Does Vitamin D Status Influence Lumbar Disc Degeneration and Low Back Pain in Postmenopausal Women? A Retrospective Single-center Study
Menopause. February 10, 2020; Vol. 27; No. 5; [epub]
Hao-Wei Xu, MD, Yu-Yang Yi, MD, Shu-Bao Zhang, MD, Tao Hu, MD, PhD, Shan-Jin Wang, MD, PhD, Wei-Dong Zhao, MD, and De-Sheng Wu, MD, PhD: From Tongji University School of Medicine, Shanghai, China.
Lumbar disc degeneration (LDD) is a prevalent musculoskeletal ailment, often synonymous with low back pain (LBP), affecting a significant portion of the population. Particularly noteworthy is its impact on postmenopausal women, whose declining estrogen levels predispose them to more severe disc degeneration and associated pain compared to their male counterparts. Recent research delving into the relationship between serum vitamin D concentration and LDD in this demographic sheds light on potential avenues for both understanding and managing this condition.
In a study encompassing 232 postmenopausal women aged between 45 and 90 years, several key insights emerged:
- Estrogen’s Influence on Disc Degeneration: Estrogen plays a pivotal role in disc health, with its decline correlating strongly with more severe LDD. As estrogen concentrations plummet postmenopause, older women are at heightened risk of LDD and consequent LBP.
- Role of Vitamin D: Vitamin D, renowned for its role in calcium and phosphorus regulation, emerges as a potential player in disc degenerative diseases. Notably, hypovitaminosis D is prevalent among postmenopausal women, further exacerbating their susceptibility to LDD and associated pain.
- Impact of Vitamin D Supplementation: There is growing evidence suggesting that vitamin D supplementation holds promise in alleviating LBP and delaying disc degeneration. However, it’s imperative to note that the optimal serum vitamin D level for this demographic may be higher than previously thought, with studies advocating for a minimum threshold of 40 ng/mL.
- Association Between Vitamin D Levels and Disc Degeneration: Lower serum vitamin D concentrations (<10 ng/mL) are significantly linked to more severe LDD, particularly in the lumbosacral region (L4-L5, L5-S1). This underscores the potential role of vitamin D deficiency as a marker for severe disc degeneration and LBP.
- Multifaceted Influences on Pain: Various factors, including smoking, obesity, osteoporosis, and vitamin D deficiency, contribute to the prevalence of moderate-to-severe LBP. Additionally, vitamin D’s anti-inflammatory properties offer promise in attenuating inflammation and cartilage loss, thereby alleviating pain.
- Pathophysiological Mechanisms: Estrogen decline and vitamin D deficiency intertwine in the development of sarcopenia, a condition characterized by muscle loss. Vitamin D supplementation emerges as a potential therapeutic intervention for postmenopausal women grappling with sarcopenia-induced disc degeneration.
- Implications for Clinical Practice: Recognizing the high prevalence of hypovitaminosis D among postmenopausal women is paramount. Serum vitamin D concentrations below 10 ng/mL should serve as a red flag for clinicians, signaling potential severe disc degeneration and LBP.
In conclusion, the interplay between serum vitamin D concentration, estrogen levels, and lumbar disc degeneration underscores the multifaceted nature of LBP in postmenopausal women. Addressing vitamin D deficiency through supplementation presents a promising avenue for not only alleviating pain but also delaying the progression of disc degeneration. Moving forward, a comprehensive understanding of these relationships is crucial for optimizing the management and care of individuals grappling with LDD and its associated symptoms.