Vitamin D in the Life of the Athlete: A Narrative Review of Biology, Status, Performance, Injury and Practical Management
DOI:
https://doi.org/10.12775/QS.2025.47.66735Keywords
vitamin D, athletes, supplementation, performance, stress fracture, respiratory infection, bone health, muscleAbstract
Introduction
Vitamin D is essential for bone health and supports muscle and immune function. Deficiency is common among athletes due to indoor training, high latitudes, winter, clothing and darker skin. The main concern is how vitamin D status and supplementation affect performance, recovery and risk of illness or injury.
Aim
This review summarizes evidence on:
• mechanisms linked to muscle and immune function,
• prevalence and causes of deficiency,
• impact on strength, endurance and recovery,
• role in bone health, fractures and soft tissue injuries,
• associations with respiratory infections,
• strategies for screening and supplementation.
Material and Methods
A narrative review was conducted using PubMed and Google Scholar. Priority was given to randomized controlled trials, systematic reviews, meta-analyses and clinical guidelines.
Results
Vitamin D receptor activity regulates calcium handling, mitochondrial function and tissue repair. Deficiency affects 40–70% of athletes in winter, particularly those engaged in indoor and high-latitude sports. Supplementation effectively raises serum 25(OH)D levels. Effects on performance are modest but more pronounced when deficiency is corrected. Calcium combined with vitamin D reduces stress fracture risk in military cohorts. Observational studies indicate that low vitamin D increases the risk of bone stress injuries. Evidence for protection against respiratory infections is inconclusive.
Conclusions
Adequate vitamin D supports bone integrity and recovery. Ergogenic effects are modest and mainly relevant in deficiency. Guidelines recommend individualized vitamin D₃ supplementation, usually 1,000–2,000 IU/day, and screening for high-risk athletes. High-dose bolus regimens are not recommended. Maintaining sufficiency reduces bone injury risk and supports overall health, though performance benefits in sufficient athletes remain uncertain.
References
[1] Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev. 2013 Feb;34(1):33-83. https://doi.org/10.1210/er.2012-1012.
[2] Girgis CM, Brennan-Speranza TC. Vitamin D and Skeletal Muscle: Current Concepts From Preclinical Studies. JBMR Plus. 2021 Nov 15;5(12):e10575. https://doi.org/ 10.1002/jbm4.10575.
[3] Olsson K, Saini A, Strömberg A, Alam S, Lilja M, Rullman E, Gustafsson T. Evidence for Vitamin D Receptor Expression and Direct Effects of 1α,25(OH)2D3 in Human Skeletal Muscle Precursor Cells. Endocrinology. 2016 Jan;157(1):98-111. https://doi.org/10.1210/en.2015-1685.
[4] Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol. 2019 Apr;119(4):825-839. https://doi.org/10.1007/s00421-019-04104-x.
[5] Ceglia L, Harris SS. Vitamin D and its role in skeletal muscle. Calcif Tissue Int. 2013 Feb;92(2):151-62. https://doi.org/10.1007/s00223-012-9645-y.
[6] Harju T, Gray B, Mavroedi A, Farooq A, Reilly JJ. Prevalence and novel risk factors for vitamin D insufficiency in elite athletes: systematic review and meta-analysis. Eur J Nutr. 2022 Dec;61(8):3857-3871. https://doi.org/10.1007/s00394-022-02967-z. Epub 2022 Jul 26. Erratum in: Eur J Nutr. 2023 Feb;62(1):523. https://doi.org/10.1007/s00394-022-03021-8.
[7] Bârsan M, Chelaru VF, Râjnoveanu AG, Popa ȘL, Socaciu AI, Bădulescu AV. Difference in Levels of Vitamin D between Indoor and Outdoor Athletes: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2023 Apr 20;24(8):7584. https://doi.org/10.3390/ijms24087584.
[8] Morton JP, Iqbal Z, Drust B, Burgess D, Close GL, Brukner PD. Seasonal variation in vitamin D status in professional soccer players of the English Premier League. Appl Physiol Nutr Metab. 2012 Aug;37(4):798-802. https://doi.org/10.1139/h2012-037.
