Vitamin D status and risk of all-cause and cause-specific mortality in osteoarthritis patients: results from NHANES III and NHANES 2001-2018

OBJECTIVES: The role of Vitamin D (VD) in calcium balance and bone health makes VD a vital factor in osteoarthritis (OA). Studies that have evaluated the effect of VD on OA patients have mainly been performed on a short-term basis. In this analysis, we aimed to evaluate whether VD was associated with mortality, a long-term outcome, in OA patients. METHODS: Participants with self-reported OA from NHANES III and NHANES 2001-2018 were included. Associations of 25(OH)D concentrations with mortality risk were assessed continuously using restricted cubic splines and by categories (i.e., <25.0, 25.0-49.9, 50.0-74.9, and ≥75.0 nmol/L) using the Cox regression model. Sensitivity and stratified analyses were performed to evaluate the robustness of the results. RESULTS: A total of 4570 patients were included, of which 1388 died by 31 December 2019. An L-shaped association was observed between 25(OH)D concentrations and all-cause mortality, whereas an inverse association was found for cardiovascular disease (CVD) mortality. The adjusted hazard ratios (95% confidence intervals) across four categories were 1.00 (reference), 0.49 (0.31, 0.75), 0.45 (0.29, 0.68), and 0.43 (0.27, 0.69) for all-cause mortality and 1.00 (reference), 0.28 (0.14, 0.59), 0.25 (0.12, 0.51), and 0.24 (0.11, 0.49) for CVD-specific mortality; no significant associations were found for cancer-specific mortality. Similar results were observed when stratified and sensitivity analyses were performed. CONCLUSIONS: Compared with patients with insufficient or deficient serum 25(OH)D, those with sufficient 25(OH)D concentrations had a lower risk of all-cause and CVD mortality, supporting a beneficial role of VD on a long-term basis.