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Vitamina D e saúde musculoesquelética

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How vitamin D affects bone, muscle strength, falls, fracture and tendon healing, and surgical outcomes — including who benefits from supplementation.

Updated Oct 2026
Um sol brilhando sobre um osso.
A vitamina D, a “vitamina do sol”, é essencial para a força dos ossos e o funcionamento dos músculos. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que é

A vitamina D é um nutriente que o seu corpo usa para formar e manter os ossos. Ela também participa da forma como os músculos e os tendões cicatrizam após uma lesão ou uma cirurgia. Quando o seu nível de vitamina D está baixo, isso se chama deficiência de vitamina D.

A vitamina D baixa é importante para pessoas com problemas nos ossos e nas articulações. As pesquisas associam a deficiência a taxas maiores de ruptura do ligamento cruzado anterior, o ligamento do joelho que costuma ser lesionado no esporte, e à falha da reconstrução desse ligamento [1]. Ela também foi relacionada às fraturas por estresse, que são pequenas rachaduras no osso causadas por cargas repetidas [2]. Os adultos mais velhos que quebram um osso após uma simples queda, a chamada fratura por fragilidade, são outro grupo em que a vitamina D é importante para a saúde dos ossos [3].

A vitamina D também pode influenciar o quanto você cicatriza bem após a cirurgia. Os estudos sugerem que ela pode ajudar na cicatrização dos tendões, principalmente após o reparo do manguito rotador, embora as pesquisas até agora sejam limitadas e de qualidade modesta [4]. A vitamina D baixa antes da cirurgia foi associada a uma cicatrização mais lenta da ferida após algumas operações da mão [5] e a complicações após a prótese de ombro [6]. Por esse motivo, o seu médico pode verificar o seu nível de vitamina D antes de algumas operações e tratar uma deficiência, se ela for encontrada.

Dentro do seu corpo, a vitamina D ajuda as células que formam osso a fazer o seu trabalho. Em estudos sobre fraturas em consolidação, dar vitamina D melhorou a resistência do osso novo que se forma enquanto a fratura se consolida [7]. Ela também parece influenciar fatores imunológicos envolvidos na consolidação das fraturas [8].

Nem toda operação articular precisa de exames ou suplementos de rotina. As evidências não apoiam fazer o exame de vitamina D e dar suplementos de forma rotineira a todos os que vão fazer um reparo do manguito rotador [9] ou uma prótese de joelho [10]. O seu médico vai conversar com você sobre se faz sentido verificar o seu nível.

Funciona mesmo?

A resposta honesta é que depende do que você espera que a vitamina D faça. Para ossos quebrados, o quadro é bastante positivo. Em estudos sobre fraturas em consolidação, a vitamina D melhorou a resistência do osso novo que se forma enquanto a fratura se consolida [7]. O tratamento com uma forma ativa da vitamina D3 também favoreceu a consolidação das fraturas em pessoas com osteoporose, que é o osso que ficou fino e fraco [8]. E, quando mulheres com osteoporose combinaram a vitamina D com treino intervalado de alta intensidade, a densidade dos seus ossos melhorou mais do que com qualquer um dos dois sozinho [11].

Mas alguns resultados apontam na direção oposta. Os suplementos combinados de cálcio e vitamina D melhoraram a densidade óssea na pelve e corrigiram os níveis baixos de vitamina D em mulheres na pós-menopausa com osteoporose [12]. Mesmo assim, esses mesmos suplementos não diminuíram o número de fraturas que essas mulheres realmente tiveram [12]. Essa diferença é importante. Um osso que parece mais forte em um exame de imagem nem sempre significa menos fraturas.

