Vitamina D e saúde musculoesquelética Folheto

O que é

A vitamina D é um nutriente que o seu corpo produz quando a pele fica exposta à luz do sol. Ela também vem de alguns alimentos e de suplementos. Os seus ossos precisam dela para se manterem fortes, e os seus músculos e tendões também a utilizam.

Se o seu nível de vitamina D estiver baixo, isso pode afetar os seus ossos e a sua recuperação de uma lesão ou cirurgia. Pesquisas associam a vitamina D baixa a mais rupturas do ligamento do joelho chamado ligamento cruzado anterior e a uma chance maior de falha da reconstrução desse ligamento [1]. Níveis baixos também foram associados a fraturas por estresse em pessoas de alto risco, e é por isso que se sugere verificar a vitamina D nesses grupos [2]. Em pessoas com artrose do joelho (a artrite por desgaste), a vitamina D baixa é comum, e níveis mais baixos estão associados a artrose nos dois joelhos e a dores em várias articulações ao mesmo tempo [3].

Acredita-se que a vitamina D funcione como o estoque de materiais de um construtor. O seu corpo recorre a ela para manter os ossos e ajudar os tecidos a cicatrizar. Estudos sugerem que ela pode favorecer a cicatrização dos tendões, especialmente após o reparo do manguito rotador, embora essa pesquisa seja limitada e de qualidade modesta [4]. Em estudos de laboratório com coelhos, combinar vitamina D administrada pela corrente sanguínea com vitamina D aplicada no local do reparo melhorou a cicatrização do tendão ao osso, a regeneração muscular e a resistência do reparo [5].

Nem todos os resultados apontam na mesma direção. Uma revisão constatou que a vitamina D baixa antes da cirurgia está associada a alteração gordurosa no músculo do manguito rotador, mas isso não justificou fazer o exame de rotina em todas as pessoas submetidas ao reparo do manguito rotador [6]. As evidências sobre suplementos de vitamina D após a prótese de joelho também são contraditórias e não são fortes o suficiente para justificar sua administração a todos os pacientes [7]. O seu médico pode verificar o seu nível se você fizer parte de um grupo de maior risco e tratar uma deficiência, caso seja encontrada.

Funciona mesmo?

A resposta honesta é que a vitamina D é importante para a saúde dos ossos, mas as evidências de que os suplementos melhoram os resultados da cirurgia são contraditórias.

Alguns resultados são consistentes. A vitamina D baixa é comum em pessoas com artrose do joelho, e níveis mais baixos estão associados a artrose nos dois joelhos e a dores em várias articulações ao mesmo tempo [3]. A vitamina D baixa antes de uma prótese de ombro está associada a mais problemas clínicos depois da cirurgia [8]. Manter o seu nível de vitamina D adequado também pode melhorar as suas chances de viver mais tempo após a cirurgia de fratura do quadril [9].

Outros resultados são menos claros. Uma grande revisão de ensaios clínicos constatou que suplementos de cálcio e vitamina D, tomados juntos, não reduziram a chance de fratura em mulheres com osteoporose após a menopausa, embora os suplementos tenham melhorado os resultados do exame de densidade óssea [10]. Em pacientes submetidos a prótese de joelho, uma única dose alta de vitamina D administrada no dia da cirurgia não fez diferença na recuperação inicial nem nas complicações em comparação com um comprimido sem efeito (placebo) [11]. Para o reparo do manguito rotador, uma revisão concluiu que o exame e os suplementos de rotina não se justificam para todas as pessoas submetidas a essa operação [6].

A própria pesquisa tem limitações. Os estudos sobre vitamina D e cicatrização dos tendões após a cirurgia são poucos e de qualidade modesta [4]. Alguns trabalhos envolvem uma única articulação ou grupos pequenos, portanto os resultados podem não se aplicar a todos.

O que isso significa para você é simples. Vale a pena ter a vitamina D em um nível saudável, especialmente antes de uma cirurgia, porque níveis baixos estão associados a resultados piores em diversas situações. Mas tomar vitamina D extra quando o nível já está saudável não demonstrou acelerar a recuperação nem prevenir complicações. O seu médico pode verificar o seu nível se você fizer parte de um grupo de maior risco e tratar uma deficiência, caso seja encontrada.