[9] Kawashima I, Hiraiwa H, Ishizuka S, Kawai R, Hoshino Y, Kusaka Y, Tsukahara T. Comparison of vitamin D sufficiency between indoor and outdoor elite male collegiate athletes. Nagoya J Med Sci. 2021 May;83(2):219-226. https://doi.org/10.18999/nagjms.83.2.219.
[10] Perrone MA, Pieri M, Caminiti G, Ali W, Bernardini S, Parisi A, Iellamo F, Barone R, Farsetti P. Vitamin D Deficiency in Professional Football Players during Competitive Season of Italian First Division (Serie A). Sports (Basel). 2024 May 29;12(6):153. https://doi.org/10.3390/sports12060153.
[11] Langley CK, Morse CI, Buffey AJ. The Prevalence of Low Vitamin D in Elite Para-Athletes: A Systematic Review. Sports Med Open. 2024 Sep 4;10(1):96. https://doi.org/10.1186/s40798-024-00756-y.
[12] Koundourakis NE, Androulakis NE, Malliaraki N, Margioris AN. Vitamin D and exercise performance in professional soccer players. PLoS One. 2014 Jul 3;9(7):e101659. https://doi.org/10.1371/journal.pone.0101659.
[13] Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64. https://doi.org/10.3945/ajcn.111.031070.
[14] van den Heuvel EG, Lips P, Schoonmade LJ, Lanham-New SA, van Schoor NM. Comparison of the Effect of Daily Vitamin D2 and Vitamin D3 Supplementation on Serum 25-Hydroxyvitamin D Concentration (Total 25(OH)D, 25(OH)D2, and 25(OH)D3) and Importance of Body Mass Index: A Systematic Review and Meta-Analysis. Adv Nutr. 2024 Jan;15(1):100133. https://doi.org/10.1016/j.advnut.2023.09.016.
[15] Han Q, Li X, Tan Q, Shao J, Yi M. Effects of vitamin D3 supplementation on serum 25(OH)D concentration and strength in athletes: a systematic review and meta-analysis of randomized controlled trials. J Int Soc Sports Nutr. 2019 Nov 26;16(1):55. https://doi.org/10.1186/s12970-019-0323-6.
[16] Han Q, Xiang M, An N, Tan Q, Shao J, Wang Q. Effects of vitamin D3 supplementation on strength of lower and upper extremities in athletes: an updated systematic review and meta-analysis of randomized controlled trials. Front Nutr. 2024 May 27;11:1381301. https://doi.org/10.3389/fnut.2024.1381301.
[17] Wyon MA, Koutedakis Y, Wolman R, Nevill AM, Allen N. The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study. J Sci Med Sport. 2014 Jan;17(1):8-12. https://doi.org/10.1016/j.jsams.2013.03.007.
[18] Wyon MA, Wolman R, Kolokythas N, Sheriff K, Galloway S, Mattiussi A. Effect of Vitamin D on Muscle Function and Injury in Elite Adolescent Dancers: A Randomized Double-Blind Study. Int J Sports Physiol Perform. 2019 Jan 1;14(1):55-59. https://doi.org/10.1123/ijspp.2018-0084.
[19] Bezrati I, Ben Fradj MK, Hammami R, Ouerghi N, Padulo J, Feki M. A single mega dose of vitamin D3 improves selected physical variables in vitamin D-deficient young amateur soccer players: a randomized controlled trial. Appl Physiol Nutr Metab. 2020 May;45(5):478-485. https://doi.org/10.1139/apnm-2019-0525.
[20] Jastrzębska M, Kaczmarczyk M, Jastrzębski Z. Effect of Vitamin D Supplementation on Training Adaptation in Well-Trained Soccer Players. J Strength Cond Res. 2016 Sep;30(9):2648-55. https://doi.org/10.1519/JSC.0000000000001337.