Para a prótese articular, os resultados são mistos. Uma única dose alta de vitamina D3 dada no dia da cirurgia de prótese de joelho não fez diferença na recuperação inicial, nas complicações ou no quanto as pessoas se movimentavam bem, em comparação com um comprimido sem efeito (placebo) [13]. As pessoas que começaram com deficiência precisaram de suplementos em dose média a alta para recuperar os seus níveis e, mesmo assim, apenas 33,7% atingiram um nível saudável [14]. Por outro lado, manter os níveis de vitamina D adequados pode melhorar a sobrevida a longo prazo após a cirurgia de uma fratura na parte superior do fêmur (o osso da coxa) [15].

Para a cicatrização dos tendões, as evidências não apoiam exames ou suplementos de rotina para todos os que vão fazer um reparo do manguito rotador [9]. A vitamina D baixa antes dessa operação foi associada a mais degeneração gordurosa no tendão, mas é pouco provável que isso mude o resultado do próprio reparo [9].

Portanto, a vitamina D parece útil para a consolidação dos ossos e para corrigir uma deficiência real. É menos claro que ela melhore a recuperação de uma prótese articular ou de uma cirurgia de tendão. O seu médico pode ajudar você a decidir se faz sentido verificar o seu nível na sua situação.

Quais são os riscos?

A maior parte do risco não está no tratamento com vitamina D em si. A preocupação maior é o que acontece quando um nível baixo passa despercebido. As pesquisas associam a deficiência de vitamina D a problemas após algumas operações, incluindo uma cicatrização mais lenta da ferida após certas cirurgias da mão [5] e complicações após a prótese de ombro [6]. A deficiência também é comum em pessoas que vão fazer uma prótese articular, e ainda mais no inverno [16]. É por isso que o seu médico pode verificar o seu nível antes de algumas operações, em vez de esperar que um problema apareça.

Mesmo quando um nível baixo é tratado, não há garantia de que ele volte ao normal. Entre os pacientes de prótese de joelho que começaram com deficiência, os suplementos em dose média a alta ajudaram, mas muitos ainda não atingiram um nível saudável [14]. Uma única dose alta de vitamina D3 no dia da prótese de joelho não fez diferença na recuperação inicial nem nas complicações, em comparação com um comprimido sem efeito (placebo) [13]. Portanto, mais suplemento nem sempre significa mais benefício, e o seu médico vai conversar com você sobre quais exames e tratamentos fazem sentido para a sua operação.

As pesquisas também têm limites, e é honesto reconhecê-los. As evidências sobre suplementos após a prótese de joelho são inconsistentes e não são fortes o suficiente para justificar tratar todos os pacientes [10]. Para o reparo do manguito rotador, os estudos sugerem que a vitamina D pode ajudar na cicatrização do tendão, mas as pesquisas são de qualidade modesta e abrangem apenas um grupo de tendões [4]. E, embora a vitamina D baixa antes dessa operação tenha sido associada a mais alteração gordurosa no tendão, é pouco provável que isso mude o resultado do próprio reparo [9].

Mais um ponto que vale a pena conhecer. Os suplementos combinados de cálcio e vitamina D melhoraram a densidade óssea em mulheres na pós-menopausa com osteoporose, mas não diminuíram o número de fraturas que essas mulheres realmente tiveram [12]. Um exame de imagem com aparência melhor nem sempre significa menos fraturas. Se você está pensando em tomar suplementos para a saúde dos ossos, vale a pena conversar sobre essa diferença com o seu médico.

É a opção certa para você?

O exame e o tratamento da vitamina D costumam ser adequados para pessoas com um motivo claro para verificar o nível. Se o seu nível puder estar baixo antes da cirurgia, especialmente abaixo de 20 ng/mL, fazer o exame antes pode orientar o tratamento [17]. Isso também pode ajudar a evitar uma cicatrização mais lenta da ferida após algumas operações da mão [5]. Pessoas com artrose por desgaste no joelho e vitamina D baixa podem ter dor articular mais generalizada, por isso verificar o nível também faz sentido nesse caso [18]. Os adultos mais velhos e as pessoas com ossos finos e fracos são outros grupos que muitas vezes se beneficiam de uma verificação.

