Musculoskeletal, Bone and Periodontal Health
Vitamin D deficiency is directly associated with some bones and
musculoskeletal problems such as rickets, osteopenia, osteomalacia,
osteoporosis and osteoarthritis (26). Vitamin D supplementation showed
beneficial effects in Musculoskeletal pain proving it to be a sign of
Vitamin D deficiency (27, 28). A study conducted in 400 participants
with complain of musculoskeletal pain (43.5% males and 55.5% females)
with age ranging from 18 to 80 years in a less developed city Swat (29)
which showed only 7% of the subjects had adequate levels of vitamin D
(>30 ng/mL). Similar results were obtained from a
cross-sectional observational study conducted in an outpatient
department of Rahim Yar Khan, Punjab (30). About 400 patients with
musculoskeletal pain showed that 47% of the subjects had low vitamin D
levels (<30 ng/mL). In another study, fibromyalgia and
nonspecific musculoskeletal pain were reported with lower levels of
vitamin D in female subjects in Karachi (31). Similarly, out of 100
subjects with sign of fatigue, 92 subjects were also found vitamin D
deficienct (32).
Vitamin D deficiency with poor bone health was observed in premenopausal
women (33). It was found that out of 174 subjects, the high bone
turnover was present in 36.8% subjects and vitamin D deficiency was
observed in 96.9% subjects. A similar study was conducted in 143
postmenopausal women in rural communities to assess bone mineral density
by quantitative ultrasound index (QUI) and their dietary habits (34).
The results showed that 42% of the women had osteopenia and 29% had an
indicative score of osteoporosis. Vitamin D deficiency and low calcium
intake in the diet were found more prevalent in this study.
Another study conducted to assess dietary calcium, vitamin D status and
bone turnover in 305 women subjects in three towns of Karachi city (35).
Overall, 90.5% subjects were found vitamin D deficient and in these,
42.6% subjects had secondary hyperparathyroidism. The 76.7% female
subjects had low while, only 23.3% had normal bone turnover.
A survey was conducted to assess the status of calcium and vitamin D
deficiency along with awareness about osteopenia and osteoporosis in 252
female subjects in Karachi out of which only 34% subjects had its
awareness while 77% subjects had pain in back, legs and joints. (36)
A multicentric cross-sectional study including 291 subjects (39.5%
males and 60.5% females) from three big cities (Karachi, Lahore and
Islamabad) was conducted (37). Overall 84% subjects had vitamin D
levels below the normal limit (30 ng/mL). A significant difference in
Vitamin D levels was found on the basis of age and skin color. Total 147
(48%) subjects had low BMD and out of them 98 (66.6%) had osteopenia.
In these total 98 osteopenic subjects, 80 (81.6%) had low vitamin D
levels. The vitamin D levels were not significantly different between
subjects having low bone mineral density, serum calcium and phosphorus
levels.
The association of periodontal health with vitamin D deficiency is quite
prevalent worldwide (38). A study conducted in pregnant (n=36) and
non-pregnant women (n=35) revealed that pregnant women were more vitamin
D deficient than non-pregnant women but no association between vitamin D
deficiency and periodontal diseases was found (39). The results of a
randomized clinical trial conducted in 85 female of 12 weeks of
gestation revealed that after 4000 IU dose of vitamin D on daily basis
could not improve the periodontal status and birth weight among the
study subjects (40).
The association of vitamin D level with above mentioned disease
conditions was not described on the basis of adequately adjusted model,
therefore it could not be inferred that only vitamin D deficiency is
responsible for above mentioned conditions.