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Does vitamin D help with knee pain and cartilage loss in osteoarthritis?

Posted on: January 30, 2013   by  John Cannell, MD


Osteoarthritis (OA), also known as degenerative joint disease, is a mechanical abnormality involving degradation of joints, including cartilage and bone. The joints just wear out from a lifetime of use. Common symptoms include joint pain, tenderness and stiffness.

Osteoarthritis affects nearly 27 million people in the United States, accounting for 25% of visits to primary care physicians. It is estimated that 80% of the population have radiographic evidence of OA by age 65.

Does vitamin D help OA? Dr. Timothy McAlindon and colleagues at Tufts Medical Center wanted to know, and recently conducted a study to find out. They found that vitamin D does not help.

McAlindon T, LaValley M, Schneider E, Nuite M, Lee JY, Price LL, Lo G, Dawson-Hughes B.  Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA. 2013 Jan 9;309(2):155-62.

They randomized 146 participants to a vitamin D group or a placebo group. Sixty-four patients finished the study taking vitamin D and 60 finished it on placebo. For the vitamin D arm, participants took at least 2000 IU/day, and researchers increased the dose to ensure that levels were at least 36 ng/mL. Twenty-three participants received vitamin D dose escalations as follows:

  • 18 patients had their dose increased to 4000 IU/day
  • 4 to 6000 IU/day
  • 1 to 8000 IU/day

Knee pain decreased in both groups with no significant differences between groups at any time. Cartilage volume decreased equally in both groups by about 4% during the two years of the study. There were no significant differences in pain relief or functional assessments between groups, although trends in pain (p=.17) and functionality (P=.07) favored the treatment group.

However, the mean plasma 25-hydroxyvitamin D level rose in the treatment group only rose from 22.7 to 38.5ng/mL after 24 months of treatment. Despite the goal of getting the entire treatment arm above 36 ng/ml with dose escalation, only 61% of the vitamin D group reached the target level of 36 ng/mL by the 24th month. The authors did not explain why their dose escalation regimen did not get all participants above their stated goal of 36 ng/ml.

It is unlikely that vitamin D can repair worn out joints, although I do find it likely that higher vitamin D doses can help the pain of OA. In fact, their own study showed that trends favored the treatment group in both pain and functionality.

9 Responses to Does vitamin D help with knee pain and cartilage loss in osteoarthritis?

  1. kenmerrimanmd

    I would agree that as done and by it self Vit D probably would not have much effect on advanced OA or on cartilage loss

    but it does seem to help with other issues and a 50 ng/ml level would be best

    at least in this study they measured levels as opposed to using one standard dose and no testing

    it continues to amaze me as to how many of my pts need a 20,00 IU/day dose to break into the >50ng/ml club of course these are generally the “bigger” ones

  2. [email protected]

    Raising the 25(OH)D level to 38.5 ng/mL in the treatment group is probably too low a level to see any significant change. Over and over we see conclusions made about vitamin D when the blood serum levels are increased just marginally. While I agree it’s likely that higher vitamin D doses can help the pain of OA, we shouldn’t close the door to the possibility that vitamin D at much higher levels can increase cartilage volume.

    I ran for almost a year with pain in my left knee before finally succumbing to the pain. I tried Synvisc and cortisone to no avail. The pain was terrible climbing stairs and I couldn’t run two steps without the pain. I finally had arthroscopic surgery and the orthopedist found that there was no cartilage left on the femur which was digging into the underside of my patella. The future for that knee was bleak.

    I came across a supplement (ASU) for which claims were made that it helped regrow cartilage. I started taking it in May of 2009. By that August I could run a half mile. By the end of the year I was up to 5 miles. In 2010 I ran over 800 miles with the longest being a 10-miler. I could still feel some discomfort but not enough to stop running. In 2011 I ran over 1,100 miles with the longest being an 18-miler. There was no longer any discomfort. In 2012, I ran over 1,700 miles with the longest being 21 miles and there were eight 18-milers. In October I turned 70.