É menos claro quem não vai se beneficiar. As evidências não apoiam fazer o exame e tratar todos os que vão fazer uma prótese de joelho [10] ou um reparo do manguito rotador [9]. E, mesmo quando um nível baixo é tratado, não há garantia de que ele volte ao normal. Entre os pacientes de prótese de joelho que começaram com deficiência, os suplementos em dose média a alta ajudaram, mas muitos ainda não atingiram um nível saudável [14].

Em comparação com simplesmente tomar um suplemento sem fazer o exame, verificar primeiro significa que o tratamento é direcionado às pessoas que realmente precisam dele. Dito isso, as pesquisas sobre essa escolha são limitadas, e a abordagem certa depende da sua operação e da sua saúde.

Esta é uma decisão compartilhada. Converse com o seu médico sobre a sua alimentação, o tempo que você passa ao ar livre e qualquer fratura que você já tenha tido. Juntos, vocês podem decidir se um exame de sangue faz sentido antes da sua operação e o que fazer se o seu nível vier baixo.

Conclusão

Vale a pena pensar na vitamina D se o seu nível puder estar baixo, especialmente antes de certas operações. Ela parece útil para a consolidação dos ossos e para corrigir uma deficiência real, mas é menos claro que melhore a recuperação de uma prótese articular ou de uma cirurgia de tendão. A ressalva mais importante: mesmo quando um nível baixo é tratado, não há garantia de que ele volte ao normal, por isso converse com o seu médico sobre se um exame de sangue faz sentido para você.

Referências

[1] A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.011

[2] Vitamin D and the Risk of Stress Fractures in Athletes and Military Personnel: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261441254

[3] Forgetting the Frail: National Trends in Vitamin D Prescription After Fragility Fracture—A Large Insurance Claims Database Study. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00932

[4] The Role of Vitamin D in Postoperative Tendon Healing: A Scoping Review. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251371300

[5] The Effect of Serum Vitamin D Level on Wound Healing Process After Open Carpal Tunnel Release Surgery: Clinical Outcomes of 55 Cases. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00410

[6] Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.010

[7] Effect of 25‐OH‐vitamin D on fracture healing in elderly rats. Journal of Orthopaedic Research. 1998. DOI: 10.1002/jor.1100160604

[8] Determination of immune factor levels in serum and local hematoma samples of osteoporotic fracture patients and clinical study of the effect of active vitamin D3 treatment on immune factor levels. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03777-7

[9] Preoperative serum vitamin D deficiency is associated with increased rotator cuff fatty degeneration but is unlikely to influence post repair outcomes: a systematic review and meta-analysis of correlation coefficients. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.02.006

[10] Effect of Vitamin D Supplementation on Total Knee Arthroplasty Outcomes: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261432670

[11] Concurrent effects of high-intensity interval training and vitamin D supplementation on bone metabolism among women diagnosed with osteoporosis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08275-x

[12] The effects of combined calcium and vitamin D supplementation on bone mineral density and fracture risk in postmenopausal women with osteoporosis: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09089-7

[13] Vitamin D3 Supplementation Prior to Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.08.020

[14] Vitamin D Supplementation May Prevent or Treat Deficiency After Total Knee Arthroplasty: A Retrospective Cohort Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00005

[15] 25-Hydroxyvitamin D Levels, Free Serum Calcium, Glomerular Filtration Rate, Albumin, and Femoral Fracture Elderly Patient Mortality. JAAOS: Global Research and Reviews. 2026. DOI: 10.5435/jaaosglobal-d-25-00108

[16] Higher prevalence of vitamin D deficiency among arthroplasty patients presenting in winter. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06482-9

[17] Impact of Vitamin D Deficiency on Short- and Long-Term Mortality in Patients Receiving Hip Fracture Surgery Under General Anesthesia: A Matched Cohort Study. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.04.080

