Vitamin D Deficiency May Contribute to Musculoskeletal Pain

Almost on a daily basis at my office in Germantown, MD, I see patients who commonly present with idiopathic musculoskeletal pain, or in plain english, physical pain of an unknown origin. Despite the high incidence and potential consequences of such pain, precise diagnosis and effective treatment are not always easily attained.

Additionally, extremely low levels of vitamin D, known as hypovitaminosis D, may be a cause of nonspecific musculoskeletal pain that goes undetected, leading to more severe consequences, such as softening of the bones, which occurs in osteomalacia.

In a study designed to evaluate the prevalence of hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain, researchers screened 150 consecutive patients (ages 10-65) who presented to a primary care clinic between February 2000 and June 2002 with complaints of idiopathic musculoskeletal pain. Patients had no known health condition that would decrease production or absorption of vitamin D, and none had fibromyalgia, temporomandibular disorder or complex regional pain syndrome that could account for their musculoskeletal pain.

Rates of vitamin D deficiency were "unexpectedly high," according to the authors, "particularly in this population of nonelderly, nonhousebound, primary care outpatients." Overall, 28% of patients had severely deficient vitamin D levels; 55% of those individuals were younger than age 55. These deficiencies were similar for men and women, and season was not a significant variable in determining vitamin D levels.

Conclusion: "All patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D," state the authors. "Because osteomalacia is a known cause of persistent, nonspecific non-musculoskeletal pain, screening all outpatients with such pain for hypovitaminosis D should be standard practice in clinical care."

Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clinic Proceedings 2003;78:1463-70.

Dr. Michael Cramer

Cramer Chiropractic & Rehabilitation

Germantown, MD