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The role of vitamin D supplementation in patients with rheumatic diseases

Nature Reviews Rheumatology volume 9, pages 411–422 (2013)Cite this article

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Abstract

Vitamin D is a dietary vitamin that can also be synthesized in adequate amounts from cholesterol in most mammals exposed to sunlight. Vitamin D has classical roles in calcium and phosphate metabolism, and thus the skeleton; however, this molecule also has nonclassical effects that might influence the function of the immune, cardiovascular and endocrine systems. Vitamin D deficiency, due to insufficient sunlight exposure, dietary uptake and/or abnormalities in its metabolism, has been associated with rheumatic diseases, and both the classical and nonclassical effects of vitamin D might be of relevance to patients with rheumatic disease. However, conclusive data from intervention trials demonstrating the relationship between vitamin D levels and pathogenetic processes separate from classical effects of this molecule are lacking. Furthermore, the majority of studies linking vitamin D to health outcomes, harmful or beneficial, are observational in nature, linking clinical events to vitamin D exposure or serum levels of vitamin D metabolites. Evidence from high quality, prospective, double-blind, placebo-controlled, randomized trials should be obtained before vitamin D supplementation is recommended in the treatment of the many rheumatic conditions in which deficiency of this compound has been implicated. Herein, we review the evidence for vitamin D supplementation in the management of patients with rheumatic diseases.

Key Points

  • Vitamin D has classical roles in calcium and phosphate metabolism that influence the skeleton, as well as putative nonclassical effects that affect the cardiovascular, endocrine and immune systems

  • Vitamin D deficiency has been associated with a number of diseases, among them rheumatic diseases, including osteoporosis, osteoarthritis, rheumatoid arthritis and connective tissue diseases

  • Vitamin D given with calcium supplements modestly reduces the risk of osteoporotic fractures

  • Few intervention trials with vitamin D have been designed to address nonskeletal outcomes

  • Insufficient data are available to inform public health recommendations regarding vitamin D supplementation in rheumatic diseases other than osteoporosis

  • High quality prospective, double-blind, placebo-controlled randomized trials of vitamin D supplementation are needed

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Figure 1: Schematic illustration of the regulation of vitamin D metabolism.
Figure 2: Environmental factors affecting low serum levels of 25(OH)D.

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Authors and Affiliations

  1. Department of Medicine F, Gentofte Hospital, Niels Andersensvej 65, Copenhagen, DK-2900, Hellerup, Denmark

    Bo Abrahamsen

  2. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK

    Nicholas C. Harvey

Authors
  1. Bo Abrahamsen
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  2. Nicholas C. Harvey
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Both authors contributed equally to all stages of the preparation of this manuscript for publication.

Corresponding author

Correspondence to Bo Abrahamsen.

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Competing interests

B. Abrahamsen declares that he has acted as a consultant for Amgen and Takeda/Nycomed, has received research support from Amgen, Novartis and NPS Pharmaceuticals, and has received speakers bureau (honoraria) from Amgen, Eli Lilly, Merck and Nycomed. N. C. Harvey declares that he has received research support from Servier, and has received speakers bureau (honoraria) from the Alliance for Better Bone Health, Amgen, Lilly, Nycomed, Proctor and Gamble, Sanofi-Aventis, Servier and Shire.

Supplementary information

Supplementary Table 1

Studies of vitamin D and fractures, falls and BMD (DOC 209 kb)

Supplementary Table 2

Studies of vitamin D in SLE or CLE (DOC 199 kb)

Supplementary Table 3

Studies of vitamin D in SSc and myopathy (DOC 148 kb)

Supplementary Table 4

Studies of vitamin D in RA (DOC 198 kb)

Supplementary Table 5

Studies of vitamin D in OA (DOC 185 kb)

Supplementary Table 6

Studies of vitamin D in seronegative diseases and chronic pain syndromes (DOC 199 kb)

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Abrahamsen, B., Harvey, N. The role of vitamin D supplementation in patients with rheumatic diseases. Nat Rev Rheumatol 9, 411–422 (2013). https://doi.org/10.1038/nrrheum.2013.71

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