Document Detail

Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial.
MedLine Citation:
PMID:  23299607     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Knee osteoarthritis (OA), a disorder of cartilage and periarticular bone, is a public health problem without effective medical treatments. Some studies have suggested that vitamin D may protect against structural progression.
OBJECTIVE: To determine whether vitamin D supplementation reduces symptom and structural progression of knee OA.
DESIGN, SETTING, AND PATIENTS: A 2-year randomized, placebo-controlled, double-blind, clinical trial involving 146 participants with symptomatic knee OA (mean age, 62.4 years [SD, 8.5]; 57 women [61%], 115 white race [79%]). Patients were enrolled at Tufts Medical Center in Boston between March 2006 and June 2009.
INTERVENTION: Participants were randomized to receive either placebo or oral cholecalciferol, 2000 IU/d, with dose escalation to elevate serum levels to more than 36 ng/mL.
MAIN OUTCOME MEASURES: Primary outcomes were knee pain severity (Western Ontario and McMaster Universities [WOMAC] pain scale, 0-20: 0, no pain; 20, extreme pain), and cartilage volume loss measured by magnetic resonance imaging. Secondary end points 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.
RESULTS: Eighty-five percent of the participants completed the study. Serum 25-hydroxyvitamin D levels increased by a mean 16.1 ng/mL (95% CI, 13.7 to 18.6) in the treatment group and by a mean 2.1 mg/mL (95% CI, 0.5 to 3.7) (P < .001) in the placebo group. Baseline knee pain was slightly worse in the treatment group (mean, 6.9; 95% CI, 6.0 to 7.7) than in the placebo group (mean, 5.8; 95% CI, 5.0 to 6.6) (P = .08). Baseline knee function was significantly worse in the treatment group (mean, 22.7; 95% CI, 19.8 to 25.6) than in the placebo group (mean, 18.5; 95% CI, 15.8 to 21.2) (P = .04). Knee pain decreased in both groups by a mean -2.31 (95% CI, -3.24 to -1.38) in the treatment group and -1.46 (95% CI, -2.33 to -0.60) in the placebo group, with no significant differences at any time. The percentage of cartilage volume decreased by the same extent in both groups (mean, -4.30; 95% CI, -5.48 to -3.12 vs mean, -4.25; 95% CI, -6.12 to -2.39) (P = .96). There were no differences in any of the secondary clinical end points.
CONCLUSION AND RELEVANCE: Vitamin D supplementation for 2 years at a dose sufficient to elevate 25-hydroxyvitamin D plasma levels to higher than 36 ng/mL, when compared with placebo, did not reduce knee pain or cartilage volume loss in patients with symptomatic knee OA.
TRIAL REGISTRATION: Identifier: NCT00306774.
Timothy McAlindon; Michael LaValley; Erica Schneider; Melynn Nuite; Ji Yeon Lee; Lori Lyn Price; Grace Lo; Bess Dawson-Hughes
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-01-10     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  155-62     Citation Subset:  AIM; IM    
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MeSH Terms
Cartilage / pathology*
Dietary Supplements
Disease Progression
Double-Blind Method
Knee Joint / pathology
Magnetic Resonance Imaging
Middle Aged
Osteoarthritis, Knee / complications*,  drug therapy*,  pathology
Pain / etiology*,  prevention & control
Treatment Outcome
Vitamin D / therapeutic use*
Vitamins / therapeutic use*
Grant Support
Reg. No./Substance:
0/Vitamins; 1406-16-2/Vitamin D
Comment In:
JAMA. 2013 Apr 17;309(15):1583-4   [PMID:  23592097 ]
Ann Intern Med. 2013 Apr 16;158(8):JC9   [PMID:  23588774 ]
Phys Sportsmed. 2013 Sep;41(3):115-7   [PMID:  24113710 ]
JAMA. 2013 Apr 17;309(15):1583   [PMID:  23592096 ]

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