Serum Levels of Vitamin D, Sunlight Exposure, and Knee Cartilage Loss in Older Adults
Ding, C and Cicuttini, F and Parameswaran, V and Burgess, JR and Quinn, SJ and Jones, G, Serum Levels of Vitamin D, Sunlight Exposure, and Knee Cartilage Loss in Older Adults, Arthritis and Rheumatism, 60, (5) pp. 1381-1389. ISSN 0004-3591 (2009) [Refereed Article]
Objective. To determine the associations between
serum levels of vitamin D, sunlight exposure, and knee
cartilage loss cross-sectionally and longitudinally in
Methods. A total of 880 randomly selected subjects
(mean age 61 years [range 51-79 years], 50% women) were studied at baseline, and 353 of these subjects were studied 2.9 years later. Serum levels of
25-hydroxyvitamin D (25[OH]D) were assessed by radioimmunoassay,
and sunlight exposure was assessed by questionnaire. T1-weighted fat-suppressed magnetic resonance imaging (MRI) of the right knee was performed
to determine knee cartilage volume and defects. Knee radiographic osteoarthritis (OA) and knee pain were also assessed.
Results. The mean 25(OH)D serum level was 52.8 nmoles/liter at baseline (range 13-119 nmoles/liter). Winter sunlight exposure and serum 25(OH)D level
were both positively associated with medial and lateral tibial cartilage volume, and a serum 25(OH)D level <50 nmoles/liter was associated with increased medial tibiofemoral joint space narrowing (all P < 0.05). Longitudinally,baseline serum 25(OH)D level predicted change in both medial and lateral tibial cartilage volume ( 0.04% per annum per nmole/liter for both; P < 0.05), and change in serum 25(OH)D level was positively associated with change in medial tibial cartilage volume. These associations were consistent in subjects with radiographic OA and knee pain and/or in women, but
not in men or in subjects without radiographic OA or knee pain.
Conclusion. Sunlight exposure and serum 25(OH)D levels are both associated with decreased knee cartilage loss (assessed by radiograph or MRI). This is
best observed using the whole range of 25(OH)D levels rather than predefined cut points and implies that achieving vitamin D sufficiency may prevent and/or
retard cartilage loss in knee OA.