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Kevin Williams,1 Christian Askew,1 Christopher Mazoue,1 Jeffrey Guy,1 Toni M Torres-McGehee,2 J Benjamin Jackson III1 1University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA; 2University of South Carolina School of Public Health, Columbia, SC, USACorrespondence: Kevin WilliamsDepartment of Orthopaedic Surgery, University of South Carolina School of Medicine, 2 Medical Park, Suite 404, Columbia, SC 29203, USATel +1 317-946-9810Email kwillmd@gmail.comIntroduction: Vitamin D is paramount to bone health and little is known about vitamin D’s role in the prevention of stress fractures in high-risk athletes. This study consists of a prospective, cross-sectional analysis accompanied by a retrospective review for control comparison of vitamin D3 supplementation in high-risk athletes. Our hypothesis is that supplemental vitamin D3 treatment will decrease the occurrence of stress fractures in high-risk collegiate athletes.Materials and Methods: A total of 118 NCAA Division I athletes were recruited from 6 high-risk collegiate teams. Blood draws in August and February established baseline 25(OH)D levels. Subjects with serum 25(OH)D < 30 ng/mL were supplemented with 50,000 IU of vitamin D3/week for 8 weeks. Treated subjects were re-tested to ensure serum 25(OH)D levels rose to sufficient status. All enrolled subjects were monitored for the development of stress fractures. A 5-year retrospective chart review of athletes from the same sports teams was conducted to determine the incidence of any reported stress fractures in the past.Results: Prospective: 112 of the 118 enrolled subjects were tested in August. Sixty-one demonstrated vitamin D sufficiency (40.2 ng/mL ± 8.28) and 51 were either insufficient or deficient (22.7 ng/mL ± 4.89). Of the 118 enrolled subjects, 104 were tested in February. Fifty-six demonstrated vitamin D sufficiency (40.7 ng/mL ± 9.47) and 48 were insufficient or deficient (21.6 ng/mL ± 5.87). Two stress fractures were diagnosed amongst our cohort of 118 student athletes (1.69%). Retrospective: 34 stress fractures were diagnosed in 453 subjects from 01/2010-05/2015 (7.51%). Amongst our athletic teams, the cross-country team specifically demonstrated a statistically significant decrease in stress fracture incidence (p< 0.05). We also found a statistically significant reduction in stress fracture incidence amongst the current overall cohort compared to our retrospective cohort (p< 0.05).Conclusion: In our population, almost half of the tested athletes proved to be vitamin D deficient. Hypovitaminosis D was prevalent throughout the winter months compared with the summer. With vitamin D3 supplementation, the stress fracture rate in our overall cohort demonstrated a statistically significant decrease from 7.51% to 1.65% (p=0.009).Keywords: vitamin D, stress injuries, sports medicine, bone health