Restorative Effect of Vitamin D Deficiency on Knee Pain and Quadriceps Muscle Strength in Knee Osteoarthritis
Both vitamin D deficiency and quadriceps muscle weakness are associated with knee osteoarthritis (KOA) and pain. The aim of this study was to determine the restorative effect of vitamin D deficiency on pain and quadriceps muscle strength in knee osteoarthritis. Patients with KOA aged≥30 years, the presence of knee pain for at least one month or longer and serum 25-hydroxyvitamin (25-OHD) deficiencies were recruited in the study. Participants with KOA compatible with Kellgren-Lawrence grade 4, joint instability, and effusion, history of surgery or inflammatory arthropathies were excluded. Serum 25-OHD was assessed by ELISA method and concentrations<20 ng/ml was considered deficiency. Quadriceps muscle strength was measured by dynamometry method and intensity of knee pain by Western Ontario and McMaster University Osteoarthritis index scored by Likert scale and visual analog scale. All participants received 50.000 IU oral cholecalciferol weekly for at least two months. The influence of raising serum 25-OHD on uadriceps muscle strength and pain was assessed by calculation of mean changes from baseline at the end of the treatment period using paired t-test. A total of 67 patients with mean age of 50±6.6 years of age were treated for 2 months. Serum 25-OHD reached to sufficient levels in all except one patient. At the end of the study period, serum 25-OHD and quadriceps muscle strength increased significantly as compared with baseline (P=0.007 and P=0.002, respectively), whereas knee pain decreased significantly based on Western Ontario and McMaster University Osteoarthritis index (P=0.001) as well as visual analogue scale scores (P=0.001).These findings indicated that correction of vitamin D deficiency in patients with KOA exerts a significant favorable effect on quadriceps muscle streng h and knee pain.
Heidari B. Knee osteoarthritis diagnosis, treatment and associated factors of progression: Part II. Caspian J Inter Med 2011;2(3):249-55.
Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med 2011;2(2):205-12.
Heidari B. Muscle strength, vitamin D deficiency and knee osteoarthritis. J Babol Univ Med Sci 2012;14(5):84-91.
Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, et al. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil 2010;89(7):541-8.
Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997;127(2):97-104.
Segal NA, Glass NA. Is quadriceps muscle weakness a risk factor for the incident or progressive knee osteoarthritis? Phys Sportsmed 2011;39(4):44-50.
Brandt KD, Heilman DK, Slemenda C, et al. Quadriceps strength in women with radiographically progressive osteoarthritis of the knee and those with stable radiographic changes. J Rheumatol 1999;26(11):2431-7.
O'Reilly SC, Jones A, Muir KR, et al. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998;57(10):588-94.
Rice DA, McNair PJ, Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritis and healthy control subjects. Arthritis Res Ther 2011;13(5):R151.
Becker R, Berth A, Nehring M, et al. Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee J Orthop Res 2004;22(4):768-73.
Jenkinson CM, Doherty M, Avery AJ, et al. Effects of dietary intervention and quadriceps strengthening exercises non pain and function in overweight people with knee pain: Randomized controlled trial. BMJ 2009;339:b3170.
Glass NA, Torner JC, Frey Law LA, et al. The relationship between quadriceps muscle weakness and worsening of knee pain in the MOST cohorts: a 5-year longitudinal study. Osteoarthritis Cartilage 2013;21(9):1154-9.
Segal NA, Torner JC, Felson D, et al. Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort. Arthritis Rheum 2009;61(9):1210-11.
Rinaldi I, Setiati S, Oemardi M, et al. Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength in Indonesian elderly women living in three nursing homes. Acta Med Indones 2007;39(3):107-11.
Moreira-Pfrimer LD, Pedrosa MA, Teixeira L, et al. Treatment of vitamin D deficiency increases lower limb muscle strength in institutionalized older people independently of regular physical activity: a randomized double-blind controlled trial. Ann Nutr Metab 2009;54(4):291-300.
Zamboni M, Zoico E, Tosoni P, et al. Relation between vitamin D, physical performance, and disability in elderly persons. J Gerontol A Biol Sci Med Sci 2002;57(1):M7-11.
