Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis

Abstract

IMPORTANCE Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current trial evidence is contradictory.OBJECTIVE To compare the effects of vitamin D supplementation vs placebo on knee pain and knee cartilage volume in patients with symptomatic knee osteoarthritis and low vitamin D levels. DESIGN, SETTING, AND PARTICIPANTSA multicenter randomized, double-blind, placebo-controlled clinical trial in Tasmania and Victoria, Australia. Participants with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D (12.5-60 nmol/L) were enrolled from June 2010 to December 2011. The trial was completed in December 2013. INTERVENTIONS Participants were randomly assigned to receive monthly treatment with oral vitamin D 3 (50 000 IU; n = 209) or an identical placebo (n = 204) for 2 years. MAIN OUTCOMES AND MEASURES Primary outcomes were change in tibial cartilage volume (assessed using magnetic resonance imaging [MRI]) and change in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (0 [no pain] to 500 [worst pain]) from baseline to month 24. Secondary outcomes were cartilage defects and bone marrow lesions (assessed using MRI).RESULTS Of 413 enrolled participants (mean age, 63.2 years; 50% women), 340 (82.3%) completed the study. The level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/L) than in the placebo group (6.7 nmol/L) (P < .001) over 2 years. There were no significant differences in annual change of tibial cartilage volume or WOMAC pain score. There were no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Adverse events (Ն1 per patient) occurred in 56 participants in the vitamin D group and in 37 participants in the placebo group (P = .04). End Point Change, Mean Difference (95% CI) P Value Vitamin D Placebo Tibial cartilage volume, %/y −3.4% −4.2% 0.8% (−0.2% to 1.8%) .13 WOMAC pain −49.9 −35.1 −14.8 (−32.5 to 2.9) .10 Tibiofemoral cartilage defects 0.3 0.5 −0.2 (−0.4 to 0.1) .21 Tibiofemoral bone marrow lesions −0.1 0.3 −0.5 (−0.9 to 0.0) .06CONCLUSIONS AND RELEVANCE Among patients with symptomatic knee osteoarthritis and low serum 25-hydroxyvitamin D levels, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or WOMAC knee pain score over 2 years. These findings do not support the use of vitamin D supplementation for preventing tibial cartilage loss or improving WOMAC knee pain in patients with knee osteoarthritis.

A randomized clinical trial in vitamin D–deficient adults comparing replenishment with oral vitamin D3 with narrow-band UV type B light: effects on cholesterol and the transcriptional profiles of skin and blood ,

“…Indeed, previous studies have shown an inverse correlation between 25(OH)D concentrations and LDL cholesterol with an independent effect of solar UV radiation (32 (39)(40)(41)(42)(43)(44)(45).…”

Vitamin D and Its Effects on Articular Cartilage and Osteoarthritis

“…A 2-year randomized controlled trial in which 413 participants were given monthly treatments with oral vitamin D showed that oral supplementation did not produce significant clinical or cartilage volume structural differences in patients who were previously vitamin D deficient. 25 In a double-blind, randomized placebo-controlled trial, Arden et al 4 also showed that there was no significant difference in the rate of joint space narrowing in the medial compartment of knees due to vitamin D supplementation.…”

Витамин D И Остеоартроз

“…Пацієнти з гонартрозом і низьким рівнем 25(OH)D (12,5-60 нмоль/л) протягом 2 років отримували щомісячно перорально 50 000 МО віта-міну D [58]. Група пацієнтів, що отримувала плацебо, служила контролем.…”