Vitamin D Supplement Did Not Reduce Knee Pain,
Cartilage Loss in Seniors with Osteoarthritis
Older American men and women participated in study of
how to control age-related problem
Jan. 8, 2013 Senior citizens taking vitamin D
supplements in hopes of finding relief from the pain of age-related knee
osteoarthritis should consider another option. A report on a two-year
clinical trial found a placebo did as much good as vitamin D in
relieving pain or saving cartilage.
Knee osteoarthritis (OA) is a common age-related
musculoskeletal disorder that has significant functional impact and has
considerable societal costs through work loss, early retirement, and
arthroplasty. Despite its impact, there are no medical treatments
established to influence the course of the disease, according to
background on the study in the January 9 issue of the Journal of the
American Medical Association (JAMA).
Some studies, the authors point out, have
suggested that vitamin D may protect against structural progression.
Timothy McAlindon, D.M., M.P.H., of Tufts Medical
Center, Boston, and colleagues conducted the clinical trial to examine
whether vitamin D supplementation is associated with reductions in
symptomatic and structural progression of knee OA.
The 2-year randomized, placebo-controlled clinical
trial included 146 participants with symptomatic knee OA (average age,
62 years; 61 percent women), who were enrolled in the study between
March 2006 and June 2009.
Participants were randomized to receive either
placebo or oral cholecalciferol, 2,000 IU/day, with dose escalation to
increase serum levels to more than 36 ng/mL. Eighty-five percent of the
participants completed the study.
The primary measured outcomes for the study were
knee pain severity (Western Ontario and McMaster Universities WOMAC -
pain scale: 0, no pain; 20, extreme pain), and cartilage volume loss
measured by magnetic resonance imaging.
Secondary outcomes included physical function, knee
function (WOMAC function scale, 0-68: 0, no difficulty; 68, extreme
difficulty), cartilage thickness, bone marrow lesions, and radiographic
joint space width.
Serum 25-hydroxyvitamin D levels increased by an
average 16.1 ng/mL in the treatment group and by an average 2.1 ng/mL in
the placebo group.
Knee pain at the beginning of the study was
slightly worse in the treatment group (average, 6.9) than in the placebo
group (average, 5.8).
Knee function at the beginning of the study was
significantly worse in the treatment group (average, 22.7) than in the
placebo group (average, 18.5).
In the subset analyses for the WOMAC pain outcome,
the effects were generally similar, and nonsignificant. The researchers
found that knee pain decreased in both groups by an average -2.31 in the
treatment group and -1.46 in the placebo group, with no significant
differences at any time.
The percentage of cartilage volume decreased by the
same extent in both groups, by about 4 percent. There were no
differences in any of the secondary clinical end points.
There were 31 serious adverse events in the vitamin
D group and 23 in the placebo group but the number of participants who
experienced an event was 16 in each group additional results from
epidemiologic studies that emerged during the course of this study have
been mixed demonstrating positive and negative associations.
Two studies appeared to show strong associations of
bone density with the development of knee OA, but some of those
investigators later published concerns about the possibility of such
associations arising as a result of contingent confounding. Therefore,
together with the results of this clinical trial, the overall data
suggest that vitamin D supplementation at a dose sufficient to elevate
25-hydroxyvitamin D levels to more than 36 ng/mL does not have major
effects on clinical or structural outcomes in knee OA, at least in a
U.S. sample, the authors conclude.
This study was funded by a grant from the National
Institutes of Health, NIAMS, and the Office of Dietary Supplements, a
grant from the National Center for Research Resources, and a grant from
the Houston Veterans Affairs Health Services Research and Development
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