平较高与下半身过度使用性肌肉骨骼和骨应力损伤发生率较低相关。血清24,25(OH)₂D可能在预防进行艰苦体育训练的年轻人发生过度使用损伤方面发挥作用。©2023英国皇家版权及作者所有。《骨与矿物质研究杂志》由Wiley Periodicals LLC代表美国骨与矿物质研究学会（ASBMR）出版。本文经英国皇家文书局局长及苏格兰国王印刷商许可发表。