Quais são os riscos?

O principal risco aqui não é a vitamina D em si. É o risco de ter um nível baixo sem saber. A vitamina D baixa antes da cirurgia está associada a mais problemas clínicos depois de uma prótese de ombro [8]. Também é um fator de risco que pode ser modificado: um estudo com pessoas com artropatia de Charcot, uma doença das articulações do pé ligada a lesões nos nervos, sugeriu corrigir a vitamina D baixa como parte do tratamento tanto cirúrgico quanto não cirúrgico [12].

Há alguns limites reais ao que os suplementos conseguem fazer. Uma única dose alta de vitamina D no dia da prótese de joelho não fez diferença na recuperação inicial em comparação com um comprimido sem efeito (placebo) [11]. Mesmo quando pessoas com níveis baixos tomam suplementos em doses médias a altas, apenas 33,7% conseguiram normalizar o nível [13]. Portanto, tratar uma deficiência leva tempo e nem sempre funciona com um único ciclo de tratamento.

As evidências sobre alguns pontos são de fato escassas. Os estudos sobre vitamina D e cicatrização dos tendões após a cirurgia são poucos e de qualidade modesta [4]. Uma revisão constatou que a vitamina D baixa antes da cirurgia está associada a alteração gordurosa no músculo do manguito rotador, mas não justificou o exame de rotina para todas as pessoas submetidas a essa operação [6]. Os pesquisadores ainda estão investigando se corrigir um nível baixo melhora os resultados após a reconstrução do ligamento do joelho [14].

Se o seu médico achar que você tem risco maior, ele pode verificar o seu nível antes da cirurgia. Isso é sugerido para pessoas com níveis abaixo de 20 ng/mL que farão cirurgia de fratura do quadril [15], e níveis baixos são mais comuns em pacientes de prótese articular atendidos no inverno [16]. Se uma deficiência for encontrada, tratá-la antes da cirurgia pode ajudar a prevenir o atraso na cicatrização da ferida após algumas operações da mão [17].

É a opção certa para você?

Não existe um único exame que decida isso. Depende do seu risco individual. Verificar o seu nível de vitamina D faz sentido se você fizer parte de um grupo de maior risco, e o seu médico pode orientar essa escolha com você.

Algumas situações indicam que vale fazer o exame. Se o seu nível estiver abaixo de 20 ng/mL antes de uma cirurgia de fratura do quadril, sugere-se o rastreamento antes da operação [15]. Níveis baixos são mais comuns em pacientes de prótese articular atendidos no inverno [16]. Antes de algumas operações da mão, conhecer o seu nível pode ajudar a prevenir o atraso na cicatrização da ferida, e tratar uma deficiência antes também pode ajudar [17]. A vitamina D baixa antes de uma prótese de ombro é um risco que pode ser modificado, e é por isso que vale a pena identificá-la [8].

Outras situações indicam que o exame de rotina não é necessário. Uma revisão constatou que examinar todas as pessoas submetidas ao reparo do manguito rotador não se justifica [6]. O mesmo vale para dar suplementos a todos os pacientes de prótese de joelho [7]. Se o seu nível já estiver saudável, a vitamina D extra não demonstrou melhorar os resultados da cirurgia.

Então, em que situação você fica? Se você fizer parte de um grupo de maior risco, um exame simples antes da cirurgia é razoável. Se for encontrada uma deficiência, o tratamento leva tempo e pode precisar de mais de um ciclo. Se o seu nível estiver bom, suplementos adicionais provavelmente não trarão benefício.

Esta é uma decisão a ser tomada em conjunto com o seu médico. Fale sobre qualquer preocupação com os seus ossos, a sua cicatrização ou a sua recuperação, e pergunte se um exame ajudaria no seu caso.

Conclusão

Vale a pena ter a vitamina D em um nível saudável, especialmente antes de uma cirurgia. Níveis baixos estão associados a resultados piores em diversas situações, e uma deficiência é um risco que pode ser modificado. Se você fizer parte de um grupo de maior risco, um exame simples antes da cirurgia é razoável. Se o seu nível estiver bom, suplementos extras não demonstraram melhorar os resultados da cirurgia.