    I had never had so much mileage in 40 years of running. I had always been plagued with injuries in muscles and tendons. I could often get up to 12-milers in the summer months but the injuries crept in when I tried to do runs of more than 12 miles, or during winters when my mileage was relatively low. Looking back, I realize that I rarely wore sunscreen and was benefiting from UVB rays so injuries were rare in the warm months and common in the cold months.

    Last year during all those long runs, I felt twinges of strains in muscles and tendons here and there but they would disappear a mile or two later. It seemed to me that my body was constantly healing itself. Whatever aches and pains I felt during a run would always be gone before I finished and wouldn’t come back. My health was remarkably good all year long. Also, I run with a disability, peripheral neuropathy, which I’ve had for about 30 years. My feet are pretty numb and I don’t have good balance so I have to be very careful when running (and walking). My neurologist has labeled the PN as “moderately severe.” Before the OA had interfered, I had taken a number of bad falls while running. I haven’t fallen once while running in the last two years.

    I guess the punch line is that I’ve been taking 20,000 iu of D3 daily for the past two years. I had one blood test which showed 120 ng/mL. I’ve spoken with Dr. Cannell about this. I’ve had no signs of adverse effects and many signs of positive effects. Of course I’m just an experiment of one, but the D3 sure seems to be working in my favor at this dose level. I don’t know if the D3 has been protecting the cartilage in my knee because I still take the ASU but I feel that D3 is playing a role there too.

    I think that someday, maybe many years from now, we’ll find that very high levels of 25(OH)D will be very curative and protective for many things. For now, I sure like what we’re finding in studies that push 25(OH)D levels up much higher than this OA study.

  3. Rita and Misty


    We are all experiments of one, to some extent….

    I’m a runner, and I tore my MCL back around five years ago. Although the tear supposedly healed, I always had discomfort until my 25(OH)D level reached around 75 ng/ml….then the pain disappeared..coincidence? Maybe…but I tend not to think so….

    My level is currently 104 ng/ml, and I feel fantastic…

    I agree wholeheartedly with you: one day it will be proven that very high levels of 25(OH)D will be curative and protective for many health conditions….

    I am choosing not to wait until those studies “prove” the benefits of Vitamin D… I already feel the benefits in my daily life.


    Rita Celone Umile

  4. mbuck

    @ alan

    So you took the ASU for a year or so before beginning D3 at 20,000 IU /d?

  5. [email protected]

    My wife and I were suffering from chronic knee pain for over a decade. When we first started taking vitamin d, it was 2000iu and had little change. When we increased our levels to attain close to 50 ng/ml, our knee pain has almost completely diminished. It is important to know it did not happen quickly but over a period of at least a year maybe two. This is not why we were raising our levels but rather a side benefit. We are participants in the Grassroots Study.

  6. Dan

    I used to have low threshold pain in my knees and had knee surgery on left knee after a soccer injury in college. Now that I supplement with Vit D is the rare event to have knee pain even though I have less meniscus.

  7. Kate Saley

    Very encouraging observations all! I have had recent knee pain associated with running on pavement (and poor quality shoes) which has kept me from continuing my normal workout routine. I have increased my dosage (as well as better shoes and strengthening exercises) …. I’ll keep you all posted!

  8. lifedoc

    Several concerns with this study, after reading the full abstract:

    1. The treatment group’s OA was obviously somewhat worse than that of the placebo group. The treatment subjects were described as having more pain and less function in their knees.

    2. Only 85% of the treatment group completed the study.

    3. The study lasted only two years in subjects averaging 62 years of age. Vitamin D’s role may be in more in preventing OA or slowing down the progression of OA given an optimal blood level of at least 50 ng/mL and a longer interval of time for it’s benefits to be demonstrated.

  9. [email protected]

    mbuck, It was about 1 1/2 years after I started taking the ASU that I started with 20,000 iu per day of D3.

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