[18] Association between vitamin D deficiency, inflammatory markers, and knee osteoarthritis: a retrospective study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05805-0

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • A diagnosis of vitamin D deficiency is associated with increased rates of anterior cruciate ligament tears and reconstruction failure [2].
  • Vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels for stress fracture risk [3].
  • Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but awareness of the importance of vitamin D for bone health in older adults needs to be raised [4].
  • Vitamin D represents a potentially modifiable risk factor that could be optimized during both surgical and nonsurgical management of patients with Charcot arthropathy [5].
  • Regular vitamin D supplementation significantly reduces the likelihood of deficiency among arthroplasty patients presenting in winter [6].
  • Determining vitamin D levels preoperatively and providing supplementation if deficiency is present may be beneficial for preventing delayed wound healing after open carpal tunnel release surgery [7].
  • Evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, although studies remain low quality and limited to a single tendon group [8].
  • Targeted interventions are needed to optimize musculoskeletal and metabolic health in adolescents with vitamin D deficiency and adverse body composition [9].
  • Preoperative vitamin D screening and potential supplementation strategies are important for patients who have vitamin D levels below 20 ng/mL undergoing hip fracture surgery under general anesthesia [10].
  • Nonselective preoperative vitamin D supplementation appears to be more cost-effective than selective supplementation in arthroscopic rotator cuff repair, likely due to the lower cost of 25(OH)D supplementation compared to serum assays [11].
  • Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary total joint arthroplasty [12].
  • Orthopedic surgeons should recognize vitamin D deficiency as a potential modifiable risk factor for postoperative complications in total shoulder arthroplasty [14].
  • Current evidence is inconsistent and insufficient to support universal vitamin D supplementation for total knee arthroplasty outcomes [17].
  • Findings from a systematic review and meta-analysis do not justify routine testing and supplementation of vitamin D in patients undergoing rotator cuff repair [28].
  • Hand grip strength, vitamin D status, and diets might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts in 6–12 years old school children [29].

How It Works

Mechanisms of Action

  • BMP signaling plays a role in the induction of an osteoblastic phenotype in human dermal fibroblasts in response to vitamin D3 stimulation [30].
  • Retinoic acid and vitamin D are likely to be antagonists of thyroid hormone signaling in the growth plate [33].
  • With 1 a,25(OH)2D3 treatment, apoptosis was evident at higher concentrations only in human osteosarcoma cell lines [32].

Bone Healing and Fracture Outcomes

  • The administration of 25-OH-vitamin D after the production of the experimental fracture improved the mechanical strength of the callus in the healing bone in elderly rats [18].
  • Active vitamin D3 treatment promoted fracture healing by affecting the levels of immune factors in osteoporotic fracture patients [19].
  • There is a correlation between vitamin D status and radiographic fracture healing outcomes in distal humeral fractures [20].

Tendon and Soft Tissue Healing

  • Combining systemic and localized vitamin D delivery significantly enhanced tendon-to-bone healing, muscle regeneration, and biomechanical strength in a rabbit rotator cuff tear model compared to other treatment groups [21].
  • Evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, though studies remain low quality and limited to a single tendon group [8].
  • Lower preoperative serum vitamin D levels had a strong correlation with lower tissue vitamin D levels and lower serum vitamin D levels at 1 year after rotator cuff repair [25].

Immune and Metabolic Effects

  • Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels >50 ng/dl to optimally act as an immunomodulator in tuberculosis spondylitis patients [15].
  • Sixteen weeks of HIIT and vitamin D consumption showed greater benefits for BMD levels in women with osteoporosis than either vitamin D consumption or HIIT training alone [16].

Clinical Implications and Screening

  • Vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels regarding stress fracture risk [3].
  • Preoperative vitamin D screening and potential supplementation strategies are important for patients who have vitamin D levels below 20 ng/mL undergoing hip fracture surgery [10].

