Dear Raju

Here are some papers reporting on the subject:

McAlindon T, LaValley M, Schneider E, et al (2013). Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA; 309(2):155-162.

Ding C, Cicuttini F, Parameswaran V, et al.(2009). Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults. Arthritis Rheum; 60(5):1381-1389

Sanghi D, Mishra A, Sharma AC, et al. (2013). Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res; 471(11):3556-3562.

Glover TL, Goodin BR, Horgas AL et al (2012).. Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis. Arthritis Rheum; 64(12):3926-3935.

Heidari B, Heidari P, Haijan-Tilaki K. (2011). Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop; 35(11):1627-1631.

Bergink AP, Uitterlinden AG, Van Leeuwen JP, et al. (2009).Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee. J Clin Rehumatol; 15(5):230-237.

McAlindon TE, Felson DT, Zhang Y, et al. (1996). Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med; 125(5):353-359.

Muraki S, Dennison E, Jameson K, et al. (2001).Association of vitamin D status with knee pain and radiographic knee osteoarthritis. Osteoarthritis Cartilage; 19(11):1301-1306.

Felson DT, Niu J, Clancy M, et al. (2007). Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum; 56(1):129-136.

Al-Jarallah KF, Shehab D, Al-Awadhi A, et al. (2012). Are 25(OH)D levels related to the severity of knee osteoarthritis and function? Med Prince Pract; 21(1):74-78.

Konstari S, Paananen M, Heliövaara M, et al. (2012). Association of 25-hydroxyvitamin D with the incidence of knee and hip osteoarthritis: a 22-year follow-up study. Scand J Rheumatol; 41(2):124-131.

Chaganti RK, Parimi N, Cawthon P, et al. (2010). Association of 25-hydroxyvitamin D with prevalent osteoarthritis of the hip in elderly men: the osteoporotic fractures in men study. Arthritis Rheum; 62(2):511-514.

Felson DT. (2013). CORR Insights: Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res; 471(11):3563-3564.

Thomas Mabey and Sittisak Honsawek (2015). Role of Vitamin D in Osteoarthritis: Molecular, Cellular, and Clinical Perspectives. International Journal of Endocrinology Article; 2015, ID 383918,  http://dx.doi.org/10.1155/2015/383918

Hope you will find them interesting

Regards

George

Thanks George for these references. But, what is your take on this issue?

The answer is difficult. There are many reasons that lately drive us to research further on different factors that may influence OA and mainly in the knee.

1. In US the BMI of the patients is increasing and revision surgery and expenses are increasing too.

2. In UK on top of that there is an increasing waiting list for surgery, that drives the NHS and the Government to their limits.

New avenues had to be explored.

So suddenly in the last few years we returned to the biology and biochemistry with the help of endocrinologists and we are trying to understand things that we abandoned many years ago, concentrating to the mechanics and their failures.

There is some evidence that Vit. D is playing a role to the function of the muscles and the articular cartilage. It is known that it is playing a role on bone metabolism anyway. Do we know though how to prevent or treat with only Vit. D the OA of the knee? No we do not. The reason is that it will take time

1. to convince surgeons that biology exists and so make them to understand it.

2. to establish which is the correct dose of Vit. D for OA treatment.

In my view endocrinology plays a role in bone and so in OA as it is a bone disease. we have though still to work hard to understand how. I am sure that rheumatologists will understand this before us and they will explain it to us. The future may have protocols of treatment produced by them for us.

The evidence we have for the moment is not enough to create the shift to more non operative treatment. We need more research and possibly to be communicated clearly to us, in plain language.

Thanks for your inputs, George

My take is Vit D has deleterious effect or at-least no effect on knee OA. You will find that most of the epidemiological studies failed to adjust for potential confounders or effect modifiers i.e. season of blood collection, latitude while analysing this effect. Some of the RCTs included people with vit D deficiencies and showed a protective effect. but large studies from McAlindon failed to show any protective effect. Yes we know that vitamin D acts on bone and cartilage but not sure whether the effects are good or bad.

I am really surprised to notice the views of Sultana. I have never come across with a publication or discussion pointing towards the deleterious effects of Vit D on knee OA. Can she provide some references on this point?

Vitamin D deficiency is still an association with OA and not a causative factor. But still it cannot be ignored.

I would also be surprised, if someone would say me something like what I have wrote.

Please check these recent articles

Konstari S, Paananen M, Heliövaara M, et al. (2012). Association of 25-hydroxyvitamin D with the incidence of knee and hip osteoarthritis: a 22-year follow-up study. Scand J Rheumatol; 41(2):124-131.

Konstari S, Kaila-Kangas L, Jääskeläinen T, Heliövaara M, Rissanen H, Marniemi J, Knekt P, Arokoski J, Karppinen J. Serum 25-hydroxyvitamin D and the risk of knee and hip osteoarthritis leading to hospitalization: a cohort study of 5274 Finns. Rheumatology (Oxford). 2014 Oct;53(10):1778-82.

Hussain SM, Daly RM, Wang Y, Shaw JE, Magliano DJ, Graves S, Ebeling PR, Wluka AE, Cicuttini FM. Association between serum concentration of 25-hydroxyvitamin D and the risk of hip arthroplasty for osteoarthritis: result from a prospective cohort study.Osteoarthritis Cartilage. 2015 Dec;23(12):2134-40.

There is no credible scientific data supporting vitamin D has anything to do with OA. However OA is associated  with increased body weight and overweight/ obesity is associated with low serum 25(OH)D levels. Thus, may be indirectly linked; but no causality .

Hallo @ all,

interesting discussion! In my opinion (eminence as internist in the osteoporosis field, not evidence ;-) ), I await no strong (in other words: clinically relevant) influence of Vit.D-deficiency on prevalent or rapid incident hip/knee OA, because the overweight and otherwise reduced muscular effects on the joint cartilage will drive the disease. So reducing body weight will be much more effective in reducing OA worsening, than giving Vit.D to get "optimal" Vit.D-serum levels. The story of linkage of low Vit.D to many chronic diseases maybe mostly coincidentally (like reduced activities in sunlight of ill vs. healthy probands, other food intakes, body weight etc.).

But, there are a number of large, long-lasting, population based, randomized clinical trials on the way looking on multiple clinical outcomes of Vit.D supplementation with "sufficient" Vit.D doses.  Those studies will provide many data regarding our questions. Publications will supposedly start in 2017. See:

http://do-health.eu/wordpress/

Thanks

Currently, there is a conflicting evidence concerning the supplementation of vitamin D in knee osteoarthritis condition. A latest systematic review assess the impact vitamin D supplementation particularly in the knee osteoarthritis patients. It found that though there was a significant increase in serum vitamin D level, it didn't translate into significant pain reduction and stiffness. It concluded that, current evidence is insufficient to promote the use of vitamin D in knee osteoarthritis patients.

Source: Article Vitamin D supplementation for the management of knee osteoar...

Thank you. But, we have seen that Vitamin D deficiency is much higher in patients who present with early onset of OA.

Rightly said, vitamin D deficiency may be present in the patients with OA more. Howsoever, there are studies for and against the role of Vitamin D deficiency in Knee OA.

For the role of Vitamin D deficiency in Knee OA:

http://jn.nutrition.org/content/144/12/2002

Against the role of Vitamin D deficiency in Knee OA:

Article Serum 25-hydroxyvitamin D and the risk of knee and hip osteo...

In fact this was the very reason it resulted in many RCTs to explore this hypothesis, however currently available evidence is insufficient to demonstrate a tangible benefit from Vitamin D supplementation in Knee OA patients.

Thanhsfor your contributions