Osteoporosis International

, Volume 25, Issue 2, pp 525–533 | Cite as

Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia

  • F. MateosEmail author
  • C. Valero
  • J. M. Olmos
  • B. Casanueva
  • J. Castillo
  • J. Martínez
  • J. L. Hernández
  • J. González Macías
Original Article



No differences in either bone mineral density or serum 25OHD levels have been found between 205 women with fibromyalgia (both pre- and postmenopausal) and their controls. However, a lack of the expected 25OHD summer rise was observed in patients.


Contradictory data have been published regarding a possible association between fibromyalgia and osteoporosis or hypovitaminosis D. Most studies, however, have been performed in small size samples and have excluded postmenopausal women. We decided to study this association in a larger sample of fibromyalgia patients including both pre- and postmenopausal women.


Two hundred five patients were recruited from a clinic specializing in fibromyalgia and 205 healthy controls were enrolled from the census of a Primary Care Center. Controls were matched with patients by age and the time of the year they were included in the study. Bone mineral density (BMD) was measured by DXA. Serum 25OHD, iPTH, P1NP, and CTX were also determined.


BMD was similar in both groups (lumbar spine, 0.971 ± 0.146 g/cm2 in patients and 0.970 ± 0.132 g/cm2 in controls; femoral neck, 0.780 ± 0.122 g/cm2 and 0.785 ± 0.117 g/cm2, respectively). 25OHD levels were also similar: 23.0 ± 9.5 ng/ml and 24.1 ± 9.6 ng/ml. However, while controls showed the usual summer rise in 25OHD, fibromyalgia patients did not. PTH did not show seasonal changes, but on average was higher in patients (51 pg/ml vs. 48 pg/ml; p = 0.034). P1NP or CTX were similar in both groups.


No differences in BMD were found between patients and controls. As for 25OHD, a lack of its expected summer rise was observed. It is doubtful whether this has any homeostatic consequence. We consider that the association reported in other studies is merely circumstantial, and not due to the intrinsic characteristics of these disorders.


Bone mass Bone turnover markers Bone ultrasounds Fibromyalgia Osteoporosis Vitamin D 



This work was supported by grants from the Instituto de Salud Carlos III-FIS, Spain (PI08/0183 and PI11/01092).

