Back Pain, Hypovitaminosis D Relationship in Postmenopause
Back Pain, Hypovitaminosis D Relationship in Postmenopause
The multicenter study included 9354 women. In this cross-sectional study, 49 participants were excluded due to incomplete data; no one was excluded due to clinical vertebral fractures, neurological problems affecting the spine or diseases that could affect bone metabolism and use of drugs that interfere with vitamin D metabolism (once they were already excluded in the multicenter trial). Therefore, 9305 individuals underwent analysis in this study.
The mean age of participants was 67 years (range 60–85 years) and the average age of menopause was 48 years(18–72 years).
Hypovitaminosis D was found in 2272 individuals (24.4%). The vertebral fractures were found in 1412 (15.3%) of the women studied; 67.5% had back pain and 14.8% had limitations in their daily activities in the six previous months.
The Hypovitaminosis D individuals were older, with lower age on menopause and higher body mass index (BMI) than non-hypovitaminosis D women (Table 1).
Women with hypovitaminosis D reported more back pain than those with regular serum 25OHD concentrations (69.5% vs. 66.9%, p: 0.022), and the pain was more frequent and more severe (Table 2).
The Hypovitaminosis D was related to back pain even when analyzed only in individuals without fractures. In this case, 1302 subjects with hypovitaminosis D reported back pain (69.2%), against 3998 women without hypovitaminosis D (66.5%) (p:0.021).
The logistic regression analysis pointed out that presence of hypovitaminosis D was independently related to back pain (p:0.027; Exp(B): 0.890; IC95% 0.802 – 0.987). The ROC curve demonstrated that serum 25OHD concentration below 39.1 had a sensibility of 90% to indicate back pain; concentration above 95.0 had a specify of 90% to rule out back pain. However, the weak area under the curve of 0.525 ± 0.006 (p < 0.001, CI95% 0.512 – 0.538), does not lead to a proper cut off point.
Both populations did not differ regarding back pain localization: cervical pain present in 311 (13.7%) of women with hypovitaminosis D and 974 (13.8%) of those without hypovitaminosis D (p:0.847); thoracic pain was identified in 553 (24.3%) vs. 1594 (22.7%), p:0.099; the thoraco-lumbar transition were referred as painful by 460 (20.2%) vs 1440 (20.5%), p: 0.814; lumbar pain was present in 881 (38.8%) vs 2605 (37.0%), p:0,137. The only region more prevalent in hypovitaminosis D subjects was the lumbar-sacra: 321 (14.1%) vs 876 (12.5%) (p: 0.038).
More hypovitaminosis D subjects reported more daily activities restrictions than those without hypovitaminosis D (17.2% vs 14.0%, p: 0.001). They reported more daily activity restrictions (5.2 +/- 23.3 vs 3.85 +/- 20.4 days, p: <0.001) and longer bedridden (0.7 +/- 5.3 vs 0.3 +/- 3.5 days, p: < 0.001). Moreover, women with hypovitaminosis D had more trouble in performing all daily activities, according to the Newitt/Cummings questionnaire, and the degree of difficulty was higher compared to those with normal serum 25OHD concentrations (Table 3).
Results
The multicenter study included 9354 women. In this cross-sectional study, 49 participants were excluded due to incomplete data; no one was excluded due to clinical vertebral fractures, neurological problems affecting the spine or diseases that could affect bone metabolism and use of drugs that interfere with vitamin D metabolism (once they were already excluded in the multicenter trial). Therefore, 9305 individuals underwent analysis in this study.
The mean age of participants was 67 years (range 60–85 years) and the average age of menopause was 48 years(18–72 years).
Hypovitaminosis D was found in 2272 individuals (24.4%). The vertebral fractures were found in 1412 (15.3%) of the women studied; 67.5% had back pain and 14.8% had limitations in their daily activities in the six previous months.
The Hypovitaminosis D individuals were older, with lower age on menopause and higher body mass index (BMI) than non-hypovitaminosis D women (Table 1).
Women with hypovitaminosis D reported more back pain than those with regular serum 25OHD concentrations (69.5% vs. 66.9%, p: 0.022), and the pain was more frequent and more severe (Table 2).
The Hypovitaminosis D was related to back pain even when analyzed only in individuals without fractures. In this case, 1302 subjects with hypovitaminosis D reported back pain (69.2%), against 3998 women without hypovitaminosis D (66.5%) (p:0.021).
The logistic regression analysis pointed out that presence of hypovitaminosis D was independently related to back pain (p:0.027; Exp(B): 0.890; IC95% 0.802 – 0.987). The ROC curve demonstrated that serum 25OHD concentration below 39.1 had a sensibility of 90% to indicate back pain; concentration above 95.0 had a specify of 90% to rule out back pain. However, the weak area under the curve of 0.525 ± 0.006 (p < 0.001, CI95% 0.512 – 0.538), does not lead to a proper cut off point.
Both populations did not differ regarding back pain localization: cervical pain present in 311 (13.7%) of women with hypovitaminosis D and 974 (13.8%) of those without hypovitaminosis D (p:0.847); thoracic pain was identified in 553 (24.3%) vs. 1594 (22.7%), p:0.099; the thoraco-lumbar transition were referred as painful by 460 (20.2%) vs 1440 (20.5%), p: 0.814; lumbar pain was present in 881 (38.8%) vs 2605 (37.0%), p:0,137. The only region more prevalent in hypovitaminosis D subjects was the lumbar-sacra: 321 (14.1%) vs 876 (12.5%) (p: 0.038).
More hypovitaminosis D subjects reported more daily activities restrictions than those without hypovitaminosis D (17.2% vs 14.0%, p: 0.001). They reported more daily activity restrictions (5.2 +/- 23.3 vs 3.85 +/- 20.4 days, p: <0.001) and longer bedridden (0.7 +/- 5.3 vs 0.3 +/- 3.5 days, p: < 0.001). Moreover, women with hypovitaminosis D had more trouble in performing all daily activities, according to the Newitt/Cummings questionnaire, and the degree of difficulty was higher compared to those with normal serum 25OHD concentrations (Table 3).
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