The Effects Of Vitamin D On Muscle Strength And Functional Status Of The Elderly Patients With Knee Osteoarthritis

Year 2020, Volume: 3 Issue: 2, 46 - 53, 18.08.2020

Serap Erkeç Alkan , Burcu Duyur Çakıt , Ender Salbaş , Hakan Genç

https://doi.org/10.33713/egetbd.748584

Cited By: 2

Abstract

Introductıon: The aim of this study was to evaluate the effects of vitamin D levels on pain intensity, muscle strength and functional status of elderly patients with osteoarthritis of the knee.
Methods: Eighty one patients with osteoarthritis of the knee were enrolled in this study. The pain was measured with visual analogue scale (VAS). Western Ontario and McMaster University Arthritis Index (WOMAC) was used to evaluate pain, stiffness, and physical function. The maximum isokinetic muscle strength and the peak torque/body weight values were measured.
Results: The patients were divided into two groups according to their 25 (OH) vitamin D levels: Group 1 consisted of patients whose 25 (OH) vitamin D levels were below 20 ng/ml and Group 2 comprised those with levels above 20 ng/ml. The VAS scores, the mean WOMAC pain, function and total scores were higher in Group 1 than Group 2. The maximal isokinetic muscle strength of extensor and flexor muscles of the knee and the peak torque/body weight values were significantly lower in Group 1 than in Group 2 (p<0.001 for all values).
Conclusion: vitamin D deficiency seems to be a factor contributing to pain, muscle weakness, and disability in patients with knee osteoarthritis.

Keywords

elderly, function, isokinetic, knee, muscle, osteoarthritis, pain, strength, vitamin D

Gonartrozlu Yaşlı Hastada D Vitamininin Kas Gücü ve Fonksiyonel Durum Üzerine Etkisi

Abstract

Giriş: Bu çalışmanın amacı, diz osteoartriti olan yaşlı hastaların D vitamini düzeylerinin ağrı şiddeti, kas gücü ve fonksiyonel durumu üzerindeki etkilerini değerlendirmektir.
Gereç ve Yöntem: Çalışmaya diz osteoartritli seksen bir hasta dahil edildi. Ağrı görsel analog skala (VAS) ile ölçüldü. Ağrı, eklem sertliği ve fiziksel fonksiyonu değerlendirmek için Western Ontario ve McMaster Üniversitesi Artrit İndeksi (WOMAC) kullanıldı. Maksimum izokinetik kas kuvveti ve pik tork/vücut ağırlığı değerleri ölçüldü.
Bulgular: Hastalar 25 (OH) D vitamini seviyelerine göre iki gruba ayrıldı: Grup 1, 25 (OH) D vitamini seviyeleri 20 ng / ml'nin altında ve Grup 2 20 ng / ml'nin üstünde olanlardan oluşuyordu. VAS skorları, ortalama WOMAC ağrısı, fonksiyon ve toplam skorlar Grup 1'de Grup 2'ye göre daha yüksekti. Dizdeki ekstansör ve fleksör kasların maksimum izokinetik kas kuvveti ve pik tork/vücut ağırlığı değerleri Grup 1'de Grup 2'ye göre anlamlı olarak daha düşüktü (tüm değerler için p <0.001).
Sonuç: D vitamini eksikliği, diz osteoartriti olan hastalarda ağrı, kas güçsüzlüğü ve sakatlığa katkıda bulunan bir faktör gibi görünmektedir.

