Pre-season Vitamin D and Iron Levels as a Predictor of Musculoskeletal Injury in Division I Athletes

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Veach, Mariellen Katherine
Injury; Musculoskeletal; Prediction; Vitamin D; Musculoskeletal, Neural, and Ocular Physiology
thesis / dissertation description
Context: Pre-season testing that includes the analysis of micronutrient serum levels in the blood has become a routine part of pre-participation examinations in collegiate football. Objective: Assess the predictability of vitamin D and iron serum levels as indicators of future injury during a subsequent competitive season for lower extremity sprains, strains, and fractures. Additionally, determine the effectiveness of vitamin D supplementation on increasing serum 25(OH)D levels and preventing injury. Design: Cohort Study. Setting: National Collegiate Athletic Association Division I football program. Participants: Football athletes (n=349) who underwent pre-participation examinations and participated in at least one of three competitive football seasons. Main Outcome Measure(s): Vitamin D and Iron serum levels collected during pre-season testing and injury occurrence of the lower extremity or core was analyzed to determine if a predictive association existed. A vitamin D serum level cut-point for high-risk or low-risk athletes was established using a receiver operator characteristic analysis (ROC) for various injury associations including all injuries, fractures, and muscle strains. Cross-tabulation analysis produced sensitivity, specificity, positive and negative likelihood ratios, and odds ratios for each cut-point. Backwards stepwise logistic regression was used to determine the best combination of injury risk factors. Individuals supplemented with vitamin D were analyzed using a paired-samples T-Test to determine if supplementation procedures were effective. Results: Muscular injuries were significantly predicted by low vitamin D levels (<23.15 ng/mL; OR=3.042; 90% CI [1.426, 6.486], p=0.019) high game exposure (OR=2.636; 90% CI [1.208, 5.753], p=0.036), previous injury (OR=3.390; 90% CI [1.546,7.431], p=0.010). Based on a three-factor prediction model, athletes with two or more risk factors were at an increased risk of injury with an odds ratio of 6.000 (90% CI [2.639, 13.642], p=0.001). Vitamin D supplementation increased mean pre-season levels by 32.206 15.52 (p<.001). Conclusion: Use of a model with multiple risk factors can help identify athletes who are at risk for injury based on both intrinsic and extrinsic factors. The modifiable factor of vitamin D status may help athletic trainers to decrease injury risk in those with low serum 25(OH)D levels through a short-term supplementation program.