Vitamin D deficiency may lead to more pain following total knee replacement

By Danielle Masterson

- Last updated on GMT

Getty Images / stefanamer
Getty Images / stefanamer

Related tags Vitamin d deficiency Osteoarthritis Menopause

Older women with low levels of vitamin D may experience more pain after total knee replacement than those with adequate levels of the nutrient, a new study suggests.

According to the study, published in Menopause​, the journal of The North American Menopause Society (NAMS)​, vitamin D plays a role in the degree of postoperative pain postmenopausal women experience after undergoing total knee replacement. 

During perimenopause, the ovaries make less estrogen. This could result in estrogen deficiency, which along with inactivity and a lack of sun exposure, have been linked to vitamin D deficiency in this age group.

“Estrogen deficiency in perimenopausal women is associated with decreased levels of vitamin D. In addition, low dietary intake of vitamin D, impaired skin synthesis of vitamin D, a sedentary lifestyle that reduces sunlight exposures and decreased hydroxylation of the liver and kidneys also contribute to vitamin D deficiency in perimenopausal women,”​ the authors noted. 

The study

Researchers examined the effect of vitamin D levels on function outcomes and risk factors of moderate to severe pain by retrospectively analyzing the results of 226 postmenopausal women who underwent total knee replacement surgery for osteoarthritis-related symptoms from 2017 to 2019. They grouped the women into two cohorts: a vitamin D-sufficient group and a vitamin D-deficient group. 


The authors found that preoperative vitamin D deficiency adversely affects early functional outcomes in postmenopausal women after total knee replacement surgery. Furthermore, vitamin D deficiency, smoking, and high body mass index were independent risk factors for moderate to severe knee pain after surgery.

Previous studies have found that postmenopausal status and low estrogen levels are associated with joint paint in women aged 50 to 59 years old. This new study further illuminates a link between vitamin D deficiency and a greater risk of postoperative pain. 

The study also found that nearly 70% postmenopausal women scheduled for total knee replacement had vitamin D deficiency. Previous studies suggest that vitamin D deficiency is associated with the development of osteoarthritis, bone pain, decreased bone mineral density and fractures. 

The results of studies like this could provide valuable insights to clinicians evaluating postmenopausal women before major joint surgeries.

“Clinicians must carefully screen preoperative vitamin D levels in postmenopausal women scheduled for  total knee arthroplasty to identify high-risk women before surgery and improve prognosis,”​ the authors concluded. 

“Those with preoperative vitamin D deficiency had poorer functional outcomes. These findings highlight opportunities for clinicians to address these modifiable factors before postmenopausal women undergo joint replacement surgeries,"​ said Dr. Stephanie Faubion, NAMS medical director.

Worldwide problem

Vitamin D deficiency extends beyond postmenopausal women. An estimated 60% of adults worldwide have insufficient levels of the nutrient. 

Source: Menopause
Volume Publish Ahead of Print - doi: 10.1097/GME.0000000000001789
“Effects of preoperative serum vitamin D levels on early clinical function outcomes and the moderate-to-severe pain prevalence in postmenopausal women after primary total knee arthroplasty”
Authors: Y. Song et al.

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