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Current Rheumatology Reports

Erschienen in:

01.06.2012 | INFLAMMATORY MUSCLE DISEASE (I LUNDBERG, SECTION EDITOR)

Vitamin D Deficiency: Subclinical and Clinical Consequences on Musculoskeletal Health

verfasst von: Muhammad Haroon, Oliver FitzGerald

Erschienen in: Current Rheumatology Reports | Ausgabe 3/2012

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Abstract

Vitamin D is an important contributor to musculoskeletal health through its well-established key role in calcium and phosphorus metabolism. The association between vitamin D and various muscle disease outcomes appears promising. However, the role of vitamin D extends well beyond this traditionally labeled effect on muscle and bone health (eg, as a modulator of cell growth and immune function). While further research is needed (as there are still divergent opinions regarding these extraskeletal effects of vitamin D), strong, convincing evidence supports the benefits of vitamin D in promoting bone growth and maintenance, and this has been acknowledged in the recent Institute of Medicine report. However, it should be recognized that the research on vitamin D is still an emerging field, and it is beyond the scope of this paper to include more than a brief review of the published work.

Norman AW, Nemere I, Zhou LX, Bishop JE, Lowe KE, Maiyar AC. 1,25(OH)2D3, a steroid hormone that produces biologic effects via both genomic and nongenomic pathways. J Steroid Biochem Mol Biol. 1992;41:231–40.PubMedCrossRef

Hausler MR, Myrtle JF, Norman AW. The association of a metabolite of vitamin D3 with intestinal mucosa chromatin in vivo. J Biol Chem. 1968;243:4055–64.

Norman AW, Bishop JE, Bula CM, Olivera CJ, Mizwicki MT, Zanello LP, Ishida H, Okamura WH. Molecular tools for study of genomic and rapid signal transduction responses initiated by 1alpha,25(OH)2-vitaminD3. Steroids. 2002;67:457–66.PubMedCrossRef

Holick MF. Non-calcemic actions of 1,25-dihydroxyvitamin D3 and clinical applications. Bone. 1995;17:S107–11.CrossRef

Huhtakangas JA, Olivera CJ, Bishop JE, Zanello LP, Norman AW. The vitamin D receptor is present in caveolae enriched plasma membranes and binds 1alpha,25(OH)2-vitamin D3 in vivo and in vitro. Mol Endocrinol. 2004;18:2660–71.PubMedCrossRef

Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D deficiency. Lancet. 1998;351(9105):805–6.PubMedCrossRef

McKenna MJ, Freaney R. Secondary hyperparathyroidism in the elderly: a means to determining hypovitaminosis D. Osteoporos Int. 1998;8:S3–6.PubMedCrossRef

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.PubMedCrossRef

Hollis BW, Wagner SL. Vitamin D deficiency during pregnancy: an ongoing epidemic. Am J Clin Nutr. 2006;84:272.

10.

Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations and safety. Am J Clin Nutr. 1999;69:842–56.PubMed

11.

Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 2005;97:93–101.PubMedCrossRef

12.

Bhalla AK, Amento EP, Serog B, et al. 1,25-Dihydroxyvitamin D3 inhibits antigen-induced T cell activation. J Immunol. 1984;133:1748–54.PubMed

13.

Lemire JM. Immunomodulatory role of 1,25-dihydroxyvitamin D3. J Cell Biochem. 1992;49:26–31.PubMedCrossRef

14.

Mattner F, Smiroldo S, Galbiati F, et al. Inhibition of Th1 development and treatment of chronic-relapsing experimental allergic encephalomyelitis by a non-hypercalcemic analogue of 1,25-dihydroxyvitamin D(3). Eur J Immunol. 2000;30:498–508.PubMedCrossRef

15.

Boonstra A, Barrat FJ, Crain C, et al. 1>25-Dihydroxyvitamin D3 has a direct effect on naive CD4+ T cells to enhance the development of Th2 cells. J Immunol. 2001;167:4974–80.PubMed

16.

Deluca HF, Cantorna M. Vitamin D: its role and uses in immunology. FASEB J. 2001;15:2579–85.PubMedCrossRef

17.

Berer A, Stockl J, Majdic O, et al. 1,25-Dihydroxyvitamin D(3) inhibits dendritic cell differentiation and maturation in vitro. Exp Hematol. 2000;28:575–83.PubMedCrossRef

18.

Penna G, Adorini L. 1>25-Dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol. 2000;164:2405–11.PubMed

19.

Griffin MD, Lutz WH, Phan VA, et al. Potent inhibition of dendritic cell differentiation and maturation by vitamin D analogs. Biochem Biophys Res Commun. 2000;270:701–8.PubMedCrossRef

20.

Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med. 2010;88(5):441–50.PubMedCrossRef

21.

