The Association Between Serum Vitamin D Status and Knee Joint Space Width in Adults with Early Osteoarthritis - A Cross-Sectional Study

Namra Urooj; Sumera Kanwal; Malak Mustaqeem Khan; Saima Ashraf; Nauman Akhtar; Aqil ur Rehman; Muhammad Faizan Ali

doi:10.61919/kk8apw75

Authors

Namra Urooj Physical Therapist, Mukabbir University, Gujrat, Pakistan Author
Sumera Kanwal Assistant Professor, Faculty of Health and Medical Sciences, Metropolitan University, Karachi, Pakistan Author
Malak Mustaqeem Khan Postgraduate Resident, Department of Orthopaedic Surgery, CPSP, Lady Reading Hospital, Peshawar, Pakistan Author
Saima Ashraf Senior Lecturer, Department of Veterinary Anatomy, School of Veterinary Medicine, IMU University, Kuala Lumpur, Malaysia Author
Nauman Akhtar Medical Officer, PAF Hospital, Faisal, Karachi, Pakistan Author
Aqil ur Rehman Assistant Scientific Officer, Food Science Research Institute, National Agricultural Research Centre, Islamabad, Pakistan Author
Muhammad Faizan Ali MBBS Graduate, Aziz Fatima Medical and Dental College, Faisalabad, Pakistan Author

DOI:

https://doi.org/10.61919/kk8apw75

Keywords:

25-Hydroxyvitamin D; joint space width; Kellgren–Lawrence grade; knee osteoarthritis; nutritional status; radiography; WOMAC

Abstract

Background: Knee osteoarthritis (OA) is a progressive degenerative joint disease in which early cartilage loss determines long-term functional trajectory. Vitamin D, beyond its classical skeletal role, modulates chondrocyte metabolism and joint inflammatory signaling through vitamin D receptor pathways; however, its cross-sectional association with radiographic cartilage preservation in early knee OA remains incompletely characterized. Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] sufficiency and medial tibiofemoral joint space width (JSW) as a radiographic marker of cartilage integrity in adults with early knee osteoarthritis. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, enrolling 135 adults aged 40–65 years with Kellgren–Lawrence grade I–II knee OA. Serum 25(OH)D was measured by chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL) per Endocrine Society guidelines. Standardized weight-bearing JSW was measured digitally by two blinded musculoskeletal radiologists (ICC = 0.91). WOMAC pain and function subscales provided secondary clinical outcomes. ANOVA with Tukey post-hoc testing, Pearson correlation with 95% CIs, and multivariable linear regression adjusting for age, sex, BMI, and symptom duration were applied. Results: Mean serum 25(OH)D was 26.7 ± 8.4 ng/mL. Sufficient participants demonstrated significantly greater JSW than deficient individuals (3.89 ± 0.57 mm vs. 3.11 ± 0.54 mm; mean difference 0.78 mm, 95% CI 0.51–1.05, p < 0.001). Serum 25(OH)D correlated positively with JSW (r = 0.41, 95% CI 0.26–0.54, p < 0.001) and inversely with WOMAC pain (r = -0.36, p = 0.002) and function (r = -0.33, p = 0.004). Associations remained significant after confounder adjustment (β = 0.023 mm/ng/mL, 95% CI 0.011–0.035, p < 0.001). Conclusion: Vitamin D sufficiency was independently associated with greater radiographic joint space width and reduced symptomatic burden in early knee OA, supporting its evaluation as a modifiable nutritional target in early OA prevention.

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