Vitamin D and the Risk of Stress Fracture: A Systematic Review and Meta-Analysis of Case-Control and Cohort Studies
Bibliographic record
Abstract
Research Type: Level 1 - Randomized controlled trial (RCT), Meta-analysis of randomized trials with homogeneous results Introduction/Purpose: Background: A stress fracture is an overuse injury to the bone caused by repetitive, submaximal forces that gradually exceed the bone’s natural capacity for self-repair and several biological and mechanical risk factors influence its occurrence. Given the role of vitamin D in bone health, the potential relationship between this micronutrient and stress fractures is of great importance and warrants further investigation. Hypothesis/Purpose: This study aims to establish an association between lower vitamin D status and a higher risk of stress fractures Methods: This systematic review and meta-analysis was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Systematic search was performed without date restriction until June 2024. After the selection process, 7 studies (9 trials and 797 subjects) were included. Risk of bias assessment was performed by independent reviewers using the Newcastle-Ottawa Scale (NOS) (Wells et al., 2021). Mean and standard deviation results of the variables of interest were obtained from the included studies. I2 statistic was used to evaluate the heterogeneity of the studies included in the meta-analysis. The effect size (ES) Cohen’s or Hedges’ was calculated for all studies. The weighted mean of the ES was calculated based on the differences in sample sizes. The unweighted mean ES was also calculated and associated with a 95 % CI. The Cohen classification was used to assess the magnitude of the ES. Results: 8500 articles were identified through the database and references. After removing duplicates and excluding articles that did not meet eligibility criteria according to their titles, abstracts and full texts, 7 studies were selected for inclusion in the systematic review and meta-analysis A total of 7 studies (9 trials and 797 subjects) were included in the meta-analysis. Pooling data from 9 trials that evaluated the influence of serum vitamin D on stress fracture incidence, the meta-analysis revealed that subjects diagnosed with stress fractures had lower vitamin D levels, with a small effect size (-0.23; 95% CI: [-0.32, -0.13]; p = 0.01). The fixed-effects analysis showed no heterogeneity between the studies (I 2 = 0.00%, Q = 12.29, df = 8, p = 0.14) Conclusion: In summary, the results clearly show a correlation between a lower vitamin D status and a higher incidence of stress fractures. Thus, serum vitamin D should be evaluated when dealing with patients with a higher risk of presenting a stress fracture, since it may be an important measure in order to determine prevention and therapeutic approaches
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.057 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.039 |
| Bibliometrics | 0.008 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".