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


The 197 excluded participants were older and had more depressive symptoms, and poorer cognition. Also, men with low vitamin D levels had lower calcium and vitamin D intake than the remainder of the cohort. Excluded women had more moderate to severe lower extremity pain without back pain than those who were included, and excluded men had more sites with moderate to severe pain than men who were included.

The median 25(OH)D levels (interquartile range (IQR)) were 48.9 nmol/L (35.4, 73.6) for men and 33.9 nmol/L (23.5, 50.7) for women. The mean age was 75.1 ± 7.3 for women included in the study and 73.9 ± 6.8 for men. Selected baseline characteristics of the study sample are displayed in Table 1. Men and women with low vitamin D were older and had more depressive symptoms, poorer cognition, and higher PTH levels than those with high vitamin D. Also, men with low vitamin D had lower calcium intake than those with low vitamin D.

Reports of significant musculoskeletal pain were fairly common in the women in this cohort but not in the men (Figure 1); 57.1% of the women reported having at least moderate severity pain in one or more locations, compared with 27.5% of the men. Having dual regions of pain (lower extremity and back) was also more common in women than men (35.5% vs 12.8%). In terms of back pain alone, reports were similar between men (10.7%) and women (11.5%).

With the exception of back pain alone in women, pain distributions of subjects classified as vitamin D deficient and those not deficient were similar (overall P-value .57 for men and .06 for women). The relationship between back pain alone and vitamin D status was largely responsible for the nearly significant overall P-value seen in women. As seen in Table 1 and Figure 1, in women who were vitamin D deficient, the percentage with significant back pain alone was nearly double that of the women who were not vitamin D deficient (P = .04).

As seen in Table 2 , women who were classified as vitamin D deficient had 1.96 greater odds (95% confidence interval = 1.01-3.59) of at least moderate back pain without lower extremity pain versus no or mild pain only than those who were not classified as vitamin D deficient (P = .04), although vitamin D deficiency did not lead to significantly greater odds of moderate or severe pain in the lower extremities or of dual-region pain (lower extremity and back). The addition of PTH to the model attenuated the odds ratio for back pain only marginally. In men, the same relationship between vitamin D status and back pain did not exist; low vitamin D levels did not appear to be related to any pain pattern in men ( Table 3 ).

Figure 1.

Cumulative self-reported pain burden of the sample according to sex and vitamin D status.
LE = lower extremity.


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