Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Abstract

The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

Preventing muscle wasting by osteoporosis drug alendronate in vitro and in myopathy models via sirtuin‐3 down‐regulation

“…testosterone, vitamin D, and parathyroid hormone). 49,50 However, in the present study, we found that an antiosteoporotic drug, ALN at low doses, could effectively reverse the impaired effects of Dexa on the muscle hypertrophy and the regenerative capacity via SIRT3 down-regulation in vitro and muscle degeneration therapy in vivo, suggesting that ALN may be provided as a novel potential remedy for steroid myopathy in the clinic in the future.…”

Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature

“…Chronic kidney disease, for example, is prevalent in approximately 50% of all patients with HF, and CKD itself has been associated with wasting, because, very similar to HF, inflammation is involved in mediating skeletal muscle wasting in these patients. 67 Indoxyl sulfate induces mitochondrial dysfunction in models with CKD. 65 Like in HF, it has been difficult to suppress muscle wasting in patients with CKD.…”

“…66 Like in osteopenia development mentioned earlier, vitamin D acts a as a modulator of musculoskeletal health in patients with CKD. 67 Indoxyl sulfate induces mitochondrial dysfunction in models with CKD. This uraemic toxin is known to accelerate skeletal muscle atrophy, and therefore, indoxyl sulfate may be a potential target for mitrochondrial-targeted intervention in CKD-induced muscle atrophy.…”

ssessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

“…Vitamin D 3 öncelikle deride sentezlenir ve karaciğerde hidroksillenerek 25 (OH) vitamin D'yi oluşturur (7)(8)(9)(10). 1,25 (OH) vitamin D, böbreklerde bir hidroksilasyon işlemi daha geçirerek aktif metabolik formuna dönüşür (7,8,11).…”

“…Erişkin yaşlarda patognomonik bulgusu bulunmamaktadır (11,13,16). Sıklıkla halsizlik, yorgunluk, duygu-durum bozukluğu, kaslarda huzursuzluk hissi, ağrı ve kramp tarzı belirtiler gösterebilir (1,3,10). D vitamini yetersizliğine bağlı oluşan osteomalazi kliniğinde genellikle lomber bölgeden başlayarak pelvis, uyluk, sırt ve kostaları içeren yaygın ağrılar görülür (3,14).…”