抑郁症患者血清维生素D水平的研究

目的:探讨抑郁症患者血清维生素D水平及其与抑郁症病情的相关性。方法:随机抽取门诊抑郁症患者80例(抑郁症组),以电发光化学法测定血清25(OH)D3;并与50名性别、年龄相匹配的体检者(对照组)比较;采用汉密尔顿抑郁量表(HAMD)24项对抑郁症患者进行评估,分析血清25(OH)D3水平与HAMD评分的关系。结果:抑郁症组血清25(OH)D3[(25.54±7.09)ng/ml]明显低于对照组[(42.03±10.21)ng/ml](P0.01);抑郁症组血清维生素D不足率(60%)或缺乏率(25%)明显高于对照组(8%,0)(P均0.01);抑郁症患者血清25(OH)D3水平与HAMD评分呈负相关(r=-0.73,P0.01)结论:抑郁症患者血清维生素D水平降低,并与其病情相关。     

血清维生素D水平与老年急性脑梗死患者预后的相关性研究

目的探讨血清25-羟维生素D[25(OH)D]水平与老年急性缺血性脑梗死患者预后的关系。方法检测218例老年急性脑梗死患者的血清25(OH)D水平。采用改良mRS评估患者1年后功能恢复情况。结果根据25(OH)D水平将患者分为极低水平组54例、低水平组54例、中水平组55例和高水平组55例。极低水平组、低水平组、中水平组和高水平组间血红蛋白、糖化血红蛋白、三酰甘油、高密度脂蛋白水平及1年mRS评分、预后良好率差异有统计学意义(均P0.01)。调整干扰因素后,高水平组患者1年后功能恢复情况良好(OR=1.95,95%CI:1.13~3.26)。结论血清25(OH)D水平可以独立预测急性脑梗死患者功能恢复情况。     

前庭神经炎患者25羟维生素D和C反应蛋白水平的研究

目的分析急性前庭神经炎和健康对照组血清25羟维生素D(25(OH) D)及C反应蛋白的(CRP)水平,并分析二者与前庭神经炎(VN)的相关性。方法在2019年3月至2020年8月之间,航天731医院共收治了46例在症状发作7 d内被诊断为VN的患者,同时招募了66例年龄和性别相匹配的健康对照者。记录所有受试者的年龄,性别,身高,体重,生活习惯,持续的健康问题和用药史,并测量和比较25(OH) D和CRP的水平。结果 VN患者的血清25(OH) D水平显著低于对照组(18.30±6.19 vs.22.43±5.23 ng/ml,P 0.001),而CRP水平显著高于对照组(15.86±8.37 vs.ng/ml,P 0.001)。回归分析表明,25(OH) D及CRP与VN的患病相关,比值比分别为1.187 (95%CI=1.046～1.093,P=0.001),1.223(95%CI=1.10～1.36,P=0.000)。结论前庭神经炎是一种急性炎症反应,在前庭神经炎患者中25(OH) D水平降低,CRP水平升高。     

急性脑梗死后不宁腿综合征的临床特征

目的  了解急性脑梗死后不宁腿综合征（restless legs syndrome,RLS）的临床特征,以及其对急性脑梗死预后的影响。 方法  按照国际不宁腿工作组（International Restless Legs Syndrome Study Group,IRLSSG）定义标准,连续筛查住院治疗的急性脑梗死患者中RLS患者,选择年龄、性别、梗死部位匹配的同时期住院的非RLS脑梗死患者为对照组,比较2组的临床特征及预后。 结果  研究筛查275例急性脑梗死患者,其中RLS患者19例,患病率为6.91%（19/275）。RLS组年龄（62.89±10.26）岁;非RLS组19例,年龄（62.63±9.96）岁。与对照组比较,RLS组Epworth嗜睡量表（Epworth Sleepiness Scale,ESS）>10分的比例更高（57.9% vs 21.1%,P=0.020）,匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）>15分的比例也更高（47.4% vs 15.8%,P=0.040）。脑梗死后90?d和180?d,RLS组Barthel指数（Barthel Index,BI）低于非RLS组（P值分别是＜0.001和＜0.001）,改良Rankin量表（modified Rankin Scale,mRS）评分高于非RLS组（P值分别是0.64和0.04）。RLS组14例（73.68%）患者合并周期性腿动,15例（78.9%）患者合并阻塞性睡眠呼吸障碍。 结论  急性脑梗死后RLS患者较无RLS患者睡眠质量及预后更差。     

