Summary
This gene-environment interaction study of 192 Royal Marines recruits (51 stress fracture cases, 141 controls) demonstrates that stress fracture risk during intensive military training is jointly determined by serum vitamin D status and VDR FokI genotype. Recruits with lower 25OHD at week 15 and carrying the f-allele had elevated fracture risk, whilst FF genotype individuals showed greater protective benefit from improved vitamin D status. The findings provide evidence for prophylactic vitamin D supplementation as an injury risk mitigation strategy in high-demand training contexts.
UK applicability
These findings are directly applicable to UK military training and occupational health policy, as the study was conducted on Royal Marines recruits. The results suggest that routine vitamin D status assessment and targeted supplementation protocols could reduce stress fracture incidence in military populations and potentially in other high-intensity training cohorts in the United Kingdom.
Key measures
Serum 25OHD concentration (nmol/L) at baseline, week 15, and week 32; VDR FokI polymorphism genotype (FF vs. f-allele carriers); stress fracture incidence (yes/no); adjusted odds ratios per 1SD increase in 25OHD
Outcomes reported
The study measured serum 25-hydroxyvitamin D (25OHD) concentration at weeks 1, 15, and 32 of Royal Marines training, genotyped participants for the VDR FokI polymorphism, and determined associations between these factors and stress fracture incidence. Stress fracture risk was evaluated as a function of vitamin D status trajectory and genetic variation.
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