Jin, X and Jones, G and Cicuttini, F and Wluka, A and Zhu, Z and Han, W and Antony, B and Wang, X and Winzenberg, T and Blizzard, L and Ding, C, Effect of vitamin D supplementation on tibial cartilage volume and knee pain among patients with symptomatic knee osteoarthritis: a randomized clinical trial, Journal of The American Medical Association, 315, (10) pp. 1005-1013. ISSN 0098-7484 (2016) [Refereed Article]
Copyright 2016 American Medical Association
IMPORTANCE: Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current trial evidence is contradictory.
OBJECTIVE: To compare the effects of vitamin D supplementation vs placebo on knee pain and knee cartilage volume in patients with symptomatic knee osteoarthritis and low vitamin D levels.
DESIGN, SETTING, AND PARTICIPANTS: A multicenter randomized, double-blind, placebo-controlled clinical trial in Tasmania and Victoria, Australia. Participants with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D (12.5-60 nmol/L) were enrolled from June 2010 to December 2011. The trial was completed in December 2013.
INTERVENTIONS: Participants were randomly assigned to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years.
MAIN OUTCOMES AND MEASURES: Primary outcomes were change in tibial cartilage volume (assessed using magnetic resonance imaging [MRI]) and change in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (0 [no pain] to 500 [worst pain]) from baseline to month 24. Secondary outcomes were cartilage defects and bone marrow lesions (assessed using MRI).
RESULTS: Of 413 enrolled participants (mean age, 63.2 years; 50% women), 340 (82.3%) completed the study. The level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/L) than in the placebo group (6.7 nmol/L) (P < .001) over 2 years. There were no significant differences in annual change of tibial cartilage volume or WOMAC pain score. There were no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Adverse events (≥ 1 per patient) occurred in 56 participants in the vitamin D group and in 37 participants in the placebo group (P = .04). [table: see text].
CONCLUSIONS AND RELEVANCE: Among patients with symptomatic knee osteoarthritis and low serum 25-hydroxyvitamin D levels, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or WOMAC knee pain score over 2 years. These findings do not support the use of vitamin D supplementation for preventing tibial cartilage loss or improving WOMAC knee pain in patients with knee osteoarthritis.
|Item Type:||Refereed Article|
|Keywords:||osteoarthritis, vitamin D|
|Research Division:||Medical and Health Sciences|
|Research Group:||Clinical Sciences|
|Research Field:||Rheumatology and Arthritis|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Skeletal System and Disorders (incl. Arthritis)|
|UTAS Author:||Jin, X (Mr Xingzhong Jin)|
|UTAS Author:||Jones, G (Professor Graeme Jones)|
|UTAS Author:||Zhu, Z (Mr Zhaohua Zhu)|
|UTAS Author:||Han, W (Dr Weiyu Han)|
|UTAS Author:||Antony, B (Dr Benny Eathakkattu Antony)|
|UTAS Author:||Wang, X (Ms Xia Wang)|
|UTAS Author:||Winzenberg, T (Professor Tania Winzenberg)|
|UTAS Author:||Blizzard, L (Professor Leigh Blizzard)|
|UTAS Author:||Ding, C (Professor Chang-Hai Ding)|
|Funding Support:||National Health and Medical Research Council (605501)|
|Web of Science® Times Cited:||38|
|Deposited By:||Menzies Institute for Medical Research|
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