Vitamin D and Musculoskeletal Health Info Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
What you're feeling
You might notice that your body feels different when your vitamin D levels are low. This nutrient helps keep your bones and muscles strong. Without enough of it, you may feel more tired than usual. Your muscles might feel weaker or ache more easily. You could also find that your bones feel more fragile. This is especially true if you are an athlete or serve in the military. These groups are at higher risk for stress fractures, which are small cracks in the bone.
If you have had a knee injury, low vitamin D can make things harder. It is linked to a higher chance of tearing the ligament in the front of your knee. It can also make it harder for that ligament to heal if you need surgery. You might feel instability or pain when you move your knee. This is because vitamin D plays a role in how well your body repairs itself after an injury.
For older adults, awareness of vitamin D is key. You might have a fragility fracture, which is a break from a minor fall. Your surgeon will check your levels to guide your care. If you are having hip fracture surgery, low levels below 20 ng/mL are common. Your surgeon may recommend supplements before your operation to help you heal better. This is a simple step that can make a big difference in your recovery.
If you are having shoulder surgery, such as a rotator cuff repair, vitamin D matters too. It may help your tendon heal, though the evidence is still growing. Some studies show that checking your levels and taking supplements is worth the cost. It helps ensure your body has what it needs to repair the torn tendon.
For children and teens, vitamin D affects more than just bones. Low levels are linked to less healthy body composition. You might notice changes in strength or growth. Hand grip strength and diet are also signs of bone health in young people. Keeping your vitamin D levels up supports their overall musculoskeletal health. This helps them stay active and strong as they grow.
What's actually happening
Vitamin D is essential for keeping your bones strong and your muscles working well. Think of it as the key that helps your body absorb calcium. Without enough of this key, your bones can become brittle and prone to breaking. This is especially true for older adults and those who have suffered a fragility fracture. Your surgeon may check your levels before major surgeries, like hip fracture repair, to ensure your body has the resources it needs to heal properly.
Low vitamin D levels are linked to a higher risk of serious injuries. For example, having a deficiency increases your chances of tearing the anterior cruciate ligament in your knee or having reconstruction surgery fail. It also raises the risk of stress fractures, which are tiny cracks in the bone caused by repeated stress. This is why your surgeon might assess your vitamin D status if you are an athlete or in a high-risk group like the military. Regular supplementation can significantly reduce the likelihood of becoming deficient, helping to protect your joints and bones from these preventable injuries.
Vitamin D also plays a role in how your tendons heal. Tendons are the tough, rope-like bands that connect your muscles to your bones. While evidence is limited, vitamin D may support healing after procedures like rotator cuff repair in the shoulder. It is also important for overall body composition and metabolic health, particularly in adolescents. In children, factors like hand grip strength and diet, along with vitamin D levels, help predict bone health. Ensuring you have adequate vitamin D supports not just your bones, but your entire musculoskeletal system, helping you stay active and resilient.
What to expect
Your outlook depends largely on your vitamin D levels and your specific health situation. If you have a deficiency, you may face higher risks for certain injuries. For example, a lack of vitamin D is linked to a greater chance of tearing the anterior cruciate ligament in your knee or having reconstruction surgery fail. It is also associated with adverse changes in body composition for teenagers.
For adults undergoing joint replacement or hip fracture surgery, your surgeon may check your vitamin D levels before your procedure. This is especially important if you are having surgery in the winter, as deficiency is more common during these months. If your levels are low, your surgeon might recommend supplements. Regular supplementation significantly reduces the likelihood of staying deficient. This simple step can help optimize your bone health and metabolic status before and after your care.
You might wonder if supplements help with tendon healing, such as in rotator cuff repairs. The evidence here is limited and of low quality. While vitamin D may support healing, we cannot promise specific outcomes based on current data. However, for arthroscopic rotator cuff repair, providing vitamin D is considered a cost-effective step. It is often more practical and affordable to provide it to everyone rather than testing everyone’s blood levels first.
For children and adolescents, vitamin D status is a key predictor of bone health alongside hand grip strength and diet. If you are a parent, targeted interventions can help optimize your child’s musculoskeletal and metabolic health. Awareness remains crucial for older adults as well. Even with improved guidelines, many still need reminders about the importance of maintaining healthy vitamin D levels to prevent fragility fractures and support long-term bone strength.
Evidence & references
Overview
- Vitamin D supplementation effects on bone health and injury risk in elite athletes require further research [1].
- A diagnosis of vitamin D deficiency is associated with increased odds of anterior cruciate ligament tears and reconstruction failure [2].
- Vitamin D status should be assessed in high-risk populations, such as athletes and military personnel, to guide preventive strategies for stress fractures [3].
- Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but awareness remains needed for older adults [4].
