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

Svært viktig studie som nevner hvordan d-vitamin har direkte sammenheng med ikke-spesifikke muskelsmerter. 98% av alle som fikk behandling for muskelplager hadde d-vitamin mangler, i gjennomsnitt 12 ng/ml (30nmol/L).

All patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D.

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.

Of the many types of chronic pain, nonspecific or idio- pathic musculoskeletal pain, such as noninflammatory arthritis, nonarticular rheumatism, and nonradicular low back pain, is seen frequently in medical and chiropractic clinics. Despite the prevalence, severity, and burdens of such pain, precise diagnosis and effective treatment are often elusive.

The prevalence of hypovitaminosis D was unexpectedly high in this population of nonelderly, nonhousebound, pri- mary care outpatients with persistent, nonspecific muscu- loskeletal pain refractory to standard pharmaceutical agents. Of all patients, 93% (140/150) had deficient levels of vitamin D (mean, 12.08 ng/mL; 95% confidence interval [CI], 11.18-12.99 ng/mL).

Unexpectedly, 100% of Af- rican American (n=22), 100% of American Indian (n=10), and 83% (29/35) of white patients with persistent pain also had hypovitaminosis D (mean, 11.7 ng/mL; 95% CI, 10.17- 13.27 ng/mL).

More than 90% of the patients in this study with persistent, nonspecific musculoskeletal pain were found to have deficient levels of 25-hydroxyvitamin D. Mean values were in the moderately severe to moderately deficient range. This was true regardless of immigrant status, sex, race, or season.

Even oral supplementation with vitamin D tablets may be inadequate at currently recommended doses.44-46 Up to 46% of persons found to be vitamin D–deficient have met the recommended daily intake.47-49 Also, oral supplements may not provide sufficient compensation for patients with existing hypovitaminosis D.50,51

These results support screening of all outpatients with persistent, nonspecific musculoskeletal pain for hypovitaminosis D. These patients are at high risk for the consequences of unrecognized and untreated hypovitaminosis D, and this risk extends to those now considered at low risk, including nonelderly, nonhousebound, or nonimmigrant persons of either sex

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