维生素D对敬老院内老年人抑郁情绪的影响——1年随访研究

目的:探讨补充维生素D制剂对老年人抑郁情绪的影响。方法:236名在养老院生活的老年人随机分成两组,每组118名。两组在补充钙片(1 000 mg/d)的基础上,研究组服用维生素D制剂1 200 IU/d;对照组服用安慰剂;疗程1年。研究前后分别检测两组血清25-羟基维生素D[25(OH)D]水平,并应用流调中心抑郁自评量表(CES-D)评估两组老年人的抑郁情绪。结果:基线时两组血清25(OH)D水平及CES-D评分比较差异无统计学意义;补充钙剂和/或维生素D 1年后,两组血清25(OH)D水平显著高于基线时,且研究组显著高于对照组(P0.05或P0.001);研究组CES-D得分显著低于对照组(t=-3.57,P0.001)。结论:常规补充维生素D制剂可有效纠正老年群体的血清维生素D水平,改善抑郁情绪。     

2型糖尿病伴发急性脑梗死患者血清维生素D水平与颅内外动脉狭窄的关系研究

目的探讨2型糖尿病(T2DM)急性脑梗死患者血清25-羟维生素D水平与颅内外动脉狭窄严重程度的相关性。方法选取132例T2DM且经头颅MRI确诊急性脑梗死患者。根据是否合并发生颅内外动脉狭窄将患者分为狭窄组(76例)和非狭窄组(56例)。检测两组患者的血清25-羟维生素D水平以及白细胞、C反应蛋白、低密度脂蛋白胆固醇、同型半胱氨酸、糖化血红蛋白、红细胞沉降率等实验室指标,分析与颅内外动脉狭窄严重程度的相关性及其预测价值。结果与非狭窄组血清25-羟维生素D [(28.34±5.09) ng·mL-1]比较,狭窄组[(20.14±5.52)ng·mL-1]显著降低。Spearman相关分析显示颅内外动脉狭窄严重程度与血清25-羟维生素D水平呈显著负相关(r=-0.689,P=0.001)。ROC曲线分析显示血清25-羟维生素D水平预测颅内外动脉狭窄的敏感度为96.0%,特异度为77.8%。结论T2DM合并急性脑梗死患者的颅内外动脉狭窄程度与血清25-羟维生素D水平显著相关,血清25-羟维生素D水平可以作为预测颅内外动脉狭窄风险的参考因素。     

伴高血压病的脑梗死患者血清基质金属蛋白酶-9水平变化及意义

目的探讨伴高血压急性脑梗死患者血清基质金属蛋白酶-9（MMP-9）水平变化及意义。方法选择临床上发病3天内入院的伴有原发性高血压病的急性前循环脑梗死患者65例,不伴原发性高血压病的急性前循环脑梗死的患者43例,原发性高血压病患者30例,健康对照组30例,采集空腹静脉血。用ELISA法检测其血清MMP-9水平。结果伴有原发性高血压病急性脑梗死组患者血清MMP-9水平（316.18±52.26ng/ml）明显高于其他三组（均P〈0.01）,不伴原发性高血压病的脑梗死组患者血清MMP-9水平（287.65±48.83ng/ml）明显高于原发性高血压病组（206.82±44.22ng/ml）和健康对照组（112.16±36.28ng/ml）（均P〈0.01）。原发性高血压组患者血清MMP-9水平明显高于对照组（P〈0.01）。结论高血压病患者及脑梗死患者血清MMP-9均有明显增高,血清MMP-9的活性增强可能是高血压导致脑梗死发生的机制之一,血清MMP-9可能在高血压脑梗死患者的发病及继发的病理损害中发挥更为重要的作用。血清MMP-9可以作为高血压病患者脑梗死前的预警指标。     

