Prevalence of Severe Hypovitaminosis D in Patients With Persistent, Nonspecific Musculoskeletal Pain

Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minn, USA.
Mayo Clinic Proceedings (Impact Factor: 6.26). 01/2004; 78(12):1463-70. DOI: 10.4065/78.12.1463
Source: PubMed


To determine the prevalence of hypovitaminosis D in primary care outpatients with persistent, nonspecific musculoskeletal pain syndromes refractory to standard therapies.
In this cross-sectional study, 150 patients presented consecutively between February 2000 and June 2002 with persistent, nonspecific musculoskeletal pain to the Community University Health Care Center, a university-affiliated inner city primary care clinic in Minneapolis, Minn (45 degrees north). Immigrant (n = 83) and nonimmigrant (n = 67) persons of both sexes, aged 10 to 65 years, from 6 broad ethnic groups were screened for vitamin D status. Serum 25-hydroxyvitamin D levels were determined by radioimmunoassay.
Of the African American, East African, Hispanic, and American Indian patients, 100% had deficient levels of vitamin D (< or = 20 ng/mL). Of all patients, 93% (140/ 150) had deficient levels of vitamin D (mean, 12.08 ng/mL; 95% confidence interval, 11.18-12.99 ng/mL). Nonimmigrants had vitamin D levels as deficient as immigrants (P = .48). Levels of vitamin D in men were as deficient as in women (P = .42). Of all patients, 28% (42/150) had severely deficient vitamin D levels (< or = 8 ng/mL), including 55% of whom were younger than 30 years. Five patients, 4 of whom were aged 35 years or younger, had vitamin D serum levels below the level of detection. The severity of deficiency was disproportionate by age for young women (P < .001), by sex for East African patients (P < .001), and by race for African American patients (P = .006). Season was not a significant factor in determining vitamin D serum levels (P = .06).
All patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D. This risk extends to those considered at low risk for vitamin D deficiency: nonelderly, nonhousebound, or nonimmigrant persons of either sex. Nonimmigrant women of childbearing age with such pain appear to be at greatest risk for misdiagnosis or delayed diagnosis. Because osteomalacia is a known cause of persistent, nonspecific musculoskeletal pain, screening all outpatients with such pain for hypovitaminosis D should be standard practice in clinical care.

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    • "Persons with SCD are at particular risk for vitamin D deficiency (VDD) due to melanin skin hyper-pigmentation, which blocks cutaneous vitamin D production and high rates of lactose intolerance that leads to a reduced intake of vitamin D fortified dairy products. This also might explain, in part, the high incidence of VDD among individuals with SCD who are primarily of African descent.[111213] "
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    ABSTRACT: Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision. A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA. There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications. The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.
    Journal of Anaesthesiology Clinical Pharmacology 03/2014; 30(1):20-4. DOI:10.4103/0970-9185.125692
    • "According to several studies, 26-100% patients with musculoskeletal pain may have vitamin D deficiency.[23242526272829] In a number of studies, skeletal pain responded to vitamin D treatment[30] In our observation, 83% patient reported musculoskeletal pain. "
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    ABSTRACT: Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature. We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH) and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH) D levels as normal (>20 ng/ml) or vitamin D deficient (<20 ng/ml). We identified 71 such patients. Fifty-two patients (73%) had low serum 25(OH) D (<20 ng/dl). Eighty-three percent patients reported musculoskeletal pain. Fifty-two percent patients fulfilled the American College of Rheumatology criteria for chronic widespread pain. About 50% patients fulfilled the criteria for biochemical osteomalacia. Low serum 25(OH) D level (<20 ng/dl) was significantly associated with headache, musculoskeletal pain, and osteomalacia. These suggest that both chronic musculoskeletal pain and chronic headache may be related to vitamin D deficiency. Musculoskeletal pain associated with vitamin D deficiency is usually explained by osteomalacia of bones. Therefore, we speculate a possibility of osteomalacia of the skull for the generation of headache (osteomalacic cephalalgia?). It further suggests that both musculoskeletal pain and headaches may be the part of the same disease spectrum in a subset of patients with vitamin D deficiency (or osteomalacia), and vitamin D deficiency may be an important cause of secondary CTTH.
    Annals of Indian Academy of Neurology 10/2013; 16(4):650-8. DOI:10.4103/0972-2327.120487 · 0.60 Impact Factor
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    • "The mean hs-CRP value declined one point, suggesting a trend toward decreased inflammation. In a previous study on musculoskeletal pain conducted at our Minneapolis BraveNet site, 93% of the participants were found to have insufficient levels of 25-hydroxyvitamin D (≤20 ng/mL) [22]. To further assess the relationship of hypovitaminosis D to pain, we included vitamin D levels in SIMTAP. "
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    BMC Complementary and Alternative Medicine 06/2013; 13(1):146. DOI:10.1186/1472-6882-13-146 · 2.02 Impact Factor
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