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.