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] 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

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

[5] 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

[6] 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

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

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

[9] 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

[10] 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

[11] 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

[12] 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

[13] 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

[14] Regarding “A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure”. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.07.033

[15] 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

[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] 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

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

More research is needed to determine the effect of vitamin D supplementation on bone health and injury risk in elite athletes [1].
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 regarding stress fracture risk [3].
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].
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].
Peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care due to the lack of robust efficacy and safety data [13].
Orthopedic surgeons should recognize vitamin D deficiency as a potential modifiable risk factor for postoperative complications in total shoulder arthroplasty [14].
Findings from a systematic review and meta-analysis do not justify routine testing and supplementation of vitamin D in patients undergoing rotator cuff repair [19].
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 [21].
Current evidence is inconsistent and insufficient to support universal vitamin D supplementation for total knee arthroplasty outcomes [22].
Recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies to inform better injury and illness prevention strategies [28].

How It Works

Bone Health and Fracture Risk

Vitamin D status should be assessed in high-risk populations to guide preventive strategies focused on maintaining optimal levels [3].
Preoperative vitamin D screening and potential supplementation strategies are important for patients who have vitamin D levels below 20 ng/mL [10].
Maintaining adequate vitamin D levels may improve longer term survival after proximal femoral fracture surgery, although vitamin D status alone may not influence immediate recovery [18].
Active vitamin D3 treatment promoted fracture healing by affecting the levels of immune factors in osteoporotic fracture patients [23].
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 [17].
Regular vitamin D supplementation significantly reduces the likelihood of deficiency [6].
Low-dose vitamin D supplementation was beneficial for vitamin D–sufficient total knee arthroplasty patients to achieve higher levels and maintain sufficiency [20].
Deficient patients benefitted from medium-to-high dose vitamin D supplementation after total knee arthroplasty, though only 33.7% achieved repletion [20].
Hand grip strength, vitamin D status, and diets might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts [21].

Soft Tissue Healing and Musculoskeletal Integrity

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].
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 [24].
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 [27].
Vitamin D deficiency was associated with increased proinflammatory cytokine expression in the deltoid muscle of patients with rotator cuff tears, unlike in the supraspinatus muscle [30].
Vitamin D deficiency was not associated with the expression of myogenesis-related or muscle atrophy–related genes in the supraspinatus muscle of patients with rotator cuff tears [30].
Preoperative serum vitamin D deficiency is associated with increased rotator cuff fatty degeneration but is unlikely to influence post repair outcomes [19].

Inflammation and Immune Modulation

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 [16].
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 [15].

Clinical Management and Outcomes

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 [25].
Future research should determine whether correcting hypovitaminosis D improves outcomes after anterior cruciate ligament injury [31].

What the Evidence Shows

Injury Risk and Prevalence

Vitamin D deficiency is highly prevalent in knee osteoarthritis patients [15].
The severity of vitamin D deficiency in knee osteoarthritis patients is associated with bilateral osteoarthritis and polyarthralgia [15].
The severity of vitamin D deficiency in knee osteoarthritis patients is not associated with inflammatory markers [15].
Higher prevalence of vitamin D deficiency is observed among arthroplasty patients presenting in winter [6].
Lower preoperative serum vitamin D levels have a strong correlation with lower tissue vitamin D levels and lower serum vitamin D levels at 1 year after rotator cuff repair surgery [27].

Fracture and Bone Health Outcomes

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].
Combined calcium and vitamin D supplementation may improve pelvic bone mineral density and correct serum 25OHD deficiencies in postmenopausal women with osteoporosis [32].
Combined calcium and vitamin D supplementation does not reduce clinical fracture risk in postmenopausal women with osteoporosis [32].
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 [34].

