Abstract MP024: Low Serum Vitamin D is Associated with Musculoskeletal Pain in Statin Users

Abstract

Introduction: Statin use is associated with higher prevalence of self-reported musculoskeletal pain in the general population. Non-blinded studies have shown improvement in myalgia symptoms and increased tolerance to statin use after treatment of vitamin D deficiency. In this study, we hypothesized that lower serum vitamin D concentration would be associated with a higher odds of self-reported musculoskeletal pain among statin users. Methods: Using the National Health and Nutrition Examination Survey (NHANES) 2001–2004, we performed logistic regression to examine the association between vitamin D concentration and self-reported musculoskeletal pain and to evaluate if statin use modified the association. We evaluated vitamin D deficiency using a serum vitamin D concentration considered in the deficient range in clinical practice and representing the lowest quintile of vitamin D concentrations in the population studied (less than15 ng/mL). We adjusted for the effects of age, sex, race, smoking, BMI, physical activity, health status, peripheral vascular disease, coronary heart disease, diabetes, osteoporosis, arthritis, statin use and use of pain medications in logistic regression models. We also explored concentration-related trends of the effect of vitamin D on musculoskeletal pain. Results: Among 6217 participants age 40 years and older, the mean vitamin D concentration was 23.5 ng/mL (95%CI 22.4 ng/mL, 24.2 ng/mL). Statin medications were used by 17% of the participants in the last 30 days. Statin users had higher odds (aOR 1.6, 95%CI 1.2, 2.1) of self-reported musculoskeletal pain in any area (specifically including the lower extremities, lower back, upper extremities, and upper back) compared with non-users. Vitamin D deficiency was not a predictor of musculoskeletal pain (aOR 1.0, 95%CI 0.8, 1.3) in the overall sample. Among 1145 statin users, we found statin use modifies the effect of vitamin D deficiency on musculoskeletal pain (p for interaction = 0.02). Compared to statin users with a vitamin D concentration 15 ng/mL or higher, those with vitamin D concentration less than 15 ng/mL had higher odds of musculoskeletal pain (aOR 1.8, 95% CI 1.1, 3.1). We did not observe a concentration-related trend between increasing vitamin D concentrations and musculoskeletal pain (p for trend=0.7). Conclusion: In conclusion, after controlling for multiple confounders, a vitamin D concentration less than 15 ng/mL was not found to be associated with musculoskeletal pain in the overall sample in this population-based study. However, statin use modifies the relationship between vitamin D deficiency and musculoskeletal pain, such that a vitamin D concentration less than 15 ng/mL is associated with higher odds of self-reported musculoskeletal pain among statin users.