- Vitamin D deficiency prevalence is higher among arthroplasty patients presenting in winter [5].
- Regular vitamin D supplementation significantly reduces the likelihood of deficiency in arthroplasty patients [5].
- Evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, but studies are low quality and limited to a single tendon group [6].
- Vitamin D deficiency is associated with adverse body composition in adolescents [7].
- Targeted interventions are needed to optimize musculoskeletal and metabolic health in adolescents regarding vitamin D status [7].
- Preoperative vitamin D screening and potential supplementation strategies are important for patients receiving hip fracture surgery under general anesthesia who have vitamin D levels below 20 ng/mL [8].
- Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair [9].
- Nonselective vitamin D supplementation appears more cost-effective than selective supplementation in arthroscopic rotator cuff repair due to lower costs compared to serum assays [9].
- Hand grip strength, vitamin D status, and diets are predictors of bone health in 6–12 year old school children [23].
- Hand grip strength, vitamin D status, and diets might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts [23].
How It Works
- Vitamin D supplementation effects on bone health and injury risk in elite athletes require further research [1].
- Vitamin D deficiency is associated with increased odds of anterior cruciate ligament tears and reconstruction failure [2].
- Vitamin D status assessment in high-risk populations (athletes and military personnel) guides preventive strategies for stress fractures [3].
- Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but awareness remains needed for older adults [4].
- Regular vitamin D supplementation significantly reduces the likelihood of deficiency in arthroplasty patients presenting in winter [5].
- Vitamin D may support tendon healing, particularly in rotator cuff repair, though evidence is low quality and limited to a single tendon group [6].
- Vitamin D deficiency is associated with adverse body composition in adolescents, highlighting the need for targeted interventions during development [7].
- Preoperative vitamin D screening and potential supplementation are important for patients receiving hip fracture surgery under general anesthesia with levels below 20 ng/mL [8].
- Nonselective preoperative vitamin D supplementation is more cost-effective than selective supplementation in arthroscopic rotator cuff repair due to lower costs compared to serum assays [9].
- Determining preoperative vitamin D levels and providing supplementation if deficient may be beneficial for preventing delayed wound healing after open carpal tunnel release surgery [10].
- Administering an oral 300,000 U single-dose vitamin D regimen to correct deficiency can positively impact outcomes following primary total joint arthroplasty [11].
- Further research is necessary to elucidate the direct role of vitamin D in rotator cuff tear pathogenesis and its impact on clinical outcomes after rotator cuff surgery and total shoulder arthroplasty [12].
- A nanofiber-based vitamin D sheet was compared to vitamin D supplementation for tendon-to-bone healing and muscle regeneration in a rabbit rotator cuff tear model [13].
- 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 [14].
- Active vitamin D3 treatment promoted fracture healing by affecting immune factor levels in osteoporotic fracture patients [17].
- Combining systemic and localized vitamin D delivery via 3D-printed nanofiber sheets significantly enhanced tendon-to-bone healing, muscle regeneration, and biomechanical strength in a rabbit rotator cuff tear model compared to other treatment groups [19].
What the Evidence Shows
- Vitamin D supplementation effects on bone health and injury risk in elite athletes require further research [1].
- A diagnosis of vitamin D deficiency is associated with increased odds of anterior cruciate ligament tears and reconstruction failure [2].
- Vitamin D status should be assessed in high-risk populations, such as athletes and military personnel, to guide preventive strategies for stress fractures [3].
- Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but awareness remains low in older adults [4].
- Vitamin D deficiency is more prevalent among arthroplasty patients presenting in winter [5].
- Regular vitamin D supplementation significantly reduces the likelihood of vitamin D deficiency [5].
- Vitamin D deficiency is associated with adverse body composition in adolescents [7].
- Targeted interventions are needed to optimize musculoskeletal and metabolic health in adolescents regarding vitamin D status [7].
- Preoperative vitamin D screening and potential supplementation are important for patients with vitamin D levels below 20 ng/mL undergoing hip fracture surgery under general anesthesia [8].
- Vitamin D deficiency is associated with increased short- and long-term mortality in patients receiving hip fracture surgery under general anesthesia [8].
- Nonselective preoperative vitamin D supplementation is more cost-effective than selective supplementation in arthroscopic rotator cuff repair, likely due to lower costs compared to serum assays [9].
- Determining preoperative vitamin D levels and providing supplementation if deficiency is present may be beneficial for preventing delayed wound healing after open carpal tunnel release surgery [10].
- Administering an oral 300,000 U single-dose vitamin D regimen to correct deficiency can positively impact outcomes following primary total joint arthroplasty [11].
- Vitamin D deficiency is associated with increased risk of periprosthetic joint infection and complications after primary total joint arthroplasty [11].
- 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 [12].