Surgical Outcomes and Complications

Preoperative vitamin D deficiency is associated with increased rotator cuff fatty degeneration but is unlikely to influence post-repair outcomes [19].
The findings regarding rotator cuff repair do not justify routine testing and supplementation of vitamin D in patients undergoing rotator cuff repair [19].
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 for total knee arthroplasty [33].
Deficient total knee arthroplasty patients benefited from medium-to-high dose vitamin D supplementation, though only 33.7% achieved repletion [20].

Supplementation Strategies and Cost-Effectiveness

Nonselective vitamin D supplementation appears to be more cost-effective than selective supplementation for arthroscopic rotator cuff repair, likely due to the lower cost of 25(OH)D supplementation compared to serum assays [11].

Tissue Healing and Preclinical Models

Other Clinical Associations

Practical Considerations

Screening and Assessment

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 associated with increased short- and long-term mortality in patients receiving hip fracture surgery under general anesthesia [10].
Vitamin D deficiency is a potentially modifiable risk factor that could be optimized during both surgical and nonsurgical management of patients with Charcot arthropathy [5].

Supplementation Strategies

Providing supplementation if vitamin D deficiency is present preoperatively may be beneficial for preventing delayed wound healing [7].
Deficient total knee arthroplasty patients benefitted from medium-to-high dose vitamin D supplementation, though only 33.7% achieved repletion [20].
Nonselective vitamin D supplementation appears to be more cost-effective than selective supplementation in arthroscopic rotator cuff repair [11].
The lower cost of 25(OH)D supplementation compared to serum assays likely contributes to the cost-effectiveness of nonselective supplementation in arthroscopic rotator cuff repair [11].

Outcomes and Prognosis

Maintaining adequate vitamin D levels may improve longer term survival after proximal femoral fracture surgery [18].
Vitamin D status alone may not influence immediate recovery after proximal femoral fracture surgery [18].
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 [29].

Research Gaps and Limitations

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 [8].

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)
[L5] Because of the lack of robust efficacy and safety data, peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care. [13] (10.1177/03635465261464420)
[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)
[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. [15] (10.1186/s13018-025-05805-0)
[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. [16] (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. [17] (10.1186/s12891-025-08275-x)
[L2] Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after PFF surgery. [18] (10.5435/jaaosglobal-d-25-00108)
[L1] This study's findings do not justify routine testing and supplementation of vitamin D in patients undergoing RCR. [19] (10.1016/j.xrrt.2025.02.006)
[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. [20] (10.5435/jaaos-d-24-00005)
[L4] These parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts. [21] (10.1186/s12891-023-06960-3)
[L2] However, current evidence is inconsistent and insufficient to support universal supplementation. [22] (10.1177/23259671261432670)
[L2] Active vitamin D3 treatment promoted fracture healing by affecting the levels of these immune factors. [23] (10.1186/s13018-023-03777-7)
[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. [24] (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. [25] (10.5397/cise.2024.00220)
[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. [27] (10.1177/03635465221145711)
[L5] Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies. [28] (10.1136/bjsports-2022-106620)
[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. [29] (10.1186/s13018-022-03491-w)
[L4] Vitamin D deficiency was not associated with the expression of myogenesis-related or muscle atrophy–related genes in the supraspinatus muscle of patients with rotator cuff tears, unlike in the deltoid muscle; rather, vitamin D deficiency was associated with increased proinflammatory cytokine expression. [30] (10.1177/03635465231184392)
[Letter] The letter commends the referenced study for assessing vitamin D status before trauma to control for confounding inflammation, and suggests future research should determine whether correcting hypovitaminosis D improves outcomes after ACL injury. [31] (10.1016/j.arthro.2023.07.033)
[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. [32] (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. [33] (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. [34] (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

[13] Peptide Supplements and Their Therapeutic Applications in Sports Medicine. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261464420

[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] 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

[16] 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

[17] 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

[18] 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

[19] 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

[20] 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

[21] 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

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

[23] 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

[24] 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

[25] 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

[27] 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

[28] Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2022-106620

[29] 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

[30] Influence of Vitamin D Deficiency on the Expression of Genes and Proteins in Patients With Medium Rotator Cuff Tears. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231184392

[31] Regarding “A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure”. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.07.033

[32] 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

[33] 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

[34] 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