Association of 25-hydroxyvitamin D with the incidence of knee and hip osteoarthritis: a 22-year follow-up study

Objective: In the light of conflicting results from previous studies on the role of vitamin D, we studied serum 25-hydroxyvitamin D [25(OH) D] with regard to its prediction of incident knee and hip osteoarthritis (OA). Methods: The study population (n = 805) consisted of participants of a national health examination survey who had undergone baseline and follow-up clinical examinations at intervals of 20-23 years. Knee and hip OA were diagnosed on the basis of a standardized clinical examination by physicians with the same diagnostic criteria at baseline and follow-up. Information on covariates, including age, sex, season of blood draw, education, body mass index (BMI), physical workload, leisure time physical activity, smoking history, and previous injuries, was collected at baseline. Serum 25(OH) D concentrations were determined from baseline serum samples kept frozen at -20 degrees C. Results: We found no significant association between serum 25(OH) D level and the risk of incident knee or hip OA. However, a statistically significant interaction between season of blood draw and serum 25(OH) D emerged when predicting the development of definite knee OA (p 0.004). After adjusting for all the covariates, the relative odds (95% confidence interval) of developing definite knee OA per increment of 1 SD (20.7 ng/mL) in winter season 25(OH) D was 1.57 (1.10-2.27), whereas for summer season sera the corresponding rate was 0.53 (0.28-1.00). Conclusion: The results do not support the hypothesis that a low level of serum 25(OH) D contributes to the development of OA. Instead, our study suggests that season is a potent effect modifier of 25(OH) D, which merits attention in future research.