title: Vitamin D status modifies the association between statin use and musculoskeletal pain: a population based study.
abstract: BACKGROUND
  Past studies examining the effect of vitamin D on statin myalgia have been variable; however, these studies were done in limited samples not representative of the general population. We aimed to evaluate whether vitamin D status modifies the association between statin use and musculoskeletal pain in a sample representative of the general population.
  
  
  METHODS
  We conducted a cross-sectional study using the National Health and Nutrition Examination Survey 2001-2004. Musculoskeletal symptoms and statin use were self-reported. Vitamin D status was assessed using serum 25 hydroxyvitamin D (25[OH]D), categorized as <15 ng/mL or ≥15 ng/mL. To evaluate if vitamin D status modifies the association between statin use and prevalent musculoskeletal pain, we performed multivariable-adjusted logistic regression models stratified by 25(OH)D status.
  
  
  RESULTS
  Among 5907 participants ≥40 years old, mean serum 25(OH)D was 23.6 ng/mL (95% CI, 22.9-24.3). In stratified multivariable-adjusted logistic regression models, individuals with 25(OH)D <15 ng/mL, using a statin had a significantly higher odds of musculoskeletal pain compared to those not using a statin (adjusted odds ratio [aOR], 1.90; 95% CI, 1.18-3.05). Among those with 25(OH)D ≥15 ng/mL, we found no significant association between statin use and musculoskeletal pain (aOR, 0.91; 95% CI, 0.71-1.16).
  
  
  CONCLUSIONS
  Among adults ≥ 40 years old with 25(OH)D <15 ng/mL, statin users had nearly 2 times greater odds of reporting musculoskeletal pain compared to non-statin users. Our findings support the hypothesis that vitamin D deficiency modifies the risk of musculoskeletal symptoms experienced with statin use.
authors.affiliation: F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Travis Y
authors.initials: TY
authors.lastname: Morioka
authors.affiliation: Harvard Catalyst Clinical Research Center, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: alee16@bidmc.harvard.edu.
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bertisch
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Buettner
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000097:blood* / Q000188:drug therapy*; D063806:Myalgia / Q000473:pathology; D009749:Nutrition Surveys; D016017:Odds Ratio; D012044:Regression Analysis; D014481:United States; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25-Hydroxyvitamin D; HMG-CoA reductase inhibitors; Muscle symptoms; Myalgia; Statin intolerance; Statins; Vitamin D