Why Should Rheumatologists Consider Vitamin D Supplementation for their Patients?

Increasing evidence suggests that common musculoskeletal diseases such as osteoporosis (OP), osteoarthritis (OA), and rheumatoid arthritis (RA) are increased in the presence of low vitamin D intake or low serum 25- hydroxyvitamin D (25(OH)D) levels. In addition, individuals with OP, OA, and RA carry an increased risk for falls and fractures, while anti-fall and anti-fracture efficacy of vitamin D has been demonstrated in the general older population. For patients with OA or RA, evidence suggests that maintenance of bone density could slow disease progression, while 25(OH)D and bone density are positively correlated among these individuals. Finally, anti-inflammatory effects of vitamin D have been proposed, which may contribute to decreased joint destruction among individuals with OA or RA. In addition, cardiovascular benefits by vitamin D may provide significant improvement to the care of patients with inflammatory rheumatologic diseases. Given the low cost of vitamin D, its excellent tolerability, combined musculoskeletal- and suggested antiinflammatory/ cardio-vascular benefits, vitamin D supplementation holds a significant public health potential. Thus, based on this review, a general supplementation with vitamin D in patients with OP, OA, and RA may be warranted, especially as a high prevalence of vitamin D deficiency has been documented among these individuals.