Linker-Israeli M, Elstner E, Klinenberg JR, et al. Vitamin D(3) and its synthetic analogs inhibit the spontaneous in vitro immunoglobulin production by SLE-derived PBMC. Clin Immunol. 2001;99:82–93.PubMedCrossRef

22.

Cutolo M, Otsa K, Laas K, et al. Circannual vitamin D serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol. 2006;24:702–4.PubMed

23.

Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D. Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum. 2007;56:2143–9.PubMedCrossRef

24.

Szodoray P, Tarr T, Bazso A, Poor G, Szegedi G, Kiss E. The immunopathological role of vitamin D in patients with SLE: data from a single centre registry in Hungary. Scand J Rheumatol. 2010 Oct 26. [Epub ahead of print].

25.

Ben-Zvi I, Aranow C, Mackay M, et al. The impact of vitamin D on dendritic cell function in patients with systemic lupus erythematosus. PLoS One. 2010;5(2):e9193.PubMedCrossRef

26.

Amital H, Szekanecz Z, Szucs G, et al. Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis. 2010;69(6):1155–7.PubMedCrossRef

27.

Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062–72.PubMedCrossRef

28.

Frances RM, Selby PL. Osteomalacia. Ballieres Clin Endocrinol. 1997;11:145–63.CrossRef

29.

Reginato AJ, Falasca GF, Pappu R, McKnight B, Agha A. Musculoskeletal manifestations of osteomalacia: report of 26 cases and literature review. Semin Arthritis Rheum. 1999;28(5):287–304. Review.PubMedCrossRef

30.

Nelson AM, Riggs BL, Jowsey JO. Atypical axial osteomalacia: report of four cases with two having features of ankylosing spondylitis. Arthritis Rheum. 1978;21:715–9.PubMedCrossRef

31.

Polisson RP, Martinez S, Khoury M, et al. Calcification of entheses associated with X-linked hypophosphatemic osteomalacia. N Engl J Ned. 1985;313:1–6.CrossRef

32.

Dent CE, Hat SM. Hereditary forms of rickets and osteomalacia. J Bone Joint Surg. 1956;38:204–26.

33.

Whyte ME, Fallon MD, Murphy WA, et al. Axial osteomalacia. Am J Med. 1981;71:1041–9.PubMedCrossRef

34.

Al-Said YA, Al-Rachad HS, Al-Qahtani HA, Jan MM. Severe proximal myopathy with remarkable recovery after vitamin D treatment. Can J Neurol Sci. 2009;36(3):336–9.PubMed

35.

Prabhala A, Garg R, Dandona P. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med. 2000;160(8):1199–203.PubMedCrossRef

36.

Karia J, Katiyar BC, Srivastava TP, Dube B. Myopathy and neuropathy associated with osteomalacia. Acta Neurol Scand. 1975;51:37–58.

37.

Campbell GA, Kemm JR, Hosking DJ, Boyd RV. How common is osteomalacia in the elderly? Lancet. 1984;2(8399):386–8.PubMedCrossRef

38.

Tucker GS, Middha VP, Sural A, Sagreiya K. Incidence of osteomalacia in fractures of the proximal end of femur. Injury. 1988;19(2):89–92.PubMedCrossRef

39.

Pettifor JM, Isdale JM, Sahakian J, Hansen JD. Diagnosis of subclinical rickets. Arch Dis Child. 1980;55(2):155–7.PubMedCrossRef

40.

Schott GD, Wills MR. Muscle weakness in osteomalacia. Lancet. 1976;1(7960):626–9.PubMedCrossRef

41.

Prineas JW, Mason AS, Henson RA. Myopathy in metabolic bone disease. Br Med J. 1965;1(5441):1034–6.PubMedCrossRef

42.

Boullion R, Carmeliet G, Daci E, et al. Vitamin D metabolism and action. Osteoporos Int. 1998;8 Suppl 2:S13–9.CrossRef

43.

Boland R. Role of vitamin D in skeletal muscle function. Endocrinol Rev. 1986;7(4):434–48.CrossRef

44.

Ekbom K, Hed R, Kirstein L, Astroem KE. Weakness of proximal limb muscles, probably due to myopathy after partial gastrectomy. Preliminary report. Acta Med Scand. 1964;176:493–6.PubMedCrossRef

45.

Smith R, Stern G. Myopathy, osteomalacia and hyperparathyroidism. Brain. 1967;90(3):593–602.PubMedCrossRef

46.

Simpson RU, Thomas GA, Arnold AJ. Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle. J Biol Chem. 1985;260(15):8882–91.PubMed

47.

Costa EM, Blau HM, Feldman D. 1,25-dihydroxyvitamin D3 receptors and hormonal responses in cloned human skeletal muscle cells. Endocrinology. 1986;119(5):2214–20.PubMedCrossRef

48.