- Vitamin D may support tendon healing, particularly in rotator cuff repair, but current studies are low quality and limited to a single tendon group [6].
- Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels to >50 ng/dl to optimally act as an immunomodulator in tuberculosis spondylitis patients [14].
- 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 intervention alone [15].
- Low-dose vitamin D supplementation was beneficial for vitamin D–sufficient total knee arthroplasty patients to achieve higher levels and maintain sufficiency [16].
- Deficient total knee arthroplasty patients benefited from medium-to-high dose vitamin D supplementation, though only 33.7% achieved repletion [16].
- Perioperative vitamin D supplementation may enhance early recovery and lower complication rates after total knee arthroplasty [20].
- 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 [21].
- 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 [22].
Practical Considerations
- Vitamin D supplementation effects on bone health and injury risk in elite athletes require further research [1].
- A diagnosis of vitamin D deficiency is associated with increased odds of anterior cruciate ligament tears and reconstruction failure [2].
- Vitamin D status should be assessed in high-risk populations, such as athletes and military personnel, to guide preventive strategies for stress fractures [3].
- Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fracture, but awareness remains a need, particularly in older adults [4].
- Regular vitamin D supplementation significantly reduces the likelihood of vitamin D deficiency in arthroplasty patients presenting in winter [5].
- Evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, but studies remain low quality and limited to a single tendon group [6].
- Vitamin D deficiency is associated with adverse body composition in adolescents, highlighting the need for targeted interventions to optimize musculoskeletal and metabolic health during this developmental window [7].
- Preoperative vitamin D screening and potential supplementation strategies are important for patients receiving hip fracture surgery under general anesthesia who have vitamin D levels below 20 ng/mL [8].
- 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 [9].
- 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 [10].
- 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 [11].
- 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 intervention alone [15].
- Low-dose vitamin D supplementation was beneficial for vitamin D–sufficient total knee arthroplasty patients to achieve higher levels and maintain sufficiency, while deficient patients benefitted from medium-to-high dose supplementation [16].
- Only 33.7% of vitamin D–deficient total knee arthroplasty patients achieved repletion with medium-to-high dose supplementation [16].
- Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty, including increased rates of readmission and periprosthetic fractures [18].
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)
- [L3] Regular vitamin D supplementation significantly reduces the likelihood of deficiency. [5] (10.1186/s13018-025-06482-9)
- [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. [6] (10.1177/23259671251371300)
- [L3] These findings highlight the need for targeted interventions to optimize musculoskeletal and metabolic health during this developmental window. [7] (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. [8] (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. [9] (10.1016/j.jse.2023.05.007)
- [L3] Determining vitamin D levels preoperatively and providing supplementation if deficiency is present may be beneficial for preventing delayed wound healing. [10] (10.5435/jaaos-d-25-00410)
- [L3] Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary TJA. [11] (10.1016/j.arth.2024.05.012)
- [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. [12] (10.5397/cise.2024.00220)
- [L5] The study aimed to compare the efficacy of a nanofiber-based vitamin D sheet versus vitamin D supplementation on tendon-to-bone healing and muscle regeneration in a rabbit model, though specific conclusion statements were not fully provided in the text. [13] (10.1016/j.jse.2023.02.077)
- [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. [14] (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. [15] (10.1186/s12891-025-08275-x)
- [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. [16] (10.5435/jaaos-d-24-00005)
- [L2] Active vitamin D3 treatment promoted fracture healing by affecting the levels of these immune factors. [17] (10.1186/s13018-023-03777-7)
- [L3] The observed association between vitamin D deficiency and increased rates of readmission and periprosthetic fractures suggests that addressing vitamin D levels may be linked to reduced future healthcare utilization. [18] (10.1016/j.jseint.2025.01.010)
- [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. [19] (10.1016/j.jse.2025.12.003)
- [L2] Our study demonstrated that perioperative vitamin D supplementation may enhance early recovery and lower complication rates after TKA. [20] (10.1177/23259671261432670)
- [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. [21] (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. [22] (10.1186/s12891-023-06896-8)
- [L4] These parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts. [23] (10.1186/s12891-023-06960-3)
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] 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 [6] The Role of Vitamin D in Postoperative Tendon Healing: A Scoping Review. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251371300 [7] Vitamin D deficiency and adverse body composition in adolescents. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06091-6 [8] 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 [9] 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 [10] 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 [11] 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 [12] 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 [13] The Effect Of Nanofiber-Based Vitamin D Sheet For Tendon-To-Bone Healing And Muscle Regeneration In A Rabbit Rotator Cuff Tear Model. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.077 [14] 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 [15] 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 [16] 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 [17] 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 [18] Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.010 [19] 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 [20] Effect of Vitamin D Supplementation on Total Knee Arthroplasty Outcomes: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261432670 [21] 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 [22] 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 [23] 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