What the Evidence Shows

Fracture Healing and Bone Health

  • Administration of 25-OH-vitamin D after experimental fracture production improved the mechanical strength of the callus in healing bone [18].
  • Vitamin D status correlates with radiographic fracture healing outcomes in distal humeral fractures [20].
  • Sixteen weeks of high-intensity interval training and vitamin D consumption showed greater benefits for bone mineral density levels in women with osteoporosis than either vitamin D consumption or high-intensity interval training alone [16].
  • Combined calcium and vitamin D supplementation may improve pelvic bone mineral density and correct serum 25OHD deficiencies in postmenopausal women with osteoporosis [35].
  • Combined calcium and vitamin D supplementation does not reduce clinical fracture risk in postmenopausal women with osteoporosis [35].
  • Regular sling core stabilization training based on calcium and vitamin D supplementation can improve bone mineral density and prevent low back pain in a patient with primary osteoporosis over a 6-year period [37].
  • Vitamin D deficiency is associated with adverse body composition in adolescents [9].

Arthroplasty and Joint Surgery

  • Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after proximal femoral fracture surgery [34].
  • Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty [14].
  • Supplementation with 50,000 international units vitamin D3 on the day of surgery failed to demonstrate statistically significant differences in functional Knee Society Score, Timed Up and Go Test times, or complications in the early postoperative period compared to placebo in total knee arthroplasty [36].
  • Low-dose vitamin D supplementation was beneficial for vitamin D–sufficient total knee arthroplasty patients to achieve higher levels and maintain sufficiency [26].
  • Deficient total knee arthroplasty patients benefitted from medium-to-high dose vitamin D supplementation, though only 33.7% achieved repletion [26].
  • Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair [11].
  • Nonselective vitamin D supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays [11].

Tendon and Ligament Pathology

  • Lower preoperative serum vitamin D levels had a strong correlation with lower tissue vitamin D levels and lower serum vitamin D levels at 1 year after rotator cuff repair surgery [25].
  • Preoperative serum vitamin D deficiency is associated with increased rotator cuff fatty degeneration but is unlikely to influence post repair outcomes [28].
  • The findings of the systematic review and meta-analysis do not justify routine testing and supplementation of vitamin D in patients undergoing rotator cuff repair [28].
  • Further research is necessary to elucidate the direct role of vitamin D in the pathogenesis of rotator cuff tears and its impact on clinical outcomes after rotator cuff surgery and total shoulder arthroplasty [22].

Wound Healing and Infection

Other Musculoskeletal Conditions

  • Vitamin D deficiency is highly prevalent in knee osteoarthritis patients and its severity is associated with bilateral osteoarthritis and polyarthralgia but not with inflammatory markers [24].

General Supplementation and Screening

  • Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but there is a need to raise awareness about the importance of vitamin D for bone health, particularly in older adults [4].
  • More research is needed to determine the effect of vitamin D supplementation on bone health and injury risk in elite athletes [1].

Practical Considerations

Screening and Assessment

  • Vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels [3].
  • Preoperative vitamin D screening is important for patients who have vitamin D levels below 20 ng/mL [10].
  • Determining vitamin D levels preoperatively may be beneficial for preventing delayed wound healing after open carpal tunnel release surgery [7].
  • Vitamin D deficiency is highly prevalent in knee osteoarthritis patients [24].
  • The severity of vitamin D deficiency in knee osteoarthritis patients is associated with bilateral osteoarthritis and polyarthralgia [24].
  • The severity of vitamin D deficiency in knee osteoarthritis patients is not associated with inflammatory markers [24].
  • Among Americans over the age of 40, the increase in serum HDL-C is related to decreased bone mineral density of the spine only in women aged 40–59 years with vitamin D insufficiency or deficiency [31].

