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Relationship between musculoskeletal pain and Vitamin D levels in elderly women

Year 2019, Volume: 4 Issue: 2, 69 - 73, 30.08.2019

Filiz Meryem Sertpoyraz , Yasemin Kilic Ozturk Eylem Gulsen Kirbiyik

https://doi.org/10.22391/fppc.456142

Abstract



Introduction: Pain is a
common symptom of aging. Vitamin D is an effective pre-prohormone with
ubiquitous receptors in many tissues, including the musculoskeletal system.
Vitamin D deficiency is known to cause pain, proximal muscle weakness in lower
extremities, skeletal mineralization defects, balance disorders, increased risk
of fall and fracture, and reduced functional capacity. This study aimed to
evaluate the relationship between vitamin D levels and the musculoskeletal pain
in female patients aged 65 years or over.



Methods: This
descriptive cross-sectional study included 120 female patients aged 65 years
and over who were admitted to physical therapy and rehabilitation outpatient
clinic. The participants were administered a questionnaire consisting of
demographic data (age, education, occupation, sun exposure, physical activity
levels, intake of calcium-rich foods), musculoskeletal pain, and location of
the pain. The levels of 25(OH) vitamin D (vitamin D), calcium, phosphorus,
alkaline phosphatase, and parathormon in the serum were recorded from the
hospital database.



Results: Of the
participants, 101 (84%) had vitamin D deficiency or insufficiency, 83 (69%) had
musculoskeletal pain, and 37 (31%) had no pain at all. Serum vitamin D levels
were significantly lower in those who had pain (p=0.008). Sixty-two (75%) of
the patients with musculoskeletal pain (n=83) had vitamin D deficiency or
insufficiency. Among those with musculoskeletal system pain and vitamin D
deficiency or insufficiency (n=62), the pain was most frequently localized to
the lower back (41%) and upper back (32%).



Conclusion: It is
important to evaluate serum 25(OH) vitamin D levels particularly in elderly
female patients admitted with musculoskeletal pain. Vitamin D deficiency should
be kept in mind for female patients suffering from the lower and upper back
pain. Considering the role of vitamin D on the musculoskeletal system,
assessment of vitamin D levels and, in case of deficiency, supplementation
therapy is recommended for elderly women.



