Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study
Ann Rheum Dis 2014;73:697-703 doi:10.1136/annrheumdis-2012-202831
Laura L Laslett 1, Stephen Quinn 2, John R Burgess 3,4, Venkateswaran Parameswaran 3, Tania M Winzenberg 1, Graeme Jones 1, Changhai Ding 1,5
1Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
2Clinical Effectiveness Cluster, Flinders University, Adelaide, South Australia, Australia
3Diabetes and Endocrine Services, Royal Hobart Hospital, Hobart, Tasmania, Australia
4School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Correspondence to: Laura Laslett, Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia; Laura.Laslett at utas.edu.au
Accepted 24 February 2013, Published Online First 17 April 2013
Background Vitamin D is important for bone, cartilage and muscle function but there are few studies on its association with joint pain.
Objective To investigate whether serum vitamin D predicts change in knee and hip pain in older adults.
Methods Longitudinal population-based cohort study of randomly selected older adults (n=769) aged 50–80 years (mean 62 years); 50% were male. Serum 25-hydroxyvitamin D (25-OHD) was assessed at baseline by radioimmunoassay, and pain at baseline, 2.6 and/or 5 years using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. We used linear regression with adjustment for age, sex, body mass index and season, then further adjusted for potential structural mechanisms (radiographic osteoarthritis, bone marrow lesions, chondral defects and muscle strength).
Results Mean total knee WOMAC score was 3.2 (range 0–39).
- 4.2% of participants had moderate vitamin D deficiency at baseline (25-OHD 12.5–25 nmol/l).
- 25-OHD <25 nmol/l predicted change in knee pain (using total WOMAC score) over 5 years (β=2.41, p=0.002) with a
similar effect size for hip pain over 2.4 years (β=2.20, p=0.083).
Results were consistent within pain subscales, and the association was independent of demographic, anthropometric and structural covariates.
No association was present when 25-OHD was analysed as a continuous measure.
Conclusions Moderate vitamin D deficiency independently predicts incident, or worsening of, knee pain over 5 years and, possibly, hip pain over 2.4 years. Therefore correcting moderate vitamin deficiency may attenuate worsening of knee or hip pain in elderly people but giving supplements to those with a higher 25-OHD level is unlikely to be effective.
- Overview Pain and Vitamin D
- Blacks had lower vitamin D and more quantifiable pain than whites with knee osteoarthritis – Nov 2012 Blacks typically have lower levels of vitamin D than whites
- Good evidence for knee osteoarthritis and vitamin D, unsure of other OA – Review March 2013
- Probability of knee osteoarthritis up 50 percent if 20 ng less vitamin D – Nov 2011
- Overview Osteoarthritis and Vitamin D
- Knee osteoarthritis treated with vitamin D, weekly 50,000 IU – May 2015