Supplementation Strategies

  • Regular vitamin D supplementation significantly reduces the likelihood of deficiency [6].
  • Nonselective vitamin D supplementation appears to be more cost-effective than selective supplementation in arthroscopic rotator cuff repair [11].
  • Nonselective vitamin D supplementation is likely more cost-effective than selective supplementation due to the lower cost of 25(OH)D supplementation compared to serum assays [11].
  • Deficient total knee arthroplasty patients benefited from medium-to-high dose vitamin D supplementation [26].
  • Only 33.7% of deficient total knee arthroplasty patients achieved repletion with medium-to-high dose vitamin D supplementation [26].

Clinical Implications and Gaps

  • There is a need to raise awareness about the importance of vitamin D for bone health, particularly in older adults [4].
  • Evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair [8].
  • Studies on the role of vitamin D in postoperative tendon healing remain low quality and limited to a single tendon group [8].
  • There is a need for targeted interventions to optimize musculoskeletal and metabolic health in adolescents with vitamin D deficiency and adverse body composition [9].

Key Evidence

  • [L1] More research is needed to determine the effect of vitamin D supplementation on bone health and injury risk in this population. [1] (10.1177/23259671231220371)
  • [L3] These results identify a population with increased odds of injury and provide valuable knowledge as we expand our understanding of the relationship between vitamin D and musculoskeletal health. [2] (10.1016/j.arthro.2023.04.011)
  • [L3] These findings suggest that vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels. [3] (10.1177/03635465261441254)
  • [L3] Educational initiatives and revised guidelines may have improved prescription rates, but there is a need to raise awareness about the importance of vitamin D for bone health, particularly in older adults. [4] (10.5435/jaaos-d-23-00932)
  • [L4] Vitamin D represents a potentially modifiable risk factor that could be optimized during both surgical and nonsurgical management of patients with Charcot arthropathy. [5] (10.5435/jaaosglobal-d-22-00162)
  • [L3] Regular vitamin D supplementation significantly reduces the likelihood of deficiency. [6] (10.1186/s13018-025-06482-9)
  • [L3] Determining vitamin D levels preoperatively and providing supplementation if deficiency is present may be beneficial for preventing delayed wound healing. [7] (10.5435/jaaos-d-25-00410)
  • [L4] Although evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, studies remain low quality and limited to a single tendon group. [8] (10.1177/23259671251371300)
  • [L3] These findings highlight the need for targeted interventions to optimize musculoskeletal and metabolic health during this developmental window. [9] (10.1186/s13018-025-06091-6)
  • [L2] These findings highlight the importance of preoperative vitamin D screening and potential supplementation strategies for patients who have vitamin D levels below 20 ng/mL. [10] (10.1016/j.arth.2025.04.080)
  • [L4] Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays. [11] (10.1016/j.jse.2023.05.007)
  • [L3] Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary TJA. [12] (10.1016/j.arth.2024.05.012)
  • [L3] Orthopedic surgeons should recognize vitamin D deficiency as a potential modifiable risk factor for postoperative complications in TSA. [14] (10.1016/j.jseint.2025.01.010)
  • [L1] Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels >50 ng/dl to optimally act as an immunomodulator. [15] (10.1186/s13018-023-04445-6)
  • [L1] Sixteen weeks of HIIT and vitamin D consumption showed greater benefits for BMD levels in women with osteoporosis than either vitamin D consumption or HIIT training alone. [16] (10.1186/s12891-025-08275-x)
  • [L2] However, current evidence is inconsistent and insufficient to support universal supplementation. [17] (10.1177/23259671261432670)
  • [L5] The administration of 25-OH-vitamin D after the production of the experimental fracture improved the mechanical strength of the callus in the healing bone. [18] (10.1002/jor.1100160604)
  • [L2] Active vitamin D3 treatment promoted fracture healing by affecting the levels of these immune factors. [19] (10.1186/s13018-023-03777-7)