[21] Bezuglov E, Shoshorina M, Lazarev A, Emanov A, Koroleva E, Anishchenko I, Waśkiewicz Z, Butovskiy M, Morgans R. Does vitamin D affect strength and speed characteristics and testosterone concentration in elite young track and field athletes in the North European summer? Nutr J. 2023 Mar 8;22(1):16. https://doi.org/10.1186/s12937-023-00848-7.
[22] Yoon S, Kwon O, Kim J. Vitamin D in athletes: focus on physical performance and musculoskeletal injuries. Phys Act Nutr. 2021 Jun;25(2):20-25. https://doi.org/10.20463/pan.2021.0011.
[23] Wyatt PB, Reiter CR, Satalich JR, O'Neill CN, Edge C, Cyrus JW, O'Connell RS, Vap AR. Effects of Vitamin D Supplementation in Elite Athletes: A Systematic Review. Orthop J Sports Med. 2024 Jan 3;12(1):23259671231220371. https://doi.org/10.1177/23259671231220371.
[24] Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008 May;23(5):741-9. https://doi.org/10.1359/jbmr.080102.
[25] Gaffney-Stomberg E, Nakayama AT, Guerriere KI, Lutz LJ, Walker LA, Staab JS, Scott JM, Gasier HG, McClung JP. Calcium and vitamin D supplementation and bone health in Marine recruits: Effect of season. Bone. 2019 Jun;123:224-233. https://doi.org/10.1016/j.bone.2019.03.021.
[26] Goolsby MA, Boniquit N. Bone Health in Athletes. Sports Health. 2017 Mar/Apr;9(2):108-117. https://doi.org/10.1177/1941738116677732.
[27] Scofield KL, Hecht S. Bone health in endurance athletes: runners, cyclists, and swimmers. Curr Sports Med Rep. 2012 Nov-Dec;11(6):328-34. https://doi.org/10.1249/JSR.0b013e3182779193.
[28] Ackerman KE, Nazem T, Chapko D, Russell M, Mendes N, Taylor AP, Bouxsein ML, Misra M. Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab. 2011 Oct;96(10):3123-33. https://doi.org/10.1210/jc.2011-1614.
[29] Christo K, Prabhakaran R, Lamparello B, Cord J, Miller KK, Goldstein MA, Gupta N, Herzog DB, Klibanski A, Misra M. Bone metabolism in adolescent athletes with amenorrhea, athletes with eumenorrhea, and control subjects. Pediatrics. 2008 Jun;121(6):1127-36. https://doi.org/10.1542/peds.2007-2392.
[30] Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun C, Lundy B, Melin AK, Meyer NL, Sherman RT, Tenforde AS, Klungland Torstveit M, Budgett R. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018 Jun;52(11):687-697. https://doi.org/10.1136/bjsports-2018-099193.
[31] Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, Rawson ES, Walsh NP, Garthe I, Geyer H, Meeusen R, van Loon LJC, Shirreffs SM, Spriet LL, Stuart M, Vernec A, Currell K, Ali VM, Budgett RG, Ljungqvist A, Mountjoy M, Pitsiladis YP, Soligard T, Erdener U, Engebretsen L. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018 Apr;52(7):439-455. https://doi.org/10.1136/bjsports-2018-099027.
[32] Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, Bergman P, Bischoff-Ferrari HA, Borzutzky A, Damsgaard CT, Dubnov-Raz G, Esposito S, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Mauger DT, Manaseki-Holland S, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Trilok-Kumar G, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021 May;9(5):276-292. https://doi.org/10.1016/S2213-8587(21)00051-6.
[33] Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Bergman P, Bischoff-Ferrari HA, Borzutzky A, Bubes VY, Damsgaard CT, Ducharme FM, Dubnov-Raz G, Esposito S, Ganmaa D, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Manaseki-Holland S, Manson JE, Mauger DT, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Kumar GT, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of stratified aggregate data. Lancet Diabetes Endocrinol. 2025 Apr;13(4):307-320. https://doi.org/10.1016/S2213-8587(24)00348-6. Epub 2025 Feb 21. Erratum in: Lancet Diabetes Endocrinol. 2025 Jul;13(7):e10. https://doi.org/10.1016/S2213-8587(25)00158-5.