Keywords

Vitamin D female musculoskeletal pain

References

  • 1. Horgas AL. Pain management in older adults. Nurs Clin North Am 2017;52(4):e1-e7.https://doi.org/10.1016/j.cnur.2017.08.001
  • 2. Leveille SG, Ling S, Hochberg MC, Resnick HE, Bandeen-Roche KJ, Won A, et al. Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med 2001;135:1038-46.https://doi.org/10.7326/0003-4819-135-12-200112180-00007
  • 3. Koundourakis NE, Avgoustinaki PD, Malliaraki N, Margioris AN. Muscular effects of vitamin D in young athletes and non-athletes and in the elderly. Hormones 2016;15:471-88.https://doi.org/10.14310/horm.2002.1705
  • 4. Bringhurst FR, Demay MB, Krane SM, Kronenberg HM: Bone and mineral metabolism in health and disease. In: Harrison's Principles of Internal Medicine, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (eds). 16th ed. New York: MC Graw-Hill Companies; 2005:2238-86.
  • 5. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003; 28:177-9. https://doi.org/10.1097/00007632-200301150-00015
  • 6. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116:2062-72. https://doi.org/10.1172/JCI29449
  • 7. Mascarenhas R, Mobarhan S. Hypovitaminosis D-induced pain. Nutr Rev 2004; 62:354-9. https://doi.org/10.1301/nr.2004.sept.354-359
  • 8. Helde-Frankling M, Björkhem-Bergman L. Vitamin D in pain management. Int J Mol Sci 2017;18(10):2170-77. https://doi.org/10.3390/ijms18102170
  • 9. Wu Z,Malihi Z, Stewart AW, Lawes CM, Scragg R. Effect of vitamin D supplementation on pain: A systematic review and meta-analysis. Pain Phys. 2016; 19:415-27. https://www.ncbi.nlm.nih.gov/pubmed/27676659
  • 10. Alshahrani F, Aljohani N. Vitamin D:Deficiency,sufficiency and toxicity. Nutrients 2013;5(9):3605-16.https://doi.org/10.3390/nu5093605
  • 11. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89(2-3):127-34. https://doi.org/10.1016/S0304-3959(00)00355-9
  • 12. Rastogi R, Meek BD. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging 2013; 8:37-46. https://doi.org/10.2147/CIA.S30165
  • 13. Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab 2002; 13:100-5. https://doi.org/10.1016/S1043-2760(01)00547-1
  • 14. Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus 2015; 24:483-9. https://doi.org/10.1177/0961203314558676
  • 15. Liu X, Nelson A, Wang X, Farid M, Gunji Y, Ikari J, et al. Vitamin D modulates prostaglandin E2 synthesis and degradation in human lung fibroblasts. Am J Respir Cell Mol Biol 2014; 50:40-50. https://doi.org/10.1165/rcmb.2013-0211OC
  • 16. Tsiaras WG, Weinstock MA. Commentary: Ultraviolet irradiation and oral ingestion as sources of optimal vitamin D. J Am Acad Dermatol 2010; 62:935-6. https://doi.org/10.1016/j.jaad.2009.09.011
  • 17. Hicks GE, Shardell M, Miller RR, Bandinelli S, Guralnik J, Cherubini A, et al. Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study. J Am Geriatr Soc 2008;56(5):785-91. https://doi.org/10.1111/j.1532-5415.2008.01644.x
  • 18. Himmelstein S, Clemens TL, Rubin A. Vitamin D supplementation in elderly nursing home residents increases 25 (OH) D but not 1,25 (OH) 2D. Am J Clin Nutr 1990;52:701-6. https://doi.org/10.1093/ajcn/52.4.701
  • 19. Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O’Neill T. An excess of widespread pain among South Asians: Are low levels of vitamin D implicated? Ann Rheum Dis 2005; 64:1217-9. https://doi.org/10.1136/ard.2004.032656
  • 20. Basaran S, Guzel R, Coskun-Benlidayi I, Guler-Uysal F. Vitamin D status: Effects on quality of life in osteoporosis among Turkish women. Qual Life Res 2007;16:1491-9.https://doi.org/10.1007/s11136-007-9257-6
  • 21. Helliwell PS, Ibrahim GH, Karim Z, Sokoll K, Johnson H. Unexplained musculoskeletal pain in people of South Asian ethnic group referred to a rheumatology clinic—relationship to biochemical osteomalacia, persistence over time and response to treatment with calcium and vitamin D. Clin Exp Rheumatol 2006;24:424-7.https://www.ncbi.nlm.nih.gov/pubmed/16956433
  • 22. Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 2005; 16:1425-31. https://doi.org/10.1007/s00198-005-1860-1
  • 23. Ghai B, Bansal D, Kapil G,Kanukula R,Lavidiya S, Sachdeva N. High prevalence of hypovitaminosis D in Indian chronic low back patients. Pain Physician 2015;18: E853-62. https://www.ncbi.nlm.nih.gov/pubmed/26431139
  • 24. Kim TH, Lee BH, Lee HM, Lee SH, Park JO, Kim HS, et al. Prevalence of vitamin D deficiency in patients with lumbar spinal stenosis and its relationship with pain. Pain Physician 2013;16(2):165-76.https://www.ncbi.nlm.nih.gov/pubmed/23511683
  • 25. Heuch I, Heuch I, Hagen K, Zwart JA. Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine 2013;38:133-9.https://doi.org/10.1097/BRS.0b013e3182647af2
  • 26. Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C et al.Is vitamin D supplementation effective for low back pain? A systematic review and meta-analysis. Pain Physician 2018;21(2):121-45.https://www.ncbi.nlm.nih.gov/pubmed/29565945
  • 27. Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C et al. Mapping the Association between Vitamin D and Low Back Pain: A Systematic Review and Meta Analysis of Observational Studies. Pain Physician 2017; 20:611-40. https://www.ncbi.nlm.nih.gov/pubmed/29149142
  • 28. Laslett LL, Quinn S, Burgess JR, Parameswaran V, Winzenberg TM, Jones G, et al. Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study.Ann Rheum Dis 2014 ;73(4):697-703.https://doi.org/10.1136/annrheumdis-2012-202831
  • 29. Glover TL, Goodin BR, Horgas AL, Kindler LL, King CD, Sibille KT, et al. Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis. Arthritis Rheumatol 2012;64(12):3926-35. https://doi.org/10.1002/art.37687
  • 30. Ingrid H, Ivar H, Knut H, Xiao-Mei M, Arnulf L, John-Anker Z. Is there an association between vitamin D status and risk of chronic low back pain? A nested case–control analysis in the Nord-Trøndelag Health Study. BMJ Open. 2017;7(11):44-50. https://doi.org/10.1136/bmjopen-2017-018521

