Korean J Pain.  2017 Oct;30(4):250-257. 10.3344/kjp.2017.30.4.250.

Vitamin D and fibromyalgia: a meta-analysis

Affiliations
  • 1Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
  • 2Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran.
  • 3Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. mmoosazadeh1351@gmail.com

Abstract

Vitamin D is a cofactor responsible for autoimmune disorders. There is no agreement in the studies investigating the association between vitamin D and fibromyalgia. This study aims to combine the conflicting results of the primary studies which compared these patients with control groups regarding the serum concentration of vitamin D. This meta-analysis has been designed based on PRISMA guidelines. Relevant keywords were searched in PubMed, Science direct, Scopus, Cochrane, and Google scholar and primary studies were selected. After screening the eligible studies according to inclusion/exclusion criteria, we investigated the risk of bias in the selected studies and also the heterogeneity between the primary results using Cochrane (Q) and I-squared (I2) indices. The primary results were combined using inverse variance method and Cohen statistics as well as a random effects model. Publication bias was assessed using Egger test. Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Suspected factors in the heterogeneity were assessed using meta-regression models. We entered 12 eligible studies in the meta-analysis including 851 cases compared with 862 controls. The standardized mean difference of Vitamin D between the two groups was −0.56 (95% confidence interval: −1.05, −0.08). Our meta-analysis showed that vitamin D serum levels of patients with fibromyalgia was significantly lower than that of control group.

Keyword

Eligibility determination; Fibromyalgia; Meta-analysis; Myofascial pain syndrome; Pain; Statistics; Vitamin D

MeSH Terms

Bias (Epidemiology)
Eligibility Determination
Fibromyalgia*
Humans
Mass Screening
Methods
Myofascial Pain Syndromes
Population Characteristics
Publication Bias
Vitamin D*
Vitamins*
Vitamin D
Vitamins

Figure

  • Fig. 1 Flowchart of study selection.

  • Fig. 2 Risk of bias summary: review authors' judgements about each risk of bias item for each included study. ‘+’ denotes low risk of bias, ‘−’ represents high risk of bias and “?” indicated unclear bias.

  • Fig. 3 Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

  • Fig. 4 Point and pooled standardized mean difference of blood vitamin D level between subjects with and without fibromyalgia according to the age-matching of the cases/controls. In studies whose cases and controls had the same mean age, the pooled estimation of standardized mean difference of vitamin D differed between cases and controls, while in the studies which cases had different mean ages than controls, no considerable difference was observed between the vitamin D concentration of these two groups.

  • Fig. 5 Point and pooled standardized mean difference of blood levels of vitamin D between cases and controls based on menopausal status of cases/controls. There is no significant difference in the standardized mean difference of vitamin D between studies conducted among populations in premenopausal, postmenopausal and unknown menopausal status.

  • Fig. 6 Sensitivity analysis of the effect of each primary study on the pooled results.


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