Association of back pain with hypovitaminosis D in postmenopausal women with low bone mass

BMC Musculoskeletal Disorders

Lizanka Paola Figueiredo Marinheiro²  Renata Alexandra Calixto Pinheiro¹  Luiz Henrique de Gregório¹  Luis Augusto Tavares Russo¹  Paulo Gustavo Sampaio Lacativa¹  Ariane Viana de Souza e Silva² 

[1] CCBR Brasil - Center for Clinical and Basic Research, Rua Mena Barreto 33 Botafogo, Rio de Janeiro, Brazil;Instituto Fernandes Figueira / Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil

关键词: Newwit/Cummings questionnaire;    Back pain;    Hypovitaminosis D;   

Others  :  1130551
DOI  :  10.1186/1471-2474-14-184

 received in 2012-12-21, accepted in 2013-06-07,  发布年份 2013

【 摘 要 】

Background

Back pain is a major public health problem due to its high frequency, to the resulting activity constraint, and the need for surgery in many cases. Back pain is more frequent in women than men, mainly in postmenopausal women. High prevalence of hypovitaminosis D has been detected in postmenopausal women, and it is associated with decreased bone mass, sarcopenia, vertebral fractures, and inflammation, which can be related to back pain.

Methods

The relation between back pain and hypovitaminosis D was evaluated in this study, as well the difference regarding the number of bedridden days, number of days away from work, and daily activities limitation between women with and without hypovitaminosis D. This study reviewed baseline data from an interventional phase III multicenter trial in low bone mass postmenopausal women. The study included demographic data, 25OHD determinations, Newitt/Cummings questionnaire on back pain, and vertebral fracture identified thought X-ray evaluation.

Results

The trial included 9354 participants, but only 9305 underwent all the evaluations. The age median was 67 (60 - 85 years old) and age at menopause was 49 (18 - 72 years). Hypovitaminosis D was found in 22.5% of the subjects, 15.3% of them had vertebral fractures, 67.5% with back pain, and 14.8% reduced their daily activities in the previous six months. Subjects with hypovitaminosis D, compared to those without hypovitaminosis D, reported more back pain (69.5 v 66.9%, p: 0.022), more cases of severe back pain (8.5% v 6.8%, p: 0,004), higher limitation in their daily activities (17.2 v 14.0%, p: 0.001), and more fractures (17.4 v 14.6%, p: 0,002); also, they had more trouble to perform daily activities addressed in the Newwit/Cummings questionnaire.

Conclusion

Hypovitaminosis D was related to back pain, to its severity, and to difficulty in perform daily activities.

Trial registration

ClinicalTrial.gov: NCT00088010

【 授权许可】

   
2013 e Silva et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Van Tulder MW, Koes BW, Bouter LM: A cost-of-illness study of back pain in The Netherlands. Pain 1995, 62(2):233-240.
• [2]Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain 2000, 84(1):95-103.
• [3]Praemer S, Furnes S, Rice DP: Musculoskeletal conditions in the United States. 1st edition. Rosemont, IL: Amer Acad of Orthopaedic Surgeons; 1992.
• [4]Taylor VM, Deyo RA, Cherkin DC, Kreuter W: Low back pain hospitalization: recent United States trends and regional variations. Spine 1994, 19:1207-1213.
• [5]Andersson GBJ: Epidemiological features of chronic low-back pain. Lancet 1999, 354:581-585.
• [6]Ahn S, Song R: Bone mineral density and perceived menopausal symptoms: factors influencing low back pain in postmenopausal women. Journal of advanced nursing 2009, 65(6):1228-1236.
• [7]Silva TAA, Junior AF, Pinheiro MM, Szejnfeld VL: Sarcopenia assocated to aging: etiologic aspects ans terapheutic options. Rev. Bras. Reumatol 2006, 46:391-397.
• [8]Lips P, Hosking K, Lipunner K, et al.: The prevalence of vitamin D inadequacy amongst women with osteoporosis. An international epidemiological investigation. J Intern Med 2006, 260(3):245-254.
• [9]Heaht IKM, Elovic EP: Vitamin D deficiency: implications in the rehabilitation setting. Am J Phys Med Rehabil 2006, 85:916-923.
• [10]Visser M, Deeg DJ, Lips P: Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2003, 88:5766-55772.
• [11]Zhu K, Austin N, Devine A, Bruce D, Prince RL: A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. J Am Geriatr Soc 2010, 58(11):2063-2068.
• [12]Goulding A: Lightening the fracture load: growing evidence suggests many older New Zealanders would benefit from more vitamin D. N Z Med J 1999, 112(1095):329-330.
• [13]Trivedi DP, Doll R, Khaw KT: Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003, 326(1387):469.
• [14]Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutics implications. Endocr Rev 2001, 22:477-501.
• [15]Lacativa PGS, Farias ML: Osteoporosis and inflammation. Arq Bras Endocrinol Metab 2010, 54(2):123-132.
• [16]Cummings SR, McClung M, Reginster JY, Cox D, Mitlak B, Stock J, Amewou-Atisso M, Powles T, Miller P, Zanchetta J, Christiansen C: Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women. J Bone Miner Res 2011, 26(2):397-404.
• [17]Newitt M, Ettinnger B, Black DM, et al.: The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Inter Med 1998, 1285:793-800.
• [18]McKenna MJ, Freaney R: Secondary hyperparathyroidism in the elderly: means to defining hypovitaminosis D. Osteoporos Int 1998, 8(Suppl 2):S3-6.
• [19]Schmidt CO, Kohlmann T: What do we know about the symptoms of back pain? Epidemiological results on prevalence, incidence, progression and risk factors. Z Orthop Ihre Grenzgeb 2005, 143(3):292-298.
• [20]Vaillant J, Vuillerme N, Martigné P, et al.: Balance, aging, and osteoporosis: effects of cognitive exercises combined with physiotherapy. Joint Bone Spine 2006, 73(4):414-418.
• [21]Vogt MT, Lauerman WC, Chirumbole M, Kuller LH: A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity. J Gerontol A Biol Sci Med Sci 2002, 57(8):544-550.
• [22]Russo LAT, Lacativa PGS, Marinheiro LPF, Gregório LH: Concentration of 25-hydroxyvitamin D in postmenopausal women with low bone mineral density. Arq Bras Endocrinol Metabol 2009, 53(9):1079-1087.
• [23]Lotfi A, Abdel-Nasser AM, Hamdy A, et al.: Hypovitaminosis D in female patients with chronic low back pain. Clinic Rheumatol 2007, 26:1895-1901.
• [24]Elfiving B, Dedering A, Németh G: Lumbar muscle fatigue and recovery in patients with long-term low-back trouble – electromyography and health-related factors. Clin Biomech 2003, 18:619-630.
• [25]Bradl I, Mörl F, Scholle HC, Graßme R, Müller R, Grieshaber R: Back muscle activation pattern and spectrum in defined load situations. Pathophysiology 2005, 12:275-280.
• [26]Crossman K, Mahon M, Watson PJ, Oldham JA, Cooper RG: Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined “adverse” fiber type composition. Spine 2004, 29:628-634.
• [27]Schwalfenberg G: Improvement of chronic back pain or failed back surgery with vitamin D repletion: a case series. J Am Board Fam Med 2009, 22(1):69-74.