  • [L4] These findings suggest a correlation between vitamin D status and radiographic fracture healing outcomes. [20] (10.1016/j.injury.2024.111671)
  • [L5] Combining systemic and localized vitamin D delivery significantly enhanced tendon-to-bone healing, muscle regeneration, and biomechanical strength in a rabbit rotator cuff tear model compared to other treatment groups. [21] (10.1016/j.jse.2025.12.003)
  • [L4] Further research is necessary to elucidate the direct role of vitamin D in the pathogenesis of rotator cuff tears and its impact on clinical outcomes after rotator cuff surgery and total shoulder arthroplasty. [22] (10.5397/cise.2024.00220)
  • [L4] Vitamin D deficiency is highly prevalent in knee OA patients and its severity is associated with bilateral OA and polyarthralgia but not with inflammatory markers. [24] (10.1186/s13018-025-05805-0)
  • [L4] Lower preoperative serum vitamin D levels had a strong correlation with lower tissue vitamin D levels and lower serum vitamin D levels at 1 year after surgery. [25] (10.1177/03635465221145711)
  • [L3] Low-dose vitamin D supplementation was beneficial for vitamin D–sufficient TKA patients to achieve higher levels and maintain sufficiency, while deficient patients benefitted from medium-to-high dose supplementation, though only 33.7% achieved repletion. [26] (10.5435/jaaos-d-24-00005)
  • [L1] This study's findings do not justify routine testing and supplementation of vitamin D in patients undergoing RCR. [28] (10.1016/j.xrrt.2025.02.006)
  • [L4] These parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts. [29] (10.1186/s12891-023-06960-3)
  • [Paper] These results suggest that BMP signaling plays a role in the induction of an osteoblastic phenotype in human dermal fibroblasts in response to vitamin D3 stimulation. [30] (10.1002/jor.20728)
  • [L4] Among Americans over the age of 40, the increase in serum HDL-C is related to decreased BMD of spine only in women aged 40–59 years with vitamin D insufficiency or deficiency. [31] (10.1186/s13018-022-03491-w)
  • [L5] With 1 a,25(OH)2D3 treatment, apoptosis was evident at higher concentrations only. [32] (10.1002/jor.21585)
  • [Paper] We conclude that retinoic acid and vitamin D are likely to be antagonists of thyroid hormone signaling in the growth plate. [33] (10.1016/s0736-0266(00)00024-3)
  • [L2] Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after PFF surgery. [34] (10.5435/jaaosglobal-d-25-00108)
  • [L1] Combined calcium and vitamin D supplementation may improve pelvic BMD and correct serum 25OHD deficiencies in postmenopausal women with osteoporosis, but does not reduce clinical fracture risk in postmenopausal women with osteoporosis. [35] (10.1186/s12891-025-09089-7)
  • [L1] Supplementation with 50,000 international units vitamin D3 on the day of surgery failed to demonstrate statistical significant differences in functional KSS, TUGT times, or complications in the early postoperative period compared to placebo. [36] (10.1016/j.arth.2022.08.020)
  • [L4] Regular sling core stabilization training based on calcium and vitamin D supplementation can improve bone mineral density and prevent low back pain in a patient with primary osteoporosis over a 6-year period. [37] (10.1186/s12891-023-06896-8)

References

[1] Effects of Vitamin D Supplementation in Elite Athletes: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671231220371

[2] A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.011

[3] Vitamin D and the Risk of Stress Fractures in Athletes and Military Personnel: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261441254

[4] Forgetting the Frail: National Trends in Vitamin D Prescription After Fragility Fracture—A Large Insurance Claims Database Study. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00932

[5] Prevalence of Vitamin D Deficiency in Patients With Charcot Arthropathy: A Single-Center Analysis. JAAOS: Global Research and Reviews. 2022. DOI: 10.5435/jaaosglobal-d-22-00162

[6] Higher prevalence of vitamin D deficiency among arthroplasty patients presenting in winter. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06482-9

[7] The Effect of Serum Vitamin D Level on Wound Healing Process After Open Carpal Tunnel Release Surgery: Clinical Outcomes of 55 Cases. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00410