Barker T, Henriksen VT, Rogers VE, et al. Vitamin D deficiency associates with γ-tocopherol and quadriceps weakness but not inflammatory cytokines in subjects with knee osteoarthritis. Redox Biol 2014;2:466-74.
Muraki S, Dennison E, Jameson K, et al. Association of vitamin D status with knee pain and radiographic knee osteoarthritis. Osteoarthritis Cartilage 2011;19(11):13010-6.
Annweiler C, Schott-Petelaz AM, Berrut G, et al. Vitamin D deficiency-related quadriceps weakness: results of the Epidemiologie De l'Osteoporose cohort. J Am Geriatr Soc 2009;57(2):368-69.
Toffanello ED, Perissinotto E, Sergi G, et al. Vitamin D and physical performance in elderly subjects: the Pro.V.A study. PLoS One 2012;7(4):e34950
Pfeifer M, Begerow B, Minne HW, et al. Effects of a longterm vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 2009;20(2):315-22.
Bunout D, Barrera G, Leiva L, et al. Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects. Exp Gerontol 2006;41(8):746-52.
Annweiler C, Beauchet O, Berrut G et al. Is there an association between serum 25-hydroxyvitamin D concentration and muscle strength among older women? Results from baseline assessment of the EPIDOS study. J Nutr Health Aging 2009;13(2):90-5.
Shaunak S, Ang L, Colston K, et al. Muscle strength in healthy white and Asian subjects: the relationship of quadriceps maximum voluntary contraction to age, sex, body build and vitamin D. Clin Sci (Lond) 1987;73(5):541-6.
Heidari B, Heidari P, Hajian K. Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop 2011;35(11):1627-31.
Altman R, Asch E, Bloch D, et al. Development of criteria for classification and reporting of osteoarthritis of the knee. Arthtitis Rheum1986;29(8):1039-49.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81(3):353-73.
Tubach F, Ravaud P, Baron G, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 2005;64(1):29-33.
Shakoor MA, Rahman MS, Azad AK, et al. Effects of isometric quadriceps muscle strengthening exercise on chronic osteoarthritis of the knee. Bangladesh Med Res Counc Bull 2010;36(1):20-2.
Hafez AR, Al-Johani AH, Zakaria AR. Treatment of knee osteoarthritis in relation to hamstring and quadriceps strength. J Phys Ther Sci 2013;25(11):1401-15
Janssen HC, Emmelot-Vonk MH, Verhaar HJ, et al. Vitamin D and muscle function: is there a threshold in the relation? J Am Med Dir Assoc 2013;14(8):627.e13-18.
Laslett LL, Quinn S, Burgess JR, et al. Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study. Ann Rheum Dis 2014;73(4):697-703.
Sanghi D, Mishra A, Sharma AC, et al. Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res 2013;471(11):3556-62.
McAlindon T, LaValley M, Schneider E, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA 2013;309(2):155-62.
Rejnmark L. Effects of vitamin d on muscle function and performance: a review of evidence from randomized controlled trials. Ther Adv Chronic Dis 2011;2(1):25-37.
Gordon PL, Sakkas GK, Doyle JW, et al. Relationship between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis. J Ren Nutr 2007;17(6):397-407.
Toffanello.ED, Perissinotto E, Sergi G, et al. Vitamin D and physical performance in elderly subjects. Thr Pro.V.A Study. Plos One 2012;7(4):e34950.
Hornikx M, van Remoortel H, Lehouck A, et al. Vitamin D supplementation during rehabilitation in COPD: a secondary analysis of a randomized trial. Respir Res 2012:13(1):84.
Heidari B, Monadi M, Asgharpour M, et al. Efficiency of supplemental vitamin D in patients with chronic obstructive pulmonary disease. Br J Med Med Res 2014;4(16):3031-41.
Rejnmark L. Effect of vitamin D on muscle function and performance. A review of Evidence from Randomized Controlled Trials. Ther Adv Chronic Dis 2011;2(1):25-37.
Cianferotti L, Marcocci QC. Subclinical vitamin D deficiency. Best Pract Res Clin Endocrinol Metab 2012;26(4):523-37.
Heidari B,Haj Mirghassemi MB.Variations in serum vitamin D according
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.