Vitamin D Supplementation for Nonspecific Musculoskeletal Pain: Ready for Prime Time?

Article for Discussion

Schreuder F, Bernsen RMD, van der Wouden JC. Vitamin D supplementation for nonspecific muscuoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med. 2012;10(6):547-555.

Discussion Tips

Vitamin D seems to be emerging as a therapeutic or preventive intervention for many diseases. This early-phase clinical trial evaluates the short-term effect of a fixed dose of vitamin D for a common primary care problem in a high-risk population. The article is rich with clinical, methodological, and mechanistic factors to consider.

Discussion Questions

• What question is asked by this study and why does it matter?

• How does this study advance beyond previous research and clinical practice on this topic?

• How strong is the study design for answering the question?

• To what degree can the findings be accounted for by:

  1. How patients were selected, excluded, or lost to follow-up?

  2. The dose and timing of the vitamin D supplementation?

  3. How the main variables were measured? The duration of measurement?

  4. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  5. Chance?

  6. How the findings were interpreted?

• What are the main study findings?

• How do you interpret the differences in the magnitude and clinical and statistical significance of the findings across the different outcomes and time periods?

• How applicable do you judge the findings to be to other patient populations?

• How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?

• What contextual factors are important for interpreting the findings?

• Are these findings ready for application in practice? How and with whom? What might the role of vitamin D testing, parathyroid hormone testing, and/or clinical assessment be in targeting treatment?

• What are the next steps in interpreting or applying the findings?

• What researchable questions remain?