Summary
This prospective observational study in Royal Marines recruits demonstrates a gene-environment interaction between vitamin D receptor genotype and serum 25-hydroxyvitamin D status in determining stress fracture risk during intensive 32-week training. Recruits who developed stress fractures failed to show the rise in 25OHD seen in controls between weeks 1–15, and higher mid-training 25OHD status was associated with reduced fracture risk, particularly in those carrying the VDR f-allele. The findings support vitamin D supplementation as a targeted injury prevention strategy, with potential for genotype-guided stratification of risk.
UK applicability
These findings are directly applicable to UK military training contexts and inform occupational health risk mitigation strategies for recruits. The study's British setting (Royal Marines) and population make the results relevant to UK defence and sports medicine guidance on vitamin D supplementation for injury prevention in young, intensively training populations.
Key measures
Serum 25-hydroxyvitamin D concentration (nmol/L) measured at weeks 1, 15, and 32; VDR FokI polymorphism genotype; stress fracture incidence and timing; adjusted odds ratios for fracture risk per 1 SD increase in 25OHD and by genotype group
Outcomes reported
The study measured serum 25-hydroxyvitamin D (25OHD) concentrations at weeks 1, 15, and 32 of Royal Marines training, and genotyped participants for the vitamin D receptor (VDR) FokI polymorphism to assess their association with stress fracture incidence. It reported the relationship between 25OHD status, VDR genotype, and stress fracture risk in 51 males who developed stress fractures and 141 uninjured controls.
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