血清25-羟维生素D水平与缺血性脑卒中复发的相关性分析

目的探讨血清25-羟维生素D水平对缺血性脑卒中复发的预测价值,同时观察高血糖、高血脂、高血压、吸烟对缺血性脑卒中复发患者血清25-羟维生素D水平的影响。方法检测30例缺血性脑卒中复发患者及30例缺血性脑卒中未复发患者的血清25-羟维生素D水平。根据血清25-羟维生素D水平,将复发组分为高水平亚组及低水平亚组,比较不同血清25-羟维生素D水平患者与性别、年龄、是否存在高血糖、高血压、高血脂、吸烟的差异。结果复发组血清25-羟维生素D水平为(7.181±0.771)ng/ml,无复发组为(16.92±1.663)ng/ml。与无复发组比较,复发组血清25-羟维生素D水平显著降低(t=5.749,P<0.01)。缺血性脑卒中复发患者血清25-羟维生素D水平与年龄、吸烟、性别、血糖、血压、血脂无明显相关性(均P>0.05)。结论缺血性脑卒中复发患者血清25-羟维生素D水平明显下降,且与患者年龄、吸烟、性别、血糖、血压、血脂无关。维生素D可能是缺血性脑卒中复发过程中关键因素之一。     

脂蛋白相关磷脂酶A2与脑梗死患者颈部动脉粥样硬化斑块的关系

目的 探讨脑梗死患者血清脂蛋白相关磷脂酶A2（lipoprotein-related phospholipase A2，Lp-PLA2）及 超敏C反应蛋白（hi gh-sensitivity C-reactive protein，hs-CRP）水平与颈部动脉粥样硬化性斑块的关系。 方法 选择2017年1月-2018年3月郑州市第三人民医院诊断为脑梗死的患者243例，另外选择同期 体检的无脑梗死患者120例作为对照组。2组研究对象均检测血清Lp-PLA2、hs-CRP水平。依据颈部动 脉超声检查结果将脑梗死患者进一步分为无斑块组、稳定斑块组和易损斑块组。 结果 ①脑梗死患者的血清Lp-PLA2（[ 180.04±35.02）ng/mL vs（152.13±39.67）ng/mL，P=0.014]、 hs-CRP[（10.02±0.47）mg/L vs（2.64±0.33）mg/L，P =0.017]水平高于对照组。②稳定斑块组 （[ 162.96±11.34）ng/mL，P=0.013]和易损斑块组（[ 197.79±32.56）ng/mL，P=0.004]Lp-PLA2水平高 于无斑块组（[ 143.67±12.35）ng/mL]；易损斑块组Lp-PLA2水平高于稳定斑块组（P=0.007），差异均 有统计学意义。③易损斑块组血清hs-CRP水平[（12.86±1.67）mg/L]高于稳定斑块组[（10.82±0.53） mg/L，P=0.029]及无斑块组（[ 9.54±0.47）mg/L，P=0.037]，差异有统计学意义。 结论 在脑梗死患者中，血清Lp-PLA2与hs-CRP可能与颈部动脉粥样硬化斑块的发生及其不稳定性 有关。     

血浆和肽素水平对急性脑梗死患者预后的评估价值

目的 探讨血浆和肽素水平对急性脑梗死患者预后的评估价值.方法 对60例急性脑梗死患者(急性脑梗死组)和60例健康体检者(正常对照组)进行血浆和肽素水平检测;并对急性脑梗死患者进行血压、血糖、血清超敏C反应蛋白(hs-CRP)水平检测,应用美国国立卫生研究院卒中量表(NIHSS)进行评分,应用MRI测量脑梗死体积,3个月后采用改良的Rankin量表(mRS)评分评价预后;分析血浆和肽素水平对急性脑梗死患者预后的影响.结果 急性脑梗死组血浆和肽素水平[( 3.73±0.49) ng/ml]明显高于正常对照组[ (2.85±0.24) ng/ml](P＜0.01);脑梗死预后不良亚组(42例)[(3.84±0.44) ng/ml]明显高于预后良好亚组(18例)[ (3.47±0.53) ng/ml] (P＜0.05);两亚组间年龄、血糖、血清hs-CPR水平、NIHSS评分、脑梗死体积的差异有统计学意义(P ＜0.05 ～0.01);单因素Logistic回归分析显示,血浆和肽素水平、年龄、NIHSS评分是影响急性脑梗死患者预后的因素(P ＜0.05 ～0.01).ROC分析显示,影响急性脑梗死患者预后的因素中,血浆和肽素水平与年龄、hs-CRP水平、脑梗死体积、NIHSS评分间差异无统计学意义.结论血浆和肽素水平升高是预测急性脑梗死患者预后不良的因素之一.     

25-Hydroxyvitamin-D-Spiegel bei antikonvulsiver Dauermedikation

In recent years, the consideration of long-term tolerability has become markedly more important in the treatment of epilepsies due to the introduction of more antiepileptic drugs (AEDs) and a greater variety of treatment choices. Ongoing discussions and various studies suggest that chronic treatment with enzyme-inducing AEDs may induce vitamin D deficiency and, hereby, reduced bone density. Especially in patients with active epilepsies, this would suggest an increased risk of fractures that might be avoided or reduced by the use of nonenzyme-inducing AEDs. We determined the serum concentration of 25(OH)-vitamin D in the serum of 187?adults patients who were on medication with enzyme-inducing (EAEDs, 57%) or nonenzyme-inducing AEDs (NEAEDs, 43%) in mono- or combination therapy without external substitution of vitamin D at the end of summer (EoS) and winter (EoW). At the EoW, only 3% of the EAED patients and no NEAED patient had 25(OH)-vitamin D levels above 25?ng/ml, which was recently proposed as the lower limit of the normal range. There was no statistically significant difference between the two groups. At the EoS, 23% of the EAED group and 39% of the NEAED group had serum levels above 25?ng/ml. The difference was statistically significant (p=0.02). Our results suggest that there is some influence of enzyme-inducing properties on vitamin D levels which was apparent only at end of summer in this study. Thus, the results indicate that most 25(OH)-vitamin D levels were below the generally accepted normal range independent of the anticonvulsant medication at the end of summer and were even more pronounced at the end of winter. This suggests that the low vitamin D levels of patients mainly reflected geographical and sociological but not medication- or disease-related reasons.     

Vitamin D levels in Hispanics with multiple sclerosis

Vitamin D has been associated with multiple sclerosis (MS) and several markers of disease state in whites. There are limited reports of vitamin D??s influence in MS in ethnic groups, such as in Hispanics. In this study, we compared vitamin D levels in Hispanics and whites with MS and tried to determine whether season or increasing disability influence hypovitaminosis D in Hispanics with MS. Serum 25-hydroxyvitamin D [25(OH)D] levels and clinical characteristics were compared in a cross-sectional sample of Hispanics (n?=?80) and whites (n?=?80) with MS recruited from the University of Southern California. Serum 25(OH)D levels were significantly lower in Hispanics than whites with MS (mean and standard deviation 25.1?±?9.4 and 37.3?±?19.8?ng/ml, respectively; p?<?0.001). Hispanics were significantly more likely than whites to be vitamin D insufficient (??30?ng/ml; 70 vs. 41?%, respectively; p?<?0.001) and deficient (??20?ng/ml; 40 vs. 14?%, respectively, p?<?0.001). In Hispanics, serum 25(OH)D levels were not influenced by season (p?=?0.8) or higher physical disability (EDSS ??6, p?=?0.7). We found that the relationship between vitamin D and MS differs by Hispanic ethnicity. Hypovitaminosis D was significantly more common among Hispanics than among whites with MS, and the majority of Hispanics were vitamin D insufficient. Interestingly, there was no association between vitamin D levels and season or increasing disability in the Hispanics. Our findings imply that factors influencing vitamin D levels and possibly vitamin D requirements may vary by ethnicity in patients with MS. These results should be confirmed in larger, prospective multi-ethnic cohort studies.     

