Complex regional pain syndrome type 1 (CRPS1) is a serious risk for postmenopausal women with low vitamin D levels after surgery for distal radius fractures, new research shows.
Vitamin D Versus Chronic Pain in Post-Menopausal Women: New Data
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Complex regional pain syndrome is a pain condition that usually affects one limb after an injury. The cause is thought to be damage to the peripheral and central nervous systems. Patients with complex regional pain syndrome have a confirmed nerve injury, according to the National Institute of Neurological Disorders and Stroke.
In the study, “Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures,” published August 14, 2020 in the Journal of Orthopaedic Surgery and Research, researchers investigated the connection between complex regional pain syndrome and vitamin D levels.
Between February 2016 and March 2017, they enrolled 158 post-menopausal patients who had a distal fracture surgically treated. Patients who were taking vitamin D or osteoporosis medication or those who had multiple injuries or neuropathy were excluded from the study. The final number of patients for analysis was 107.
Patients were grouped by whether they developed complex regional pain syndrome (group 1) or not (group 2), and their serum vitamin D levels were compared. The researchers also measured for bone mineral density of the femur and spine, osteocalcin, alkaline phosphatase (ALP), and body mass index.
The average age of the patients was 66.5 years. The follow-up period was about a year and half after surgery. Nineteen of the patients met the Budapest criteria for complex regional pain syndrome during that time.
The researchers found that the mean serum vitamin D level in group 1 (15.2 ng/ml) was significantly lower than that in group 2 (20.5 ng/ml, p = 0.027). The mean values of osteocalcin, ALP, BMI, and BMD weren’t significantly different between the two groups.
The researchers wrote, “Lower vitamin D levels in post-menopausal women can increase complex regional pain syndrome occurrence in distal radius fractures.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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