[34] Jia H, Sheng F, Yan Y, Liu X, Zeng B. Vitamin D supplementation for prevention of acute respiratory infections in older adults: A systematic review and meta-analysis. PLoS One. 2024 May 24;19(5):e0303495. https://doi.org/10.1371/journal.pone.0303495.
[35] Wang CH, Porta L, Yang TK, Wang YH, Wu TH, Qian F, Han YY, Sheng WH, Chen SC, Lee CC, Chang SC. Optimal methods of vitamin D supplementation to prevent acute respiratory infections: a systematic review, dose-response and pairwise meta-analysis of randomized controlled trials. Nutr J. 2024 Aug 14;23(1):92. https://doi.org/10.1186/s12937-024-00990-w.
[36] Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, Lips P, Mitchell DM, Murad MH, Powers S, Rao SD, Scragg R, Tayek JA, Valent AM, Walsh JME, McCartney CR. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024 Jul 12;109(8):1907-1947. https://doi.org/10.1210/clinem/dgae290. Erratum in: J Clin Endocrinol Metab. 2025 Feb 18;110(3):e916. doi: 10.1210/clinem/dgae854. Erratum in: J Clin Endocrinol Metab. 2025 Jul 15;110(8):e2810. https://doi.org/10.1210/clinem/dgaf310.
[37] Endocrine Society. Guideline recommends healthy adults <75 take the RDA of vitamin D; routine testing generally not needed. News release. June 3, 2024. https://www.endocrine.org/news-and-advocacy/news-room/2024/endocrine-society-recommends-healthy-adults-take-the-recommended-daily-allowance-of-vitamin-d
[38] Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, Lips P, Mitchell DM, Murad MH, Powers S, Rao SD, Scragg R, Tayek JA, Valent AM, Walsh JME, McCartney CR. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024 Jul 12;109(8):1907-1947. https://doi.org/10.1210/clinem/dgae290. Erratum in: J Clin Endocrinol Metab. 2025 Feb 18;110(3):e916. https://doi.org/10.1210/clinem/dgae854. Erratum in: J Clin Endocrinol Metab. 2025 Jul 15;110(8):e2810. https://doi.org/10.1210/clinem/dgaf310.
[39] Office of Dietary Supplements, National Institutes of Health. Vitamin D – Health Professional Fact Sheet. Updated August 2025; Accessed September 1, 2025. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
[40] Zittermann A, Trummer C, Theiler-Schwetz V, Pilz S. Long-term supplementation with 3200 to 4000 IU of vitamin D daily and adverse events: a systematic review and meta-analysis of randomized controlled trials. Eur J Nutr. 2023 Jun;62(4):1833-1844. https://doi.org/10.1007/s00394-023-03124-w.
[41] Houghton CC, Lew SQ. Long-term hypervitaminosis D-induced hypercalcaemia treated with glucocorticoids and bisphosphonates. BMJ Case Rep. 2020 Apr 29;13(4):e233853. https://doi.org/10.1136/bcr-2019-233853.
[42] Galior K, Grebe S, Singh R. Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports. Nutrients. 2018 Jul 24;10(8):953. https://doi.org/10.3390/nu10080953.
[43] Larson-Meyer DE, Willis KS. The importance of vitamin D for athletes. Sports Science Exchange. SSE #148. https://www.gssiweb.org/sports-science-exchange/article/sse-148-the-importance-of-vitamin-d-for-athletes
[44] Close GL. Vitamin D Measurement & Supplementation: What, When, Why, How? Sports Science Exchange. SSE #147. https://www.gssiweb.org/sports-science-exchange/article/sse-147-vitamin-d-measurement-supplementation-what-when-why-how-/1000
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Martyna Poręba, Kacper Poręba, Kamila Prokopczyk, Rafał Rusiłowicz, Julia Matuszewska, Michał Józef Peszt, Antoni Wasilczuk, Aleksandra Lewandowska-Mackiewicz, Mikołaj Szaryński, Paulina Jakubowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 147
Number of citations: 0