Keywords

yaşlı, fonksiyon, izokinetik, diz, kas, osteoartrit, ağrı, güç, D vitamini

References

• 1. Kacar G, Gilgil E, Urhan S, Arikan V, Dündar U, Oksüz MC, et al. The prevalance of symptomatic knee and distal interphalangeal joint in the urban popülation of Antalya, Turkey. Rheum Int. 2005;25:201-4. 2. Van Holsbeeck M, Intrasaco JH. Sonografy of Large Synovial Joints. In: Van Holsbeeck M, Intrasaco JH, editors. Musculoskeletal ultrasound. Chicago: Mosby Year Book; 2001. p. 235-75. 3. Linnebur SA, Vondracek SF, Vande Griend JP, Ruscin JM, McDermott MT. Prevalence of vitamin D insufficiency in elderly ambulatory outpatients in Denver, Colorado. Am J Geriatr Pharmacother. 2007;51:1-8. 4. Holick MF, Binkley NC, Bischoff- Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment and prevention of vitamin D deficiency: An Endocrine Society and clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30. 5. Davies GJ. A Compendium of Isokinetics in Clinical Usage and Rehabilitation Techniques. 4th ed. Onalaska WI: S&S Publishers; 1992. 6. Messier SP, Loeser RF, Hoover JL, Semble EL, Wise CM. Osteoarthritis of the knee: Effects on gait, strength and flexibility. Arch Phys Med Rehabil 1992;73:29-36. 7. Fisher NM, PenderVASt DR, Calkins E. Maksimal Isometric Torgue of Knee Extension as a Function of Muscle Length in subjects of Advancing Age. Arch Phys Med Rehabil 1990;71:729-34. 8. Minor MA, Hewet JE, Webel RR, Dreisinger TE, Kay DR. Exercise tolerance and diseace related measures in patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 1988;15:905-11. 9. Grimaldi AS, Parker BA, Capizzi JA, Clarkson PM, Pescatello LS, White MC et al. 25(OH) vitamin D is associated with greater muscle strength in healthy men and women. Med Sci Sports Exerc 2013;45:157-62. 10. Gordon PL, Sakkas GK, Doyle JW, Shubert T, Johansen KL. Relationship between vitamin D and muscle size and strength in patients on hemodialysis. J Ren Nutr 2007;17:397-407 (Abstract). 11. Songpatanasilp T, Chailurkit LO, Nichachotsalid A, Chantarasorn M. Combination of alfacalcidol with calcium can improve quadriceps muscle strength in elderly ambulatory Thai women who have hypovitaminosis D: a randomized controlled trial. J Med Assoc Thai. 2009;92 Suppl5:S30-41 (Abstract). 12. Hamilton B, Whiteley R, Farooq A, Chalabi H. vitamin D concentration in 342 professional football players and association with lower limb isokinetic function. J Sci Med Sport 2014;17:139-43. 13. Cao Y, Jones G, Cicuttini F, Winzenberg T, Wluka A, Sharman J et al. vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2012;13:131. 14. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29:1039-49. 15. Genç H. Osteoarthritiste Görüntüleme. In: Ataman Ş, Yalçın P, editors. Romotoloji. Ankara: MN Medikal &Nobel; 2012;681-707. 16. Tuzun EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptibility, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005;13:28-33. 17. Sallı A, Uğurlu H, Emlik D. Diz Osteoarthritisinde Konsantrik, Kombine Konsantrik-Eksantrik ve İzometrik Egzersizlerin Semptomlar ve Fonksiyonel Kapasite Üzerine Etkinliğinin Karşılaştırılması Türk Fiz Tıp Rehab Derg 2006;52:61-67. 18. Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 1989;2:1104-5. 19. Hunter DJ, McDougall JJ, Keefe J. The symptoms of osteoarthritis and genesis of pain. Rheum Dis Clin N Am 2008;34:623-43. 20. Holick MF. vitamin D deficiency: What a pain it is. Mayo Clin Proc 2003;78:1457–59. 21. Glover TL, Goodin BR, HorVAS AL, Kindler LL, King CD, Sibille KT et al. vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis. Arthritis Rheum 2012;64:3926-35. 22. Al Faraj S & Al Mutairi K. vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003;28:177–9. 23. Straube S, Derry S, Moore RA, McQuay HJ. vitamin D for the treatment of chronic painful conditions in adults. The Cochrane Database Sys Rev 2010;20:CD 007771. 24. Feldman D.Peake, J.W, Glorieux, F.H. vitamin D. Second ed. Elsevier Academic Press, London, San Diego, 2005. 25. Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalasic bone involvement. Calcif Tissue Int 2000;66:419–24. 26. Dhesi JK, Bearne LM, Moniz C, Hurley MV, Jackson SH, Swift CG et al. Neuromuscular and phychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res 2002;17:891-7. 27. Wang X, Hunter D, Xu J, Ding C. Metabolic triggered inflammation in osteoarthritis. Osteoarthritis Cartilage 2015;23(1):22-30. 28. Ding C, Parameswaran V, Blizzard L, Burgess J, Jones G. Not a simple fat-soluble vitamin:changes in serum 25-(OH)D levels are predicted by adiposity and adipocytokines in older adults. J Intern Med 2010;268(5):501-10. 29. Chen D, Li Y, Dai X, Zhou X, Tian W, Zhou Y, Zou X, Zhang C.1,25-Dihydroxyvitamin D3 activates MMP13 gene expression in chondrocytes through p38 MARK pathway. Int J Biol Sci 2013;9(6):649-55. 30. Li S, Niu G, Wu Y, Du G, Huang C, Yin X, Liu Z, Song C, Leng H. vitamin D prevents articular cartilage erosion by regulating collagen II turnover through TGF-β1 in ovariectomized rats. Osteoarthritis Cartilage 2016;24(2):345-53. 31. Heidari B, Heidari P, Hajian-Tilaki K. Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop 2011;35(11):1627-31. 32. Malas FU, Kara M, Aktekin L, Ersöz M, Ozçakar L. Does vitamin D affect femoral cartilage thickness? An ultrasonographic study. Clin Rheumatol. 2014;33(9):1331-4. 33. Jin X, Jones G, Cicuttini F, Wluka A, Zhu Z, Han W, Antony B, Wang X,Winzenberg T, Blizzard L, Ding C. Effect of vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. JAMA 2016;315(10):1005-13. 34. Lane NE, Gore LR, Cummings SR, Hochberg MC, Scott JC, Williams EN et al. Serum vitamin D levels and incident changes of radiographic hip osteoarthritis. a longitudinal study. Arthritis Rheum 1999;42:854–60. 35. Zhang FF, Driban JB, Lo GH, Price LL, Booth S, Eaton CB, Lu B, Nevitt M,Jackson B, Garganta C, Hochberg MC, Kwoh K, McAlindon TE. vitamin D deficiency is associated with progression of knee osteoarthritis. J Nutr. 2014;144(12):2002-8. 36. Sanghi D, Mishra A, Sharma AC, Singh A, Natu SM, Agarwal S, et al. Does vitamin D improve osteoarthritis of the knee a randomized controlled pilot trial. Clin Orthop Relat Res 2013;471:3556-62. 37. Mc Alindon T, Lavalley M, Schneider E, Nuite M, Lee JY, Price LL et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis. JAMA 2013;309:155-62.