[8] The Role of Vitamin D in Postoperative Tendon Healing: A Scoping Review. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251371300

[9] Vitamin D deficiency and adverse body composition in adolescents. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06091-6

[10] Impact of Vitamin D Deficiency on Short- and Long-Term Mortality in Patients Receiving Hip Fracture Surgery Under General Anesthesia: A Matched Cohort Study. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.04.080

[11] Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.05.007

[12] Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications After Primary Total Joint Arthroplasty. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.05.012

[14] Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.010

[15] Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04445-6

[16] Concurrent effects of high-intensity interval training and vitamin D supplementation on bone metabolism among women diagnosed with osteoporosis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08275-x

[17] Effect of Vitamin D Supplementation on Total Knee Arthroplasty Outcomes: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261432670

[18] Effect of 25‐OH‐vitamin D on fracture healing in elderly rats. Journal of Orthopaedic Research. 1998. DOI: 10.1002/jor.1100160604

[19] Determination of immune factor levels in serum and local hematoma samples of osteoporotic fracture patients and clinical study of the effect of active vitamin D3 treatment on immune factor levels. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03777-7

[20] Vitamin D status in healing of distal humeral fractures: Clinical observations. Injury. 2024. DOI: 10.1016/j.injury.2024.111671

[21] Localized vitamin D delivery via 3D-printed nanofiber sheets combined with systemic supplementation enhances tendon-to-bone healing in a rabbit rotator cuff tear model: a preclinical study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.003

[22] The role of vitamin D in shoulder health: a comprehensive review of its impact on rotator cuff tears and surgical results. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2024.00220

[24] Association between vitamin D deficiency, inflammatory markers, and knee osteoarthritis: a retrospective study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05805-0

[25] Serum Vitamin D Level Correlations With Tissue Vitamin D Level and Muscle Performance Before and After Rotator Cuff Repair. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465221145711

[26] Vitamin D Supplementation May Prevent or Treat Deficiency After Total Knee Arthroplasty: A Retrospective Cohort Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00005

[28] Preoperative serum vitamin D deficiency is associated with increased rotator cuff fatty degeneration but is unlikely to influence post repair outcomes: a systematic review and meta-analysis of correlation coefficients. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.02.006

[29] Hand grip strength, vitamin D status, and diets as predictors of bone health in 6–12 years old school children. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06960-3

[30] Endogenous bone morphogenetic proteins mediate 1α, 25‐dihydroxyvitamin D3‐induced expression of osteoblast differentiation markers in human dermal fibroblasts. Journal of Orthopaedic Research. 2008. DOI: 10.1002/jor.20728

[31] Effects of vitamin D deficiency on blood lipids and bone metabolism: a large cross-sectional study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03491-w

[32] Effect of 25‐hydroxyvitamin D3 and 1 α,25 dihydroxyvitamin D3 on differentiation and apoptosis of human osteosarcoma cell lines. Journal of Orthopaedic Research. 2011. DOI: 10.1002/jor.21585

[33] Both retinoic acid and 1,25(OH)2 vitamin D3 inhibit thyroid hormone‐induced terminal differentiaton of growth plate chondrocytes. Journal of Orthopaedic Research. 2001. DOI: 10.1016/s0736-0266(00)00024-3

[34] 25-Hydroxyvitamin D Levels, Free Serum Calcium, Glomerular Filtration Rate, Albumin, and Femoral Fracture Elderly Patient Mortality. JAAOS: Global Research and Reviews. 2026. DOI: 10.5435/jaaosglobal-d-25-00108

[35] The effects of combined calcium and vitamin D supplementation on bone mineral density and fracture risk in postmenopausal women with osteoporosis: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09089-7

[36] Vitamin D3 Supplementation Prior to Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.08.020

[37] Regular sling core stabilization training improves bone density based on calcium and vitamin D supplementation. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06896-8

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