The effect of vitamin D3 supplementation on chronic osteomyelitis

Vitamin D3 and osteomyelitis

Authors

Keywords:

Anti-Infective Agents, Osteomyelitis, Blood Sedimentation, Cholecalciferol

Abstract

BACKGROUND: Chronic osteomyelitis is a difficult-to-treat bone infection and has frequent relapses. Vitamin D seems to have systemic antimicrobial properties and increases therapeutic response when administered with appropriate antibiotics. The aim of the present study was to evaluate the effect of vitamin D3 supplementation on chronic osteomyelitis.

METHODS: This randomized, blinded, placebo-controlled pilot trial was conducted in Afzalipour Hospital and Besat Clinic affiliated with Kerman University of Medical Sciences, Kerman, Iran, from June 2017 to January 2020. Thirty patients with lower-extremity chronic osteomyelitis were randomly assigned to receive oral vitamin D3 pearls or a placebo. The participants were followed for 6 months. The levels of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) and the prevalence of osteomyelitis symptoms were recorded at baseline and 1, 3, and 6 months later. SPSS software and statistical tests such as generalized estimating equation (GEE) and mixed model analysis of variance (ANOVA) were used to analyze the data.

RESULTS: ESR (P = 0.045), CRP (P = 0.049), and the prevalence of osteomyelitis symptoms significantly decreased in the vitamin D3 group in comparison with the placebo one during the study.

CONCLUSION: High-dose and long-term vitamin D3 supplementation as an adjunct therapy to antibiotics may improve the outcomes of patients with chronic osteomyelitis.

References

Naderi Nabi B, Sedighinejad A, Mirbolouk A, Farzi F, Haghighi M, Atrkarroushan Z, et al. The effectiveness of ozone therapy in chronic osteomyelitis: A randomized controlled clinical trial. Arch Clin Infect Dis. 2018; 13(2): e61320.

Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci. 2019; 23(2 Suppl): 258-70.

Arshad Z, Lau EJ, Aslam A, Thahir A, Krkovic M. Management of chronic osteomyelitis of the femur and tibia: A scoping review. EFORT Open Rev. 2021; 6(9): 704-15.

Marais LC, Ferreira N, Aldous C, Le Roux TL. The outcome of treatment of chronic osteomyelitis according to an integrated approach. Strategies Trauma Limb Reconstr. 2016; 11(2): 135-42.

Geurts J, Hohnen A, Vranken T, Moh P. Treatment strategies for chronic osteomyelitis in low- and middle-income countries: systematic review. Trop Med Int Health. 2017; 22(9): 1054-62.

Signori V, Romanò CL, De Vecchi E, Mattina R, Drago L. May osteoarticular infections be influenced by Vitamin D status? An observational study on selected patients. BMC Musculoskelet Disord. 2015; 16: 183.

Ismailova A, White JH. Vitamin D, infections and immunity. Rev Endocr Metab Disord. 2022; 23(2): 265-77.

Athanassiou L, Mavragani CP, Koutsilieris M. The immunomodulatory properties of Vitamin D. Mediterr J Rheumatol. 2022; 33(1): 7-13.

Youssef DA, Miller CW, El-Abbassi AM, Cutchins DC, Cutchins C, Grant WB, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol. 2011; 3(4): 220-9.

Kearns MD, Alvarez JA, Seidel N, Tangpricha V. The impact of Vitamin D on infectious disease: A systematic review of controlled trials. Am J Med Sci. 2015; 349(3): 245-62.

Ghazizadeh H, Rezayi M, Emadzadeh M, Tayefi M, Abdollahi Z, Timar A, et al. Prevalence of Vitamin D deficiency in Iran: A systematic Review and meta-analysis. J Cardio-Thorac Med. 2022; 10(2): 945-73.

Zargaran A, Zargaran D, Trompeter A. The relationship between serum 25[OH]D concentration and orthopaedic infection: A case-control study. Orthop Res Rev. 2020; 12: 121-5.

Traven SA, Chiaramonti AM, Barfield WR, Kirkland PA, Demos HA, Schutte HD, et al. Fewer complications following revision hip and knee arthroplasty in patients with normal Vitamin D levels. J Arthroplasty. 2017; 32(9s): S193-s6.

Zargaran A, Zargaran D, Trompeter AJ. The role of Vitamin D in orthopaedic infection: A systematic literature review. Bone Jt Open. 2021; 2(9): 721-7.

Murdoch DR, Slow S, Chambers ST, Jennings LC, Stewart AW, Priest PC, et al. Effect of Vitamin D3 supplementation on upper respiratory tract infections in healthy adults: The VIDARIS randomized controlled trial. Jama. 2012; 308(13): 1333-9.

Giustina A, Adler RA, Binkley N, Bouillon R, Ebeling PR, Lazaretti-Castro M, et al. Controversies in Vitamin D: Summary statement from an international conference. J Clin Endocrinol Metab. 2019; 104(2): 234-40.

Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016; 25(3): 1057-73.

Moon AS, Boudreau S, Mussell E, He JK, Brabston EW, Ponce BA, et al. Current concepts in Vitamin D and orthopaedic surgery. Orthop Traumatol Surg Res. 2019; 105(2): 375-82.

Machaj D, Cyboran K, Płaczek A, Baran M, Wojnowski M. The importance of Vitamin D3 supplementation in orthopedics-literature review. J Educ Health Sport. 2020; 10(5): 118-22.

Marschall J, Lewis JW, Warren DK, Babcock HM, Barrack RL, Fraser VJ. Baseline hypovitaminosis D is not associated with poor clinical outcomes in osteoarticular infections. Int J Infect Dis. 2014; 26: 98-102.

Bishop EL, Ismailova A, Dimeloe S, Hewison M, White JH. Vitamin D and immune regulation: antibacterial, antiviral, anti-inflammatory. JBMR Plus. 2021; 5(1): e10405.

Maier GS, Maus U, Lazovic D, Horas K, Roth KE, Kurth AA. Is there an association between low serum 25-OH-D levels and the length of hospital stay in orthopaedic patients after arthroplasty? J Orthop Traumatol. 2016; 17(4): 297-302.

Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low Vitamin D levels? Int Orthop. 2014; 38(7): 1499-504.

Jiang N, Zhao XQ, Qin CH, Hu YJ, Wang L, Xie GP, et al. Association of Vitamin D receptor gene TaqI, BsmI, FokI and ApaI polymorphisms and susceptibility to extremity chronic osteomyelitis in Chinese population. Injury. 2016; 47(8): 1655-60.

Published

2025-07-22

How to Cite

1.
Dabaghzadeh F, Mehrabi F, Sarafzadeh F, Dehesh T. The effect of vitamin D3 supplementation on chronic osteomyelitis: Vitamin D3 and osteomyelitis. Chron Dis J. 2025;13(3):131–137.

Issue

Section

Original Article(s)