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Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study
  1. John McBeth1,
  2. Stephen R Pye1,
  3. Terence W O'Neill1,
  4. Gary J Macfarlane2,
  5. Abdelouahid Tajar1,
  6. Gyorgy Bartfai3,
  7. Steven Boonen4,
  8. Roger Bouillon5,
  9. Felipe Casanueva6,
  10. Joseph D Finn1,
  11. Gianni Forti7,
  12. Aleksander Giwercman8,
  13. Thang S Han9,
  14. Ilpo T Huhtaniemi10,
  15. Krzysztof Kula11,
  16. Michael E J Lean9,
  17. Neil Pendleton12,
  18. Margus Punab13,
  19. Alan J Silman1,
  20. Dirk Vanderschueren14,
  21. Frederick C W Wu15,
  22. EMAS Group
  1. 1ARC Epidemiology Unit, University of Manchester, Manchester, UK
  2. 2Aberdeen Pain Research Collaboration (Epidemiology Group), University of Aberdeen, UK
  3. 3Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary
  4. 4Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
  5. 5Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
  6. 6Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III; Santiago de Compostela, Spain
  7. 7Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
  8. 8Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Sweden
  9. 9Department of Human Nutrition, University of Glasgow, Glasgow, Scotland
  10. 10Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London UK
  11. 11Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland
  12. 12Clinical Gerontology, University of Manchester, Hope Hospital, Salford, UK
  13. 13Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
  14. 14Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
  15. 15Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
  1. Correspondence to Dr John McBeth, ARC Epidemiology Unit, University of Manchester, Oxford Road, Manchester M13 9PT, UK; john.mcbeth{at}


Introduction A study was undertaken to test the hypothesis that musculoskeletal pain is associated with low vitamin D levels but the relationship is explained by physical inactivity and/or other putative confounding factors.

Methods Men aged 40–79 years completed a postal questionnaire including a pain assessment and attended a clinical assessment (lifestyle questionnaire, physical performance tests, 25-hydroxyvitamin D3 (25-(OH)D) levels from fasting blood sample). Subjects were classified according to 25-(OH)D levels as ‘normal’ (≥15 ng/ml) or ‘low’ (<15 ng/ml). The relationship between pain status and 25-(OH)D levels was assessed using logistic regression. Results are expressed as ORs and 95% CIs.

Results 3075 men of mean (SD) age 60 (11) years were included in the analysis. 1262 (41.0%) subjects were pain-free, 1550 (50.4%) reported ‘other pain’ that did not satisfy criteria for chronic widespread pain (CWP) and 263 (8.6%) reported CWP. Compared with patients who were pain-free, those with ‘other pain’ and CWP had lower 25-(OH)D levels (n=239 (18.9%), n=361 (23.3) and n=67 (24.1%), respectively, p<0.05). After adjusting for age, having ‘other pain’ was associated with a 30% increase in the odds of having low 25-(OH)D while CWP was associated with a 50% increase. These relationships persisted after adjusting for physical activity levels. Adjusting for additional lifestyle factors (body mass index, smoking and alcohol use) and depression attenuated these relationships, although pain remained moderately associated with increased odds of 20% of having low vitamin D levels.

Conclusions These findings have implications at a population level for the long-term health of individuals with musculoskeletal pain.

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  • The EMAS Study Group Florence (Gianni Forti, Luisa Petrone, Antonio Cilotti); Leuven (Dirk Vanderschueren, Steven Boonen, Herman Borghs); Lodz (Krzysztof Kula, Jolanta Slowikowska-Hilczer, Renata Walczak-Jedrzejowska); London (Ilpo Huhtaniemi); Malmö (Aleksander Giwercman); Manchester (Frederick Wu, Alan Silman, Terence O'Neill, Joseph Finn, Philip Steer, Abdelouahid Tajar, David Lee, Stephen Pye); Santiago (Felipe Casanueva, Marta Ocampo, Mary Lage); Szeged (Gyorgy Bartfai, Imre Földesi, Imre Fejes); Tartu (Margus Punab, Paul Korrovitz); Turku (Min Jiang).

  • Funding Commission of the European Communities Fifth Framework Programme ‘Quality of Life and Management of Living Resources’ Grant QLK6-CT-2001-00258. Other funders: Arthritis Research Campaign, Chesterfield.

  • Competing interests None.

  • Ethics approval This study was conducted with ethical approval of the eight European centres in accordance with local requirements and written informed consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.