Yaşlı kadınlarda kas-iskelet sistemi ağrısıyla D vitamini düzeyleri arasındaki ilişki

Year 2019, Volume: 4 Issue: 2, 69 - 73, 30.08.2019

Filiz Meryem Sertpoyraz , Yasemin Kilic Ozturk Eylem Gulsen Kirbiyik

https://doi.org/10.22391/fppc.456142

Abstract



Giriş: Ağrı yaşın
ilerlemesiyle sık karşılaşılan bir semptomdur. D vitamini, yaygın reseptörleri
ile kas iskelet sistemi dahil olmak üzere pek çok dokuda etkili
pre-prohormondur. D vitamini eksikliğinin, ağrı, alt ekstremite de proksimal
kas güçsüzlüğü, iskelet mineralizasyon defekti, denge bozukluğu, kırık ve düşme
riskinde artış ve fonksiyonel kapasitede azalmaya yol açtığı bilinmektedir.
Amacımız 65 yaş ve üzeri kadın hastalarda D vitamini düzeylerini ve kas iskelet
sistemi ağrısıyla D vitamini ilişkisini değerlendirmektir.



Yöntem: Kesitsel  tanımlayıcı çalışmaya fizik tedavi ve rehabilitasyon
polikliniğine başvuran, gönüllü olur formunu imzalayan 65 yaş ve üstü,120 kadın
hasta dahil edildi. Hastaların demografik verileri (yaş, eğitim, meslek, güneşle
temas, fiziksel aktivite düzeyleri, kalsiyumlu gıda alımları), kas iskelet
sistemine ait ağrı olup olmadığı ve ağrısı olanlarda bölgesi sorgulandı. Serum
25(OH) vitamin D(vitamin D), kalsiyum, fosfor, alkalen  fosfataz, parathormon düzeyleri kaydedildi.



Bulgular: Altmış beş yaş
ve üzeri, 120 kadın hastanın D vitamin düzeyleri değerlendirildiğinde
101(%84)’inde eksiklik ve yetersizlik bulundu. Hastaların 83 (%69)’ünde kas
iskelet sistemi ağrısı varken, 37(%31)’sinde ağrı yoktu. Kas iskelet sistemi
ağrısı olanlar(n=83)ve olmayanlar(n=37) karşılaştırıldığında, ağrısı olanların
serum D vitamini düzeyleri anlamlı düşük bulundu (p=0,008). Kas iskelet sistemi
ağrısı olan (n=83) hastaların 62(%75)’sinde D vitamini eksikliği veya
yetersizliği vardı. D vitamini düzeyinde eksiklik ve yetersizlik olanlarda
(n=62), kas iskelet sistemi ağrısı değerlendirildiğinde en sıklıkla bel(%41),
ikinci sıklıkta sırt ağrısı(%32) semptomu vardı.



Sonuç: Özellikle
polikliniklere kas iskelet sistemi ağrısı ile başvuran altmış beş ve üzeri yaş
hastalarda serum 25(OH) vitamin D değerlendirilmesi önemlidir. Bel ve sırt
ağrısı şikâyetiyle gelen kadın hastalarda D vitamini eksikliği de akılda
tutulmalıdır. Kas iskelet sistemi üzerinde D vitamininin etkileri göz önüne
alındığında, ileri yaş kadın hastalarda D vitamini düzeylerinin değerlendirilerek
eksikliğinin tespiti halinde tedavisinin planlanması önerilmektedir.