Preventive effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a double blind, randomized, placebo-controlled pilot clinical trial

Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20–40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS.     

25-羟基维生素D联合尿酸对缺血性脑卒中严重程度及早期预后的评估价值

目的探讨25-羟维生素D联合尿酸对缺血性脑卒中患者病情严重程度及早期预后的评估价值。方法选取2015-07—2016-06就诊的缺血性脑卒中患者166例为病例组,并分别根据入院NIHSS评分、头颅MRI梗死面积及发病90d mRS评分分级分成不同亚组,选取同期健康体检者90例为对照组,采用ELISA法分别测定血浆25-(OH)D及尿酸浓度。比较不同亚组间血浆25-(OH)D和尿酸浓度,评价两指标联合对缺血性脑卒中患者严重程度及早期预后的临床价值。结果病例组血浆25-(OH)D水平(19.39±6.02)ng/mL明显低于健康对照(25.88±8.73)ng/mL,尿酸水平(357.76±58.40)μmol/L高于对照组(295.19±59.87)μmol/L,差异有统计学意义(P0.05)。随着缺血性脑卒中患者NIHSS评分增加、梗死面积增大及90d mRS评分增加,血浆25-(OH)D水平降低而尿酸水平增加(P0.05);相关分析显示,血浆25-(OH)D与尿酸呈负相关(r=-0.491,P0.05);ROC曲线分析显示,25-(OH)D曲线下面积(AUC)为0.736,最佳工作点(OOP)为17.23ng/mL,其诊断缺血性脑卒中不良预后的灵敏度75.2%,特异度63.2%;尿酸的AUC为0.734,最佳工作点(OOP)为363.50μmol/L,此时诊断不良预后的灵敏度70.2%,特异度71.6%。两指标联合的串联试验曲线下面积为0.770,灵敏度52.8%,特异度89.5%。结论 25-(OH)D和尿酸均为缺血性脑卒中严重程度及早期预后的预测因子,两者联合对缺血性脑卒中患者早期预后的评估优于单一指标,是判断患者病情及预后的客观指标。     

Influence of solar irradiation on vitamin D levels in children on anticonvulsant drugs

Previous studies about the serum levels of vitamin D metabolites in epileptic patients have given conflicting results. We have investigated the influence of chronic anti-epileptic treatment on mineral metabolism in 17 ambulatory epileptic children who were studied for 2 seasons with high and low levels of solar radiation, respectively. No differences in serum calcium, phosphate or 1.25-dihydroxyvitamin D were observed between patients and control children. Patients also had normal levels of 25-hydroxyvitamin D [25(OH)D] in summer. However, serum 25(OH)D concentrations were lower in patients than in controls in winter months (12.6 +/- 1.4 versus 19.6 +/- 1.2 ng/ml, P less than 0.001). These findings point out the influence of the intensity of solar irradiation, and subsequently of vitamin D availability, on the effect of anticonvulsant drugs on vitamin D metabolism, and may help to explain the conflicting results of previous reports. Prophylactic vitamin D therapy should be considered when climatic conditions or patients' life styles do not allow an adequate exposure to sunlight.     

The evaluation of vitamin D levels in patients with carpal tunnel syndrome

The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP? group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP? group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP? groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP? group was lower than EP+ group, statistically difference was not significant between EP+ and EP? groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP? groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.     