Conflicts of interests



  1. 1.
    Swezey RL, Adams J (1999) Fibromyalgia: a risk factor for osteoporosis. J Rheumatol 26:2642–2644PubMedGoogle Scholar
  2. 2.
    Armagan O, Sirmagül E, Ekim A, Sirmagül B, Tascioglu F, Öner C (2008) Levels of IGF-1 and their relationship with bone mineral density in the premenopausal women with fibromyalgia syndrome. Rheumatism 23:118–123Google Scholar
  3. 3.
    Erdal A, Yildirim K, Hacibeyoglu H, Yildirim M, Senel K (2003) The bone mineral density values in fibromyalgia syndrome. Osteoporoz Dünyasindan 9:59–62Google Scholar
  4. 4.
    Tander B, Akyol Y, Durmus D, Alayli G, Cengiz K, Ilhanli I, Ulus Y, Cantürk F (2010) Bone mineral density and depression in premenopausal women with primary fibromyalgia syndrome. Turk J Rheumatol 25:105–109CrossRefGoogle Scholar
  5. 5.
    Al-Allaf AW, Mole PA, Paterson CR, Pullar T (2003) Bone health in patients with fibromyalgia. Rheumatology (Oxford) 42:1202–1206CrossRefGoogle Scholar
  6. 6.
    Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB (2007) Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol 26:551–554CrossRefPubMedGoogle Scholar
  7. 7.
    Bhatty SA, Shaikn NA, Irfan M, Kashif SM, Vaswani AS, Sumbhai A, Gunpat (2010) Vitamin D deficiency in fibromyalgia. J Pak Med Assoc 60:949–951PubMedGoogle Scholar
  8. 8.
    Olama SM, Senna MK, Elarman MM, Elhawary G (2013) Serum vitamin D level and bone mineral density in premenopausal Egyptian women with fibromyalgia. Rheumatol Int 33:185–192CrossRefPubMedGoogle Scholar
  9. 9.
    Appelboom T, Schoutens A (1990) High bone turnover in fibromyalgia. Calcif Tissue Int 46:314–317CrossRefPubMedGoogle Scholar
  10. 10.
    Ulusoy H, Sarica N, Arslan S, Ozyurt H, Cetin I, Birgul Ozer E, Yildirim N (2010) Serum vitamin D status and bone mineral density in fibromyalgia. Bratisl Lek Listy 111:604–609PubMedGoogle Scholar
  11. 11.
    Ribel-Madsen S, Christgau S, Gronemann ST, Bartels EM, Danneskiold-Samsoe B, Bliddal H (2007) Urinary markers of altered collagen metabolism in fibromyalgia patients. Scand J Rheumatol 36:470–477CrossRefPubMedGoogle Scholar
  12. 12.
    Zerahn B, Bliddal H, Moller P, Borgwardt A, Danneskiold-Samsoe B (2001) Bone mass in the calcaneus in patients with fibromyalgia. J Musculoskelet Pain 9:17–23CrossRefGoogle Scholar
  13. 13.
    Jensen B, Wittrup IH, Bliddal H, Danneskiold-Samsoe B, Faber J (2003) Bone mineral density in fibromyalgia patients—correlation to disease activity. Scand J Rheumatol 32:146–150CrossRefPubMedGoogle Scholar
  14. 14.
    Jacobsen S, Gam A, Egsmose C, Olsen M, Danneskiold-Samsoe B, Jensen GF (1993) Bone mass and turnover in fibromyalgia. J Rheumatol 20:856–859PubMedGoogle Scholar
  15. 15.
    Huisman AM, White KP, Algra A, Harth M, Vieth R, Jacobs JW, Bijlsma JW, Bell DA (2001) Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol 28:2535–2539PubMedGoogle Scholar
  16. 16.
    Tandeter H, Grynbaum M, Zuili I, Shany S, Shvartzman P (2009) Serum 25-OH vitamin D levels in patients with fibromyalgia. Isr Med Assoc J 11:339–342PubMedGoogle Scholar
  17. 17.
    de Rezende PC, Grillo LP, das Chagas Medeiros MM (2010) Evaluation of 25-hydroxyvitamin D serum levels in patients with fibromyalgia. J Clin Rheumatol 16:365–369Google Scholar
  18. 18.
    Block SR, Gratwick F (2004) Vitamin D deficiency is not associated with non-specific musculoskeletal pain syndromes including fibromyalgia. Mayo Clin Proc 79:1585–1586CrossRefPubMedGoogle Scholar
  19. 19.
    Yunus MB (2001) The role of gender in fibromyalgia syndrome. Curr Rheumatol Rep 3:128–134CrossRefPubMedGoogle Scholar
  20. 20.
    Yunus MB, Arslan S, Aldag JC (2002) Relationship between fibromyalgia features and smoking. Scand J Rheumatol 31:301–305CrossRefPubMedGoogle Scholar
  21. 21.
    Ward KD, Klesges RC (2001) A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int 68:259–270CrossRefPubMedGoogle Scholar
  22. 22.
    Rivera J, Esteve-Vives J, Vallejo MA, Rejas J, Grupo ICAF (2011) Factors associated with temporary work disability in patients with fibromyalgia. Rheumatol Int 31:1471–1477CrossRefPubMedGoogle Scholar
  23. 23.
    Verbunt JA, Pernot DH, Smeets RJ (2008) Disability and quality of life in patients with fibromyalgia. Health Qual Life Outcomes 6:8PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Wolfe F, Aarflot T, Bruusqaard D, Henriksson KG, Littlejohn G, Moldofsky H, Raspe H, Vaeroy H (1995) Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia. Scand J Rheumatol 24:112–118CrossRefPubMedGoogle Scholar
  25. 25.
    Espallargues M, Sampietro-Colom L, Estrada MD, Solà M, del Rio L, Setoain J, Granados A (2001) Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporos Int 12:811–822CrossRefPubMedGoogle Scholar
  26. 26.
    Yunus MB, Masi AT, Aldag JC (1989) A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes. J Rheumatol Suppl 19:62–71PubMedGoogle Scholar
  27. 27.
    Epstein SA, Kay G, Clauw D, Heaton R, Klein D, Krupp L, Kuck J, Leslie V, Masur D, Wagner M, Waid R, Zisook S (1999) Psychiatric disorders in patients with fibromyalgia. A multicenter investigation. Psychosomatics 40:57–63CrossRefPubMedGoogle Scholar
  28. 28.
    Hudson JI, Hudson MS, Pliner LF, Goldenberg DL, Pope HG Jr (1985) Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiatry 142:441–446PubMedGoogle Scholar
  29. 29.
    Michelson D, Stratakis C, Hill L, Reynolds J, Galliven E, Chrousos G, Gold P (1996) Bone mineral density in women with depression. N Engl J Med 335:1176–1181CrossRefPubMedGoogle Scholar
  30. 30.
    Haney EM, Chan BK, Diem SJ, Ensrud KE, Cauley JA, Barret-Connors E, Orwoll E, Bliziotes MM, for the Osteoporotic Fractures in Men Study Group (2007) Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 167:1246–1251CrossRefPubMedGoogle Scholar
  31. 31.
    Miller LJ, Kubes KL (2002) Serotoninergic agents in the treatment of fibromyalgia syndrome. Ann Pharmacