Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study

Gregory E. Hicks, PhD, PT; Michelle Shardell, PhD; Ram R. Miller, MDCM, MSc; Stefania Bandinelli, MD; Jack Guralnik, MD, PhD; Antonio Cherubini, MD; Fulvio Lauretani, MD; Luigi Ferrucci, MD, PhD


J Am Geriatr Soc. 2008;56(5):785-791. 

In This Article

Abstract and Introduction

Objectives: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex.
Design: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
Setting: Community.
Participants: Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.
Measurements: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L.
Results: The mean age±standard deviation was 75.1±7.3 for women and 73.9±6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio = 1.96, 95% confidence interval = 1.01-3.59) but not in men.
Conclusion: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.

Musculoskeletal pain is a well-documented cause of functional decline and progressive disability in older adults.[1,2] With the expectation that the older population will increase 75% over the next 25 years,[3] there will inevitably be an increase in prevalence of chronic pain and its associated societal costs. Thus, clinicians and researchers need to gain a better understanding of underlying pain mechanisms that are potentially mutable to develop effective intervention strategies.

Vitamin D deficiency has been linked to multiple poor outcomes in older adults, such as greater fracture risk,[4] impaired lower extremity function,[5] osteomalacia, and pain.[6,7,8,9] Vitamin D is known to be critically important for the maintenance of bone and muscle health through its role in calcium homeostasis.[10] The role of vitamin D in development of pain syndromes is less well known. It has been proposed that hypovitaminosis D-induced pain is due to a lack of calcium phosphate available to mineralize the collagen matrix of bone, with the matrix expanding under the innervated periosteum, leading to diffuse pain.[11]

Although multiple studies have suggested a link between vitamin D status and pain, particularly back pain,[6,7,9,12,13] there have been several studies that have found no relationship between vitamin D status and pain.[14,15,16] The relationship between vitamin D status and pain needs to be further explored. No large-scale study in older adults has examined the association between 25-hydroxyvitamin D (25(OH)D) concentrations and pain in ambulatory older persons. The objective of this study was to examine cross-sectional associations between vitamin D status and musculoskeletal pain using data from the Invecchiare in Chianti (InCHIANTI) Study. The hypothesis was that lower levels of 25(OH)D would be associated with the presence of significant pain in older adults. Because chronic pain is more prevalent in older women,[17] whether these relationships would differ according to sex was also examined.


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