Vitamin D from different sources is inversely associated with Parkinson disease

An inverse association between Parkinson disease (PD) and total vitamin D levels has been reported, but whether vitamin D from different sources, that is, 25(OH)D2 (from diet and supplements) and 25(OH)D3 (mainly from sunlight exposure), all contribute to the association is unknown. Plasma total 25(OH)D, 25(OH)D2, and 25(OH)D3 levels were measured by liquid chromatography–tandem mass spectrometry in PD patients (n = 478) and controls (n = 431). Total 25(OH)D was categorized by clinical insufficiency or deficiency; 25(OH)D2 and 25(OH)D3 were analyzed in quartiles. Vitamin D deficiency (total 25[OH]D < 20 ng/mL) and vitamin D insufficiency (total 25[OH]D < 30 ng/mL) are associated with PD risk (odds ratio [OR] = 2.6 [deficiency] and 2.1 [insufficiency]; P < 0.0001), adjusting for age, sex, and sampling season. Both 25(OH)D2 and 25(OH)D3 levels are inversely associated with PD (P_trend < 0.0001). The association between 25(OH)D2 and PD risk is largely confined to individuals with low 25(OH)D3 levels (P_trend = 0.0008 and 0.12 in individuals with 25[OH]D3 < 20 ng/mL and 25[OH]D3 ≥ 20 ng/mL, respectively). Our data confirm the association between vitamin D deficiency and PD, and for the first time demonstrate an inverse association of 25(OH)D2 with PD. Given that 25(OH)D2 concentration is independent of sunlight exposure, this new finding suggests that the inverse association between vitamin D levels and PD is not simply attributable to lack of sunlight exposure in PD patients with impaired mobility. The current study, however, cannot exclude the possibility that gastrointestinal dysfunction, a non‐motor PD symptom, contributes to the lower vitamin D2 levels in PD patients. © 2014 International Parkinson and Movement Disorder Society     

Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial

OBJECTIVE: Vitamin D supplementation is suggested to reduce the risk of falls among ambulatory or institutionalized elderly subjects. The present study was undertaken to address the reduced risk of falls and hip fractures in patients with long-standing stroke by vitamin D supplementation. METHODS: Ninety-six elderly women with poststroke hemiplegia were followed for two years. Patients were randomly assigned to one of the two groups, and 48 patients received 1,000 IU ergocalciferol daily, and the remaining 48 received placebo. The number of falls per person and incidence of hip fractures were compared between the two groups. Strength and tissue ATPase of skeletal muscles on the nonparetic side were assessed before and after the study. RESULTS: At baseline, serum 25-hydroxyvitamin D levels were in the deficient range (<10 ng/ml) in all patients; and vitamin D treatment enhanced serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels. Vitamin D treatment accounted for a 59% reduction in falls (95% CI, 28-81%; p = 0.003). There were increases in the relative number and size of type II muscle fibers and improved muscle strength in the vitamin D-treated group. Hip fractures occurred in 4 of 48 placebo group and 0 in 48 vitamin D2 group during the 2-year study period (log-rank, p = 0.049). CONCLUSION: Vitamin D may increase muscle strength by improving atrophy of type II muscle fibers, which may lead to decreased falls and hip fractures.     

Interrelationships between chronic tension-type headache,musculoskeletal pain,and vitamin D deficiency: Is osteomalacia responsible for both headache and musculoskeletal pain?

Background:

Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature.

Materials and Methods:

We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH) and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH) D levels as normal (>20 ng/ml) or vitamin D deficient (<20 ng/ml).

Results:

We identified 71 such patients. Fifty-two patients (73%) had low serum 25(OH) D (<20 ng/dl). Eighty-three percent patients reported musculoskeletal pain. Fifty-two percent patients fulfilled the American College of Rheumatology criteria for chronic widespread pain. About 50% patients fulfilled the criteria for biochemical osteomalacia. Low serum 25(OH) D level (<20 ng/dl) was significantly associated with headache, musculoskeletal pain, and osteomalacia.

Discussion:

These suggest that both chronic musculoskeletal pain and chronic headache may be related to vitamin D deficiency. Musculoskeletal pain associated with vitamin D deficiency is usually explained by osteomalacia of bones. Therefore, we speculate a possibility of osteomalacia of the skull for the generation of headache (osteomalacic cephalalgia?). It further suggests that both musculoskeletal pain and headaches may be the part of the same disease spectrum in a subset of patients with vitamin D deficiency (or osteomalacia), and vitamin D deficiency may be an important cause of secondary CTTH.Key Words: Chronic daily headache, chronic musculoskeletal pain, chronic pain, chronic tension-type headache, osteomalacia, pain, vitamin D