FibromyalgiaVitamin D levels

There are several studies reporting that those with fibromyalgia have lower serum 25-hydroxyvitamin D [25(OH)D] levels as well as lower bone mineral density.

A study in Santa Monica, California found fibromyalgia frequently associated with osteoporosis:

OBJECTIVE: To investigate associations of bone mineral density (BMD) and osteoporosis in patients with fibromyalgia (FM) and healthy controls.
METHODS: Twenty-four women meeting the American College of Rheumatology criteria for FM (23 Caucasians, one Asian) were each compared to 2 age (+/-3 years) and ethnically matched controls by bone densitometry of the femoral neck and lumbar spine. The patients’ ages were 33 to 60 years. No patient or control used steroids or other bone demineralizing agents. Simple T tests were used to compare hip and lumbar spine BMD of FM cases to controls by 3 decades (31-40, 41-50, 51-60 years).
RESULTS: The patients with FM in all 3 decades had a lower mean BMD of the spine (p<0.05). The femoral neck BMD were also lower, but reached significance (p<0.05) only in the 51-60 age group.
CONCLUSION: FM in this pilot study was frequently associated with osteoporosis. Early detection and implementation of appropriate nutritional supplementation (calcium/vitamin D), resistive and weight bearing exercise, and specific bone mineral enhancing pharmacological therapy may be indicated in pre, peri, and postmenopausal subjects1.

A study in the United Kingdom found very low serum 25(OH)D levels in 43% of females with fibromyalgia compared to 19% without fibromyalgia:

OBJECTIVES: To determine whether women with fibromyalgia are at increased risk of developing osteoporosis or osteomalacia.
METHODS: Forty premenopausal women with fibromyalgia and 37 age-matched female controls were studied. Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were measured at the calcaneum and bone mineral density was measured at the forearm and lumbar spine using dual-energy X-ray absorptiometry. Serum calcium, alkaline phosphatase, gamma-glutamyl transferase, 25-hydroxyvitamin D and plasma viscosity were measured in all subjects and parathyroid hormone was measured in subjects recruited in the latter part of the study.
RESULTS: Seventeen patients with fibromyalgia syndrome and seven controls had 25-hydroxyvitamin D concentrations <20 nmol/l (P < 0.015) and in three FMS patients serum parathyroid hormone was raised. Bone density in fibromyalgia patients was slightly lower at the mid-distal forearm but comparable to that in controls at other sites.
CONCLUSIONS: There is no reason to recommend routine bone densitometry in fibromyalgia patients. However, vitamin D subnutrition is common in these patients and this should be sought2.

Turkish nationals living in Turkey or Germany often have vitamin D insufficiency [serum 25(OH)D level <20 ng/ml (50 nmol/l)] or deficiency [25(OH)D <10 ng/ml (25 nmol/l)]: “A strong correlation between low 25(OH)D levels and higher rates and longer duration of generalized bone and/or muscle aches and pains (often diagnosed as fibromyalgia) was observed.”3

A study in Belfast, Northern Ireland, found low serum 25(OH)D levels frequent for those with fibromyalgia. In addition, a correlation between serum 25(OH)D levels of those with fibromyalgia and presence of anxiety and depression:

Fibromyalgia is a complex problem in which symptoms of anxiety and depression feature prominently. Low levels of vitamin D have been frequently reported in fibromyalgia, but no relationship was demonstrated with anxiety and depression. Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Deficient levels of vitamin D was found in 13.3% of the patients, while 56.0% had insufficient levels and 30.7% had normal levels. Patients with vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR, 31.0 (23.8-36.8] than patients with insufficient levels [25-50 nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5); Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship with global measures of disease impact or musculoskeletal symptoms. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health4.

The link to anxiety and depression is likely related to low serum 25(OH)D levels based on findings from other studies5 6.

Page last edited: 17 May 2011

References

  1. Swezey, R. L. Adams, J. Fibromyalgia: a risk factor for osteoporosis. J Rheumatol. 1999 Dec; 26 (12): 2642-4.
  2. Al-Allaf, A. W. Mole, P. A. Paterson, C. R. Pullar, T. Bone health in patients with fibromyalgia. Rheumatology (Oxford). 2003 Oct; 42 (10): 1202-6.
  3. Erkal, M. Z. Wilde, J. Bilgin, Y. Akinci, A. Demir, E. Bodeker, R. H. Mann, M. Bretzel, R. G. Stracke, H. Holick, M. F. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int. 2006; 17 (8): 1133-40.
  4. Armstrong, D. J. Meenagh, G. K. Bickle, I. Lee, A. S. Curran, E. S. Finch, M. B. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol. 2007 Apr; 26 (4): 551-4.
  5. Hoogendijk, W. J. Lips, P. Dik, M. G. Deeg, D. J. Beekman, A. T. Penninx, B. W. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008 May; 65 (5): 508-12.
  6. Stewart, R. Hirani, V. Relationship between vitamin D levels and depressive symptoms in older residents from a national survey population. Psychosom Med. 2010 Sep; 72 (7): 608-12.