Posted on 10-10-2013
VITAMIN D AND MUSCULOSKELETAL PAIN
Morning! The Global Journal of Health Science in 2013 recently performed a study that aimed at the evaluation of the association of musculoskeletal pain with vitamin D deficiency and the response of the patients to vitamin D supplementation.
KEY POINTS FROM THIS STUDY:
1) Vitamin D deficiency is common worldwide.
2) Vitamin D deficiency is associated with non-specific musculoskeletal pain.
3) “Treatment with vitamin D can relieve the pain in a majority of the patients with vitamin D deficiency. Lack of response can be due to an insufficient increase in serum vitamin D concentration.”
4) There are physiologic differences in the intestinal absorption of vitamin D.
5) “Calcium absorption from the GI is reduced in vitamin D deficiency.”
6) “Mild vitamin D deficiency may produce a variety of musculoskeletal pains such as fibromyalgia-like pain, low back pain, and arthralgia.” [Key Point]
7) Those with vitamin D deficiency were treated with 50,000 oral units of vitamin D3 per week [averaging 7,143 IU/day] for 12 weeks and 1,000 mg/day elemental calcium. Three months after end of the treatment they were reassessed for response of their pain to the treatment using the Visual Assessment Score (VAS).
8) 95.4% of the patients had vitamin D deficiency (serum 25 (OH) D concentration less than 50 nmol/l). [50 nmol/l = 20 ng/ml]
9) In 85.5% of those with vitamin D deficiency, supplementation reduced their VAS scores more than 60%.
10) In 75.8% of those with vitamin D deficiency, supplementation completely eliminated their pain.
11) Supplementing with vitamin D significantly raised the serum concentrations of 25(OH)D, and especially in those who responded favorably to the intervention.
[This suggests that vitamin D supplementation in higher doses or for longer periods may improve musculoskeletal pain in the poorer responders]. “In patients who respond to vitamin D supplementation, more notable rise in serum concentrations of 25(OH)D was detected.”
12) These authors review literature showing:
2003: 93% of patients with musculoskeletal pain have vitamin D deficiency.
2003: 83% of patients with low back pain have vitamin D deficiency.
2010: 63% of patients with musculoskeletal pain have vitamin D deficiency.
13) Dr. Michael Hollick, MD, [the discoverer of the active form of vitamin D] proposes the following biological mechanism:
Low vitamin D causes low GI absorption of calcium.
Low calcium increases secretion of parathyroid hormone (PTH).
Increased PTH increases bone osteoclast activity.
Increased osteoclast activity causes lower bone matrix mineralization.
Lower bone matrix mineralization absorbs water.
Bone water absorption causes subperiosteal space edema.
Subperiosteal space edema produces bone pain.
14) This study “confirmed that vitamin D supplementation can relieve the pain in majority of the patients” with musculoskeletal pain.
15) The rise in serum 25 (OH) D concentrations after vitamin D supplementation is variable between patients. Therefore, when musculoskeletal pain patients do not respond to vitamin D supplementation, their serum levels should be retested to assess their effectiveness of that level of supplementation for that individual.
16) It is suggested that the pain associated with vitamin D deficiency is usually sensed on the bone or muscle; bone tenderness is noted at the sternum, tibia, radius or ulna. Low back, thoracic, shoulder, ribs and pelvic pain is also common in those with vitamin D deficiency.
17) The findings of present the study show that vitamin D deficiency is widespread and associated with musculoskeletal pain which is relieve with vitamin D supplementation; “in pain nonresponders reassessment of serum 25(OH) D concentrations is recommended.”
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