Keywords

D vitamini kadın kas-iskelet sistemi ağrısı

References

  • 1. Horgas AL. Pain management in older adults. Nurs Clin North Am 2017;52(4):e1-e7.https://doi.org/10.1016/j.cnur.2017.08.001
  • 2. Leveille SG, Ling S, Hochberg MC, Resnick HE, Bandeen-Roche KJ, Won A, et al. Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med 2001;135:1038-46.https://doi.org/10.7326/0003-4819-135-12-200112180-00007
  • 3. Koundourakis NE, Avgoustinaki PD, Malliaraki N, Margioris AN. Muscular effects of vitamin D in young athletes and non-athletes and in the elderly. Hormones 2016;15:471-88.https://doi.org/10.14310/horm.2002.1705
  • 4. Bringhurst FR, Demay MB, Krane SM, Kronenberg HM: Bone and mineral metabolism in health and disease. In: Harrison's Principles of Internal Medicine, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (eds). 16th ed. New York: MC Graw-Hill Companies; 2005:2238-86.
  • 5. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003; 28:177-9. https://doi.org/10.1097/00007632-200301150-00015
  • 6. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006; 116:2062-72. https://doi.org/10.1172/JCI29449
  • 7. Mascarenhas R, Mobarhan S. Hypovitaminosis D-induced pain. Nutr Rev 2004; 62:354-9. https://doi.org/10.1301/nr.2004.sept.354-359
  • 8. Helde-Frankling M, Björkhem-Bergman L. Vitamin D in pain management. Int J Mol Sci 2017;18(10):2170-77. https://doi.org/10.3390/ijms18102170
  • 9. Wu Z,Malihi Z, Stewart AW, Lawes CM, Scragg R. Effect of vitamin D supplementation on pain: A systematic review and meta-analysis. Pain Phys. 2016; 19:415-27. https://www.ncbi.nlm.nih.gov/pubmed/27676659
  • 10. Alshahrani F, Aljohani N. Vitamin D:Deficiency,sufficiency and toxicity. Nutrients 2013;5(9):3605-16.https://doi.org/10.3390/nu5093605
  • 11. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89(2-3):127-34. https://doi.org/10.1016/S0304-3959(00)00355-9
  • 12. Rastogi R, Meek BD. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging 2013; 8:37-46. https://doi.org/10.2147/CIA.S30165
  • 13. Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab 2002; 13:100-5. https://doi.org/10.1016/S1043-2760(01)00547-1
  • 14. Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus 2015; 24:483-9. https://doi.org/10.1177/0961203314558676
  • 15. Liu X, Nelson A, Wang X, Farid M, Gunji Y, Ikari J, et al. Vitamin D modulates prostaglandin E2 synthesis and degradation in human lung fibroblasts. Am J Respir Cell Mol Biol 2014; 50:40-50. https://doi.org/10.1165/rcmb.2013-0211OC
  • 16. Tsiaras WG, Weinstock MA. Commentary: Ultraviolet irradiation and oral ingestion as sources of optimal vitamin D. J Am Acad Dermatol 2010; 62:935-6. https://doi.org/10.1016/j.jaad.2009.09.011
  • 17. Hicks GE, Shardell M, Miller RR, Bandinelli S, Guralnik J, Cherubini A, et al. Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study. J Am Geriatr Soc 2008;56(5):785-91. https://doi.org/10.1111/j.1532-5415.2008.01644.x
  • 18. Himmelstein S, Clemens TL, Rubin A. Vitamin D supplementation in elderly nursing home residents increases 25 (OH) D but not 1,25 (OH) 2D. Am J Clin Nutr 1990;52:701-6. https://doi.org/10.1093/ajcn/52.4.701
  • 19. Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O’Neill T. An excess of widespread pain among South Asians: Are low levels of vitamin D implicated? Ann Rheum Dis 2005; 64:1217-9. https://doi.org/10.1136/ard.2004.032656
  • 20. Basaran S, Guzel R, Coskun-Benlidayi I, Guler-Uysal F. Vitamin D status: Effects on quality of life in osteoporosis among Turkish women. Qual Life Res 2007;16:1491-9.https://doi.org/10.1007/s11136-007-9257-6
  • 21. Helliwell PS, Ibrahim GH, Karim Z, Sokoll K, Johnson H. Unexplained musculoskeletal pain in people of South Asian ethnic group referred to a rheumatology clinic—relationship to biochemical osteomalacia, persistence over time and response to treatment with calcium and vitamin D. Clin Exp Rheumatol 2006;24:424-7.https://www.ncbi.nlm.nih.gov/pubmed/16956433
  • 22. Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 2005; 16:1425-31. https://doi.org/10.1007/s00198-005-1860-1
  • 23. Ghai B, Bansal D, Kapil G,Kanukula R,Lavidiya S, Sachdeva N. High prevalence of hypovitaminosis D in Indian chronic low back patients. Pain Physician 2015;18: E853-62. https://www.ncbi.nlm.nih.gov/pubmed/26431139
  • 24. Kim TH, Lee BH, Lee HM, Lee SH, Park JO, Kim HS, et al. Prevalence of vitamin D deficiency in patients with lumbar spinal stenosis and its relationship with pain. Pain Physician 2013;16(2):165-76.https://www.ncbi.nlm.nih.gov/pubmed/23511683
  • 25. Heuch I, Heuch I, Hagen K, Zwart JA. Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine 2013;38:133-9.https://doi.org/10.1097/BRS.0b013e3182647af2
  • 26. Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C et al.Is vitamin D supplementation effective for low back pain? A systematic review and meta-analysis. Pain Physician 2018;21(2):121-45.https://www.ncbi.nlm.nih.gov/pubmed/29565945
  • 27. Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C et al. Mapping the Association between Vitamin D and Low Back Pain: A Systematic Review and Meta Analysis of Observational Studies. Pain Physician 2017; 20:611-40. https://www.ncbi.nlm.nih.gov/pubmed/29149142
  • 28. Laslett LL, Quinn S, Burgess JR, Parameswaran V, Winzenberg TM, Jones G, et al. Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study.Ann Rheum Dis 2014 ;73(4):697-703.https://doi.org/10.1136/annrheumdis-2012-202831
  • 29. Glover TL, Goodin BR, Horgas AL, Kindler LL, King CD, Sibille KT, et al. Vitamin D, race, and experimental pain sensitivity in older adults with knee osteoarthritis. Arthritis Rheumatol 2012;64(12):3926-35. https://doi.org/10.1002/art.37687
  • 30. Ingrid H, Ivar H, Knut H, Xiao-Mei M, Arnulf L, John-Anker Z. Is there an association between vitamin D status and risk of chronic low back pain? A nested case–control analysis in the Nord-Trøndelag Health Study. BMJ Open. 2017;7(11):44-50. https://doi.org/10.1136/bmjopen-2017-018521
There are 30 citations in total.

