Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51, Kanooka Grove, Clayton, VIC, 3168 Australia.
J Steroid Biochem Mol Biol. 2019 Jan;185:212-217. doi: 10.1016/j.jsbmb.2018.09.005. Epub 2018 Sep 7.
Back pain is currently the greatest cause of disability worldwide, and there are very limited therapeutic options available. Vitamin D deficiency and obesity are both risk factors for back pain. The few randomised controlled trials examining the effects of vitamin D supplementation on back pain have methodological limitations and largely include non-vitamin D deficient participants. Thus, the aim of this study was to determine whether vitamin D supplementation improves back pain symptoms in vitamin D deficient and overweight or obese, otherwise healthy adults. Sixty-five overweight or obese adults (BMI ≥ 25 kg/m) with vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] concentrations ≤50 nmol/L) were randomised to a bolus oral dose of 100,000 IU followed by 4000 IU cholecalciferol/day or matching placebo for 16 weeks. We measured 25(OH)D concentrations (chemiluminescent immunoassays) and self-reported back pain (Chronic Pain Grade Questionnaire) before and after the intervention. Lifestyle habits including sun exposure, physical activity, and diet were collected using questionnaires. Fifty-four participants completed the study, of which 49 had complete data for back pain and were included in the present analyses (31 M/18 F; mean ± SD age: 31.8 ± 8.9 years; BMI: 31.1 ± 4.5 kg/m). After the 16-week intervention, 25(OH)D levels increased significantly with vitamin D supplementation compared with placebo (55.7 ± 20.9 versus 3.9 ± 14.4 nmol/L, respectively, p < 0.001). There were no significant differences between vitamin D and placebo groups in change in back pain intensity or disability scores (all p > 0.05). However, in those with 25(OH)D concentrations <30 nmol/L at baseline (n = 20), there was a significantly greater reduction in back pain disability scores in the vitamin D group compared with placebo, after adjusting for important covariates known to affect vitamin D status and/or back pain (b [95%CI] = -11.6 [-22.4, -0.8], p = 0.04). Our findings suggest that vitamin D supplementation in overweight or obese and markedly vitamin D deficient adults (25(OH)D <30 nmol/L) may improve back pain disability. Although treating severe vitamin D deficiency is recommended for optimising bone health, this study suggests it may also improve back pain. Hence, testing for vitamin D deficiency in those with back pain who are overweight or obese may be warranted.
目前，背痛是全球致残的首要原因，而可供选择的治疗方法非常有限。维生素 D 缺乏和肥胖都是背痛的风险因素。少数随机对照试验研究了维生素 D 补充剂对背痛的影响，但这些试验都存在方法学上的局限性，且大多纳入了非维生素 D 缺乏的参与者。因此，本研究旨在确定维生素 D 补充剂是否能改善维生素 D 缺乏和超重或肥胖（BMI≥25kg/m2）、且健康状况良好的成年人的背痛症状。我们将 65 名超重或肥胖（BMI≥25kg/m2）且维生素 D 缺乏（25-羟维生素 D [25(OH)D] 浓度≤50nmol/L）的成年人随机分为两组，一组给予 100,000IU 的口服冲击剂量，随后每天补充 4000IU 胆钙化醇，另一组给予匹配的安慰剂，疗程为 16 周。我们在干预前后测量了 25(OH)D 浓度（化学发光免疫分析）和自我报告的背痛（慢性疼痛等级问卷）。使用问卷收集了包括阳光暴露、身体活动和饮食在内的生活方式习惯。54 名参与者完成了研究，其中 49 名参与者的背痛数据完整，被纳入本分析（31 名男性/18 名女性；平均年龄±标准差：31.8±8.9 岁；BMI：31.1±4.5kg/m2）。与安慰剂相比，维生素 D 补充剂显著增加了 25(OH)D 水平（分别为 55.7±20.9 和 3.9±14.4nmol/L，p<0.001）。维生素 D 组和安慰剂组在背痛强度或残疾评分的变化方面无显著差异（均 p>0.05）。然而，在基线时 25(OH)D 浓度<30nmol/L 的 20 名参与者中，维生素 D 组的背痛残疾评分下降幅度明显大于安慰剂组，这一差异在调整了已知影响维生素 D 状态和/或背痛的重要协变量后仍然存在（b[95%CI]=-11.6[-22.4,-0.8]，p=0.04）。我们的研究结果表明，在超重或肥胖且明显维生素 D 缺乏的成年人（25(OH)D<30nmol/L）中补充维生素 D 可能会改善背痛的残疾程度。虽然建议治疗严重的维生素 D 缺乏症以优化骨骼健康，但本研究表明，它也可能改善背痛。因此，对超重或肥胖且有背痛的患者进行维生素 D 缺乏症检测可能是合理的。
