Background: Vitamin D is important for musculoskeletal health and may have significant implications for maintaining physical activity in elderly patients. Our goal was to investigate whether serum 25-hydroxyvitamin D (25OHD) levels are associated with pre-operative physical activity in patients who are offered elective knee or hip joint replacement surgery.
Methods: We performed a single-center, retrospective analysis of patients who had elective knee or hip replacement surgery from 2002 to 2012. To investigate the association of serum 25OHD levels with pre-operative physical activity, as assessed by the University of California, Los Angeles (UCLA) activity scale, we performed a multivariable logistic regression analysis while controlling for age, sex, race, body mass index, American Society of Anesthesiologists physical status score, and season.
Results: We identified 182 patients who met inclusion criteria. Mean (± standard deviation) 25OHD level and UCLA activity scale score were 29±13 ng/mL and 4±2, respectively. Patients with 25OHD levels <20 ng/mL were almost three times more likely to have UCLA activity scale scores ≤3 [adjusted odds ratio 2.78; 95% confidence interval 1.72–9.17]. Further adjusting for “type of 25OHD assay” or “type of joint surgery” did not materially change this result.
Conclusion: In our cohort of knee or hip joint replacement surgery patients, 25OHD levels were associated with pre-operative physical activity scores. Prospective, randomized, clinical trials are needed to verify whether optimizing pre-operative vitamin D status may improve physical activity and influence clinical decision-making in knee or hip joint replacement surgery candidates.
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58(1):26–35.
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010; 26(3):355–369.
Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthritis Rheum. 2004; 50(5):1501–1510.
American Academy of Orthopaedic Surgeons. Osteoarthritis. http://orthoinfo.aaos.org/topic.cfm?topic=a00227. Accessed 03-20-2015 .
Centers for Disease Control and Prevention. FastStats – Inpatient Surgery. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm. Accessed 03-20-2015 .
Wilson NA, Schneller ES, Montgomery K, Bozic KJ. Hip and knee implants: current trends and policy considerations. Health Aff (Millwood). 2008; 27(6):1587–1598.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780–785.
Brandt KD, Dieppe P, Radin EL. Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am. 2008; 34(3):531–559.
Verweij LM, van Schoor NM, Deeg DJ, Dekker J, Visser M. Physical activity and incident clinical knee osteoarthritis in older adults. Arthritis Rheum. 2009; 61(2):152–157.
Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, et al. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint Bone Spine. 2006; 73:442–455.
Dekker J, van Dijk GM, Veenhof C. Risk factors for functional decline in osteoarthritis of the hip or knee. Arthritis Rheum. 2006; 55(5):779–785.
Fransen M, McConnell S, Bell M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J Rheumatol. 2002; 29(8):1737–1745.
van Baar ME, Assendelft WJJ, Dekker J, Oostendorp RA, Bijlsma JW. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 1999; 42(7):1361–1369.
Pisters MF, Veenhof C, Schellevis FG, Twisk JW, Dekker J, De Bakker DH. Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee. Arthritis Care Res (Hoboken). 2010; 62(8):1087–1094.
Ebeling PR. Vitamin D and bone health: epidemiologic studies. Bonekey Rep. 2014; 3:511.
Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E , Slomian J, et al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014; 99(11):4336–4345.
Quraishi SA, Camargo CA Jr. Vitamin D and major chronic illness. J Restor Med. 2012; 1(1):9–23.
Matossian-Motley DL, Drake DA, Samimi JS, Camargo CA Jr, Quraishi SA. Association between serum 25(OH)D level and nonspecific musculoskeletal pain in acute rehabilitation unit patients. J Parenter Enteral Nutr. 2014; doi: 10.1177/0148607114555909 [Epub ahead of print] .
Hoffmann MR, Senior PA, Mager DR. Vitamin d supplementation and health-related quality of life: a systematic review of the literature. J Acad Nutr Diet. 2015; 115(3):406–418.
Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus. 2015; 24(4–5):483–489.
Wanner M, Richard A, Martin B, Linseisen J, Rohrmann S . Associations between objective and self-reported physical activity and vitamin D serum levels in the US population. Cancer Cause Control. 2015; 26(6):881–891.
Bogunovic L, Kim AD, Beamer BS, Nguyen J, Lane JM. Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis. J Bone Joint Surg Am. 2010; 92(13):2300–2304.
Nalichowski R, Keogh D, Chueh HC, Murphy SN. Calculating the benefits of a Research Patient Data Repository. AMIA Annu Symp Proc. 2006:1044.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011; 96(1):53–58.
Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009; 467(4):958–965.
Tetlow LC, Woolley DE. Expression of vitamin D receptors and matrix metalloproteinases in osteoarthritic cartilage and human articular chondrocytes in vitro. Osteoarthr Cartilage. 2001; 9(5):423–431.
Attur M, Al-Mussawir HE, Patel J, Kitay A, Dave M, Palmer G, et al. Prostaglandin E2 exerts catabolic effects in osteoarthritis cartilage: evidence for signaling via the EP4 receptor. J Immunol. 2008; 181(7):5082–5088.
Fukui T, Tenborg E, Yik JH, Haudenschild DR. In-vitro and in-vivo imaging of MMP activity in cartilage and joint injury. Biochem Biophys Res Commun. 2015; 460(3):741–746.
Malas FU, Kara M, Aktekin L, Ersöz M, Ozçakar L. Does vitamin D affect femoral cartilage thickness? An ultrasonographic study. Clin Rheumatol. 2014; 33(9):1331–1334.
Felson DT, Niu J, Clancy M, Aliabadi P, Sack B, Guermazi A, et al. Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum. 2007; 56(1):129–136.
Bergink AP, Uitterlinden AG, Van Leeuwen JP, Buurman CJ, Hofman A, Verhaar JA, et al. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: the rotterdam study. J Clin Rheumatol. 2009; 15(5):230–237.
Ding C, Cicuttini F, Parameswaran V, Burgess J, Quinn S, Jones G. Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian older adult cohort study. Arthritis Rheum. 2009; 60(5):1381–1389.
McAlindon T, LaValley M, Schneider E, Nuite M, Lee JY, Price LL, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. J Am Med Assoc. 2013; 309(2):155–162.
Sanghi D, Mishra A, Sharma AC, Singh A, Natu SM, Agarwal S, et al. Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res. 2013; 471(11):3556–3562.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(7):1911–30. Erratum in: J Clin Endocrinol Metab. 2011; 96(7):1911–30. Erratum in: J Clin Endocrinol Metab. 2011; 96(12):3908.