Geusens P, Vandevyver C, Vanhoof J, Cassiman JJ, Boonen S, Raus J. Quadriceps and grip strength are related to vitamin D receptor genotype in elderly non-obese women. J Bone Miner Res. 1997;12:2082–8.PubMedCrossRef

49.

Visser M, Deeg DJ, Lips P, et al. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003;88(12):5766–72.PubMedCrossRef

50.

Joborn C, Joborn H, Rastad J, Akerström G, Ljunghall S. Maximal isokinetic muscle strength in patients with primary hyperparathyroidism before and after parathyroid surgery. Br J Surg. 1988;75(1):77–80.PubMedCrossRef

51.

Kristoffersson A, Boström A, Söderberg T. Muscle strength is improved after parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1992;79(2):165–8.PubMedCrossRef

52.

Garber AJ. Effect of parathyroid hormone on skeletal muscle protein and amino acid metabolism in the rat. J Clin Invest. 1983;71:1806–21.PubMedCrossRef

53.

Baczynski R, Massry SG, Magott M, el Belbessi S, Kohan R, Brautbar N. Effect of parathyroid hormone on energy metabolism of skeletal muscle. Kidney Int. 1985;28:722–7.PubMedCrossRef

54.

Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int. 2005;16(11):1425–31.PubMedCrossRef

55.

Dhesi JK, Jackson SH, Bearne LM, Moniz C, Hurley MV, Swift CG, Allain TJ. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004;33(6):589–95.PubMedCrossRef

56.

Bischoff HA, Stahelin HB, Urscheler N. Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil. 1999;80:54–8.PubMedCrossRef

57.

Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Mineral Res. 2000;15:1113–18.CrossRef

58.

Lord SR, Sambrook P, Gilbert C, et al. Postural stability, falls, and fractures in the elderly: results from the Dubbo osteoporosis epidemiology study. Med J Aust. 1994;160:688–91.

59.

Nguyen T, Sambrook P, Kelly PJ, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. 1993;307:1111–15.PubMedCrossRef

60.

• Gilsanz V, Kremer A, Mo AO, Wren TA, Kremer R. Vitamin D status and its relation to muscle mass and muscle fat in young women. J Clin Endocrinol Metab. 2010;95(4):1595–601. This recent article reported a significant inverse relation of low vitamin D levels with skeletal muscle fat infiltration in asymptomatic young women, which was noted to be independent of muscle mass. This potentially has an important role in the function of myocytes.PubMedCrossRef

61.

Latham NK, Anderson CS, Reid IR. Effects of vitamin D supplementation on strength, physical performance, and falls in older persons: a systematic review. J Am Geriatr Soc. 2003;51(9):1219–26.PubMedCrossRef

62.

Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1–235.

63.

• Stockton KA, Mengersen K, Paratz JD, Kandiah D, Bennell KL. Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int. 2011;22(3):859–71. This is a recent up-to-date systematic review examining the role of vitamin D in muscle strength.PubMed

64.

Ahmed W, Khan N, Glueck CJ, Pandey S, Wang P, Goldenberg N, Uppal M, Khanal S. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res. 2009;153(1):11–6. Epub 2008 Dec 6.PubMedCrossRef

65.

Glueck CJ, Budhani SB, Masineni SS, Abuchaibe C, Khan N, Wang P, Goldenberg N. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin. 2011;27(9):1683–90. Epub 2011 Jul 6.PubMedCrossRef

66.

Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMedCrossRef

67.

Tromp AM, Smit JH, Deeg DJ, et al. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res. 1998;13(12):1932–9.PubMedCrossRef

68.

Parkkari J, Kannus P, Palvanen M, et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999;65(3):183–7.PubMedCrossRef

69.

Youm T, Koval KJ, Kummer FJ, Zuckerman JD. Do all hip fractures result from a fall? Am J Orthop. 1999;28(3):190–4.PubMed

70.

Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 1998;53(2):M112–9.PubMedCrossRef

71.

Stel VS, Smit JH, Pluijm SM, Lips P. Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing. 2004;33(1):58–65.PubMedCrossRef

72.

Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health. 1992;82:1020–3.PubMedCrossRef

73.

Rizzo JA, Baker DI, McAvay G, Tinetti ME. The cost effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care. 1996;34:954–69.PubMedCrossRef

74.

Stein MS, Wark JD, Scherer SC, et al. Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc. 1999;47:1195–201.PubMed

75.

76.

Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomised controlled trial. J Bone Mineral Res. 2003;18:343–51.CrossRef

77.

Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004;291:1999–2006.PubMedCrossRef

78.

Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and alpha-hydroxylated vitamin D: a meta-analysis of randomized controlled trials. BMJ. 2009;339:b3692.PubMedCrossRef

79.

Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;(2):CD007146.

80.

Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57.CrossRef

81.

Barr R, Macdonald H, Stewart A, McGuigan F, Rogers A, Eastell R, Felsenberg D, Glüer C, Roux C, Reid DM. Association between vitamin D receptor gene polymorphisms, falls, balance and muscle power: results from two independent studies (APOSS and OPUS). Osteoporos Int. 2010;21(3):457–66. Epub 2009 Jul 24.PubMedCrossRef

82.

http://www.who.int/violence_injury_prevention/other_injury/falls/en/index.html.

83.

Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA. Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist. 2006;46(3):367–76.PubMedCrossRef

84.

Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C, PROFANE-Group. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5–10.PubMedCrossRef

85.

Staud R. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol. 2004;16:157–63.PubMedCrossRef

86.

Knutsen KV, Brekke M, Gjelstad S, Lagerløv P. Vitamin D status in patients with musculoskeletal pain, fatigue and headache: a cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scand J Prim Health Care. 2010;28(3):166–71.PubMedCrossRef

87.

Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine. 2003;28:177–9.PubMedCrossRef

88.

Erkal MZ, Wilde J, Bilgin Y, Akinci A, Demir E, Bodeker RH, et al. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int. 2006;17:1133–40.PubMedCrossRef

89.

Benson J, Wilson A, Stocks N, Moulding N. Muscle pain as an indicator of vitamin D deficiency in an urban Australian Aboriginal population. Med J Aust. 2006;185:76–7.PubMed

90.

Lotfi A, Abdel-Nasser AM, Hamdy A, Omran AA, El-Rehany MA. Hypovitaminosis D in female patients with chronic low back pain. Clin Rheumatol. 2007;26:1895–901. doi:10.1007/s10067-007-0603-4.PubMedCrossRef

91.

Atherton K, Berry DJ, Parsons T, Macfarlane GJ, Power C, Hyppönen E. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey. Ann Rheum Dis. 2009;68(6):817–22. Epub 2008 Aug 12.PubMedCrossRef

92.

McBeth J, Pye SR, O’Neill TW, Macfarlane GJ, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Wu FC, EMAS Group. Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study. Ann Rheum Dis. 2010;69(8):1448–52. Epub 2010 May 24.PubMedCrossRef

93.

de Rezende Pena C, Grillo LP, das Chagas Medeiros MM. Evaluation of 25-hydroxyvitamin d serum levels in patients with fibromyalgia. J Clin Rheumatol. 2010;16(8):365–9.PubMed

94.

Warner AE, Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol. 2008;14:12–6.PubMedCrossRef

95.

Badsha H, Daher M, Ooi KK. Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clin Rheumatol. 2009;28:971–3.PubMedCrossRef

96.

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66:419–24.PubMedCrossRef

97.

Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Intern Med. 2008;168:771–2.PubMedCrossRef

98.

Prabhala A, Garg R, Dandona P. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med. 2000;160:1199–203.PubMedCrossRef

99.

Wandless I, Jarvis S, Evans JG, Aird EG, Stevens J. Vitamin D3 in osteoporosis. Br Med J. 1980;280:1320.PubMedCrossRef

100.

Iwamoto J, Takeda T, Ichimura S, Matsu K, Uzawa M. Effects of cyclical etidronate with alfacalcidol on lumbar bone mineral density, bone resorption, and back pain in postmenopausal women with osteoporosis. J Orthop Sci. 2003;8:532–7.PubMedCrossRef

101.

Block SR. Vitamin D deficiency is not associated with nonspecific musculoskeletal pain syndromes including fibromyalgia. Mayo Clin Proc. 2004;79:1585–6.PubMedCrossRef

102.

Straube S, Andrew Moore R, Derry S, McQuay HJ. Vitamin D and chronic pain. Pain. 2009;141(1-2):10–3.PubMedCrossRef

103.

Straube S, Derry S, Moore RA, McQuay HJ. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007771.

104.

Straube S, Moore RA, Derry S, Hallier E, McQuay HJ. Vitamin D and chronic pain in immigrant and ethnic minority patients—investigation of the relationship and comparison with native Western populations. Int J Endocrinol. 2010;2010:753075. Epub 2009 Oct 19.PubMed

105.

Kragstrup TW. Vitamin D supplementation for patients with chronic pain. Scand J Prim Health Care. 2010 Nov 15. [Epub ahead of print] PMID:21073396.

Titel: Vitamin D Deficiency: Subclinical and Clinical Consequences on Musculoskeletal Health
verfasst von: Muhammad Haroon
Oliver FitzGerald
Publikationsdatum: 01.06.2012
Verlag: Current Science Inc.
Erschienen in: Current Rheumatology Reports / Ausgabe 3/2012
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-012-0244-8

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