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维生素D与肌肉骨骼健康

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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
阳光照耀在一块骨头上。
维生素D被称为“阳光维生素”，对骨骼强度和肌肉功能至关重要。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

什么是维生素D

维生素D是一种营养素，您的身体用它来构建和维护骨骼。它也影响肌肉和肌腱在受伤或手术后的愈合。当您的维生素D水平偏低时，就称为维生素D缺乏。

维生素D水平低对有骨骼和关节问题的人很重要。研究发现，维生素D缺乏与前交叉韧带（运动中常见受伤的膝关节韧带）撕裂的发生率较高有关，也与该韧带重建失败有关 [1]。它还与应力性骨折有关，应力性骨折是骨骼因反复承受负荷而出现的细小裂纹 [2]。在简单跌倒后发生骨折（称为脆性骨折）的老年人，是维生素D对骨骼健康尤为重要的另一类人群 [3]。

维生素D也可能影响您术后的愈合情况。研究提示，它可能有助于肌腱愈合，尤其是在肩袖修复术后，但目前的研究有限，质量也一般 [4]。术前维生素D水平低与某些手部手术后伤口愈合较慢有关 [5]，也与肩关节置换术后的并发症有关 [6]。因此，医生可能会在某些手术前检查您的维生素D水平，如果发现缺乏，会进行治疗。

在您体内，维生素D帮助成骨细胞完成它们的工作。在针对骨折愈合的研究中，补充维生素D提高了骨折愈合过程中形成的新骨的强度 [7]。它似乎还会影响参与骨折愈合的免疫因子 [8]。

并非每一种关节手术都需要常规检测或补充。现有证据并不支持对所有接受肩袖修复 [9] 或膝关节置换 [10] 的人常规检测和补充维生素D。医生会与您讨论检查维生素D水平对您是否有意义。

它有效吗？

坦白地说，这取决于您希望维生素D起到什么作用。对于骨折，情况总体上是积极的。在针对骨折愈合的研究中，维生素D提高了骨折愈合过程中形成的新骨的强度 [7]。使用一种活性形式的维生素D3进行治疗，也促进了骨质疏松（骨骼变薄、变脆弱）患者的骨折愈合 [8]。而当患有骨质疏松的女性将维生素D与高强度间歇训练结合时，她们的骨密度改善程度大于单独采用其中任何一种 [11]。

但也有一些研究结果指向相反的方向。钙和维生素D联合补充剂改善了绝经后骨质疏松女性的骨盆骨密度，并纠正了她们偏低的维生素D水平 [12]。然而，同样的补充剂并没有减少这些女性实际发生骨折的次数 [12]。这一差距很重要。扫描上看起来更强壮的骨骼，并不总是意味着骨折更少。

对于关节置换，结果好坏参半。在膝关节置换手术当天给予单次大剂量维生素D3，与安慰剂相比，对早期恢复、并发症或活动能力都没有影响 [13]。一开始就缺乏维生素D的人需要中至高剂量的补充剂才能恢复水平，即便如此，也只有33.7%的人达到了健康水平 [14]。另一方面，保持充足的维生素D水平，可能会提高大腿骨上段骨折手术后的长期生存率 [15]。

对于肌腱愈合，现有证据并不支持对所有接受肩袖修复的人常规检测或补充 [9]。该手术前维生素D水平低与肌腱中更多的脂肪变性有关，但这不太可能改变修复本身的效果 [9]。

因此，维生素D对骨骼愈合和纠正真正的缺乏似乎是有用的。但它能否改善关节置换或肌腱手术后的恢复，则不太明确。医生可以帮助您决定，在您的情况下检查维生素D水平是否有意义。

风险有哪些？

大部分风险并不来自维生素D治疗本身。更大的担忧是维生素D水平偏低却未被发现时会发生什么。研究发现，维生素D缺乏与某些手术后的问题有关，包括某些手部手术后伤口愈合较慢 [5]，以及肩关节置换术后的并发症 [6]。维生素D缺乏在接受关节置换的人中也很常见，在冬季更为常见 [16]。这就是为什么医生可能会在某些手术前检查您的维生素D水平，而不是等问题出现后再处理。

即使偏低的维生素D水平得到治疗，也不能保证一定能恢复。在一开始就缺乏维生素D的膝关节置换患者中，中至高剂量的补充剂有帮助，但许多人仍未达到健康水平 [14]。在膝关节置换手术当天给予单次大剂量维生素D3，与安慰剂相比，对早期恢复或并发症没有影响 [13]。因此，补充得越多并不总是获益越多，医生会与您讨论对于您的手术，哪些检测和治疗是合理的。

研究所能说明的内容也确实存在局限。关于膝关节置换后补充维生素D的证据并不一致，也不足以证明应对所有人进行治疗 [10]。对于肩袖修复，研究提示维生素D可能有助于肌腱愈合，但研究质量一般，而且只涉及一组肌腱 [4]。此外，虽然该手术前维生素D水平低与肌腱中更多的脂肪性改变有关，但这不太可能改变修复本身的效果 [9]。

还有一点值得了解。钙和维生素D联合补充剂改善了绝经后骨质疏松女性的骨密度，但并没有减少这些女性实际发生骨折的次数 [12]。扫描结果看起来更好，并不总是意味着骨折更少。如果您正在考虑为骨骼健康服用补充剂，这一差距值得与医生讨论。

这适合您吗？

维生素D检测和治疗往往适合有明确理由进行检查的人。如果您术前的维生素D水平可能偏低，尤其是低于20 ng/mL，术前筛查可以指导治疗 [17]。它也可能有助于预防某些手部手术后伤口愈合较慢 [5]。患有膝关节磨损性关节炎且维生素D水平低的人，可能会有更广泛的关节疼痛，因此在这种情况下检查也是合理的 [18]。老年人和骨骼变薄、变脆弱的人，也是常常能从检查中获益的人群。

至于谁不会获益，则不太明确。现有证据并不支持对所有接受膝关节置换 [10] 或肩袖修复 [9] 的人进行检测和治疗。而且，即使偏低的维生素D水平得到治疗，也不能保证一定能恢复。在一开始就缺乏维生素D的膝关节置换患者中，中至高剂量的补充剂有帮助，但许多人仍未达到健康水平 [14]。

与不检测就直接服用补充剂相比，先检查意味着治疗能针对真正需要的人。不过，关于这种取舍的研究有限，合适的做法取决于您的手术和您的健康状况。

这是一个共同做出的决定。请与医生谈谈您的饮食、在户外的时间以及过去的任何骨折。你们可以一起决定在手术前进行血液检查是否有意义，以及如果结果显示维生素D水平偏低该怎么办。

核心要点

如果您的维生素D水平可能偏低，尤其是在某些手术之前，就值得考虑维生素D的问题。它对骨骼愈合和纠正真正的缺乏似乎是有用的，但能否改善关节置换或肌腱手术后的恢复则不太明确。最重要的一点是：即使偏低的维生素D水平得到治疗，也不能保证一定能恢复，因此请与医生讨论进行血液检查对您是否有意义。

参考文献

[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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