Joint symptoms in postmenopausal women not reduced by calcium plus vitamin D supplementation

Main Category: Arthritis / Rheumatology
Also Included In: Menopause;  Nutrition / Diet
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
Joint symptoms in postmenopausal women not reduced by calcium plus vitamin D supplementation

A team of investigators systematically analyzed the effect of calcium and vitamin D supplementation on joint symptoms in a rigorous and controlled study of postmenopausal women. They found that supplementation did not reduce the severity of joint symptoms reported by the participants. Their results are published in the Journal of the Academy of Nutrition and Dietetics.

The influence of low calcium and vitamin D deficiency on joint symptoms has been studied with mixed results. Only some observational studies have associated vitamin D with knee osteoarthritis and results from full-scale randomized trials have been sparse. "In the current study, we addressed for the first time in a full-scale, randomized clinical trial setting, the clinically relevant question of whether postmenopausal women using calcium and vitamin D supplements in currently recommended dosage would experience any favorable effect on joint pain or swelling, common symptoms in postmenopausal women," says lead investigator Rowan T. Chlebowski, MD, PhD, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, California.

Using data from the Women's Health Initiative (WHI) calcium plus vitamin D supplementation trial, researchers identified a subgroup of 1,911 postmenopausal women for the current study, who had been randomized to receive calcium carbonate with vitamin D3 daily or placebo and had undergone serial joint symptom assessment. Responses to a questionnaire provided qualitative information on joint pain and joint swelling before entry and two years after randomization.

Between the daily supplement use and placebo groups, joint pain and swelling at baseline entry was comparable, at more than 70 percent. After two years, analysis revealed no statistically significant difference for the frequency or severity of joint pain or swelling.

The research team also evaluated data to determine the potential for interaction with age, BMI (body mass index), physical activity, non-protocol calcium and vitamin D supplement use, race/ethnicity, and hormone therapy. Investigators found no interaction with age, BMI, race/ethnicity, or physical activity. No significant interaction was evident with non-protocol vitamin D supplement use at entry. However, participants using non-protocol calcium supplements at entry reported less joint pain compared with those in the placebo group. The influence of calcium and vitamin D supplementation individually on joint symptoms was not determined because both were provided combined in a single pill in this trial.

Dr. Chlebowski concludes, "Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg of calcium carbonate and 400 IU of vitamin D3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms."

Dr. Chlebowski and his team add that these findings do not speak against current recommendations for vitamin D intakes for bone health and fracture risk reduction.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder

Main Category: Dentistry
Also Included In: Pain / Anesthetics
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder

Temporomandibular joint disorder (TMJD) is the most common form of oral or facial pain, affecting over 10 million Americans. The chronic disorder can cause severe pain often associated with chewing or biting down, and lacks effective treatments.

In a study in mice, researchers at Duke Medicine identified a protein that is critical to TMJD pain, and could be a promising target for developing treatments for the disorder. Their findings are published in the August issue of the journal PAIN.

Aside from cases related to trauma, little is known about the root cause of TMJD. The researchers focused on TRPV4, an ion channel protein that allows calcium to rapidly enter cells, and its role in inflammation and pain associated with TMJD.

"TRPV4 is widely expressed in sensory neurons found in the trigeminal ganglion, which is responsible for all sensations of the head, face and their associated structures, such as teeth, the tongue and temporomandibular joint," said senior study author Wolfgang Liedtke, M.D., PhD, associate professor of neurology and neurobiology at Duke. "This pattern and the fact that TRPV4 has been found to be involved in response to mechanical stimulation made it a logical target to explore."

The researchers studied both normal mice and mice genetically engineered without the Trpv4 gene (which produces TRPV4 channel protein). They created inflammation in the temporomandibular joints of the mice, and then measured bite force exerted by the mice to assess jaw inflammation and pain, similar to how TMJD pain is gauged in human patients. Given that biting can be painful for those with TMJD, bite force lessens the more it hurts.

The mice without the Trpv4 gene had a smaller reduction in bite force - biting with almost full force - suggesting that they had less pain. In normal mice there was more TRPV4 expressed in trigeminal sensory neurons when inflammation was induced. The increase in TRPV4 corresponded with a greater reduction in bite force.

The researchers also administered a compound to normal mice that blocked TRPV4, and found that inhibiting TRPV4 also led to smaller reductions in bite force, similar to the effects of the mice engineered without the Trpv4 gene.

Surprisingly, the researchers found comparable bone erosion and inflammation in the jaw tissue across all mice, regardless whether the mice had TRPV4 or not.

"Remarkably, the damage is the same but not the pain," Liedtke said. "The mice that had the most TRPV4 appeared to have the most pain, but they all had similar evidence of temporomandibular joint inflammation and bone erosion in the jawbone as a consequence of the inflammation."

The results suggest that TRPV4 and its expression in trigeminal sensory neurons contribute to TMJD pain in mice. Given the lack of effective treatments for this chronic pain disorder, TRPV4 may be an attractive target for developing new therapies.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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In addition to Liedtke, Duke study authors include senior pain researcher Yong Chen, Ji Hee Hong, Suk Hee Lee, Puja K. Parekh and Carlene Moore of the Department of Neurology; Amy L. McNulty, Nicole E. Rothfusz and Farshid Guilak of the Department of Orthopaedic Surgery; Fan Wang of the Department of Cell Biology/Neurobiology; and Andrea B. Taylor of the Departments of Community and Family Medicine and Evolutionary Anthropology. Susan H. Williams of the Heritage College of Osteopathic Medicine at Ohio University and Robert W. Gereau IV of the Department of Anesthesiology at Washington University in St. Louis also contributed to this research.

The research was supported by the National Institutes of Health (DE018549, DE19440, DE19440S1, NS48602, AR048182 and DE018549-S); Duke Institute for Brain Sciences; Nicholas School of the Environment, Duke University; and Keimyung University School of Medicine in South Korea.

Duke University Medical Center

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Duke University Medical Center. (2013, August 5). "Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder." Medical News Today. Retrieved from
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