Details

Primary Language English
Subjects Geriatrics and Gerontology
Journal Section Original Research
Authors

Filiz Meryem Sertpoyraz 0000-0001-5247-6412

Yasemin Kilic Ozturk 0000-0003-1463-6627

Eylem Gulsen Kirbiyik 0000-0002-2328-9914

Publication Date August 30, 2019
Submission Date December 7, 2018
Acceptance Date May 8, 2019
Published in Issue Year 2019 Volume: 4 Issue: 2

Cite

APA Sertpoyraz, F. M., Kilic Ozturk, Y., & Gulsen Kirbiyik, E. (2019). Relationship between musculoskeletal pain and Vitamin D levels in elderly women. Family Practice and Palliative Care, 4(2), 69-73. https://doi.org/10.22391/fppc.456142
AMA Sertpoyraz FM, Kilic Ozturk Y, Gulsen Kirbiyik E. Relationship between musculoskeletal pain and Vitamin D levels in elderly women. Fam Pract Palliat Care. August 2019;4(2):69-73. doi:10.22391/fppc.456142
Chicago Sertpoyraz, Filiz Meryem, Yasemin Kilic Ozturk, and Eylem Gulsen Kirbiyik. “Relationship Between Musculoskeletal Pain and Vitamin D Levels in Elderly Women”. Family Practice and Palliative Care 4, no. 2 (August 2019): 69-73. https://doi.org/10.22391/fppc.456142.
EndNote Sertpoyraz FM, Kilic Ozturk Y, Gulsen Kirbiyik E (August 1, 2019) Relationship between musculoskeletal pain and Vitamin D levels in elderly women. Family Practice and Palliative Care 4 2 69–73.
IEEE F. M. Sertpoyraz, Y. Kilic Ozturk, and E. Gulsen Kirbiyik, “Relationship between musculoskeletal pain and Vitamin D levels in elderly women”, Fam Pract Palliat Care, vol. 4, no. 2, pp. 69–73, 2019, doi: 10.22391/fppc.456142.
ISNAD Sertpoyraz, Filiz Meryem et al. “Relationship Between Musculoskeletal Pain and Vitamin D Levels in Elderly Women”. Family Practice and Palliative Care 4/2 (August2019), 69-73. https://doi.org/10.22391/fppc.456142.
JAMA Sertpoyraz FM, Kilic Ozturk Y, Gulsen Kirbiyik E. Relationship between musculoskeletal pain and Vitamin D levels in elderly women. Fam Pract Palliat Care. 2019;4:69–73.
MLA Sertpoyraz, Filiz Meryem et al. “Relationship Between Musculoskeletal Pain and Vitamin D Levels in Elderly Women”. Family Practice and Palliative Care, vol. 4, no. 2, 2019, pp. 69-73, doi:10.22391/fppc.456142.
Vancouver Sertpoyraz FM, Kilic Ozturk Y, Gulsen Kirbiyik E. Relationship between musculoskeletal pain and Vitamin D levels in elderly women. Fam Pract Palliat Care. 2019;4(2):69-73.

Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505