Research Unit, Spine Centre of Southern Denmark, Part of Clinical Locomotion Network, Hospital Lillebaelt, Institute of Regional Health Services, University of Southern Denmark, Oestre Hougvej 55, Middelfart, DK-5500, Denmark.
BMC Musculoskelet Disord. 2013 Mar 4;14:78. doi: 10.1186/1471-2474-14-78.
BACKGROUND: Hypovitaminosis D has previously been reported in both the general population, in people with chronic musculoskeletal pain, and in people with low back pain (LBP). Myopathy-related symptoms such as diffuse bone and muscle pain, weakness and paresthesia in the legs, have also been observed in people with non-specific LBP and associations with low levels of Vitamin D have been suggested. The objectives of this study were to investigate (1) Vitamin D levels in patients seeking care for LBP in a Danish out-patient secondary care setting, and (2) their possible relationship with myopathy-related symptoms, Body Mass Index (BMI), and Modic changes. METHODS: A total of 152 consecutive patients with non-specific LBP participated in a cross-sectional study. Participants were recruited at The Spine Centre of Southern Denmark during springtime 2011. Individual serum levels of 25-Hydroxyvitamin-D were determined using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Information about symptoms, height, and weight were collected from electronic questionnaires completed by the participants. All patients had an MRI from which Modic changes were identified. Correlations between Vitamin D level and pain, paresthesia, weakness in the legs, BMI or Modic changes were described using correlation coefficients and odds ratios obtained from logistic regression. RESULTS: Two-thirds of the included patients with LBP had normal Vitamin D levels of >50 nmol/L. No correlations were seen between Vitamin D deficiency and gender, age, back pain intensity, leg pain intensity, and duration of pain. Statistically significant, but low, correlation coefficients were found between Vitamin D levels and BMI as well as Modic changes. Low Vitamin D levels and Modic changes were statistically significantly associated with an odds ratio of 0.30 (95% CI 0.12; 0.75) while weakness, paresthesia and widespread pain were not. CONCLUSIONS: In patients seeking care for low back pain in a Danish outpatient clinic, Vitamin D deficiency was not common. Whether patients who are overweight or who have Modic changes might represent subgroups of people for whom their LBP may be associated with Vitamin D levels, needs further investigation.
背景：维生素 D 缺乏症以前在普通人群、患有慢性肌肉骨骼疼痛的人群以及患有下背痛（LBP）的人群中均有报道。在患有非特异性 LBP 的人群中，也观察到与肌病相关的症状，如弥漫性骨痛和肌肉疼痛、下肢无力和感觉异常，并提示与低维生素 D 水平有关。本研究的目的是调查（1）在丹麦门诊二级保健环境中寻求 LBP 治疗的患者的维生素 D 水平，以及（2）他们与肌病相关症状、体重指数（BMI）和 Modic 变化的可能关系。
方法：共有 152 名患有非特异性 LBP 的连续患者参与了一项横断面研究。参与者于 2011 年春季在丹麦南部脊柱中心招募。使用液相色谱串联质谱法（LC-MS/MS）测定个体血清 25-羟维生素 D 水平。参与者通过电子问卷收集症状、身高和体重信息。所有患者均进行了 MRI 检查，以确定 Modic 变化。使用逻辑回归获得的相关系数和比值比描述了维生素 D 水平与疼痛、感觉异常、下肢无力、BMI 或 Modic 变化之间的相关性。
结果：三分之二的患有 LBP 的患者维生素 D 水平正常，>50nmol/L。维生素 D 缺乏与性别、年龄、腰痛强度、腿痛强度和疼痛持续时间之间未见相关性。发现维生素 D 水平与 BMI 和 Modic 变化之间存在统计学上显著但相关性较低的相关系数。低维生素 D 水平和 Modic 变化与比值比为 0.30（95%CI 0.12；0.75）相关，而无力、感觉异常和广泛疼痛则不相关。
结论：在丹麦门诊诊所寻求治疗下背痛的患者中，维生素 D 缺乏并不常见。超重或 Modic 变化的患者是否可能代表其 LBP 与维生素 D 水平相关的人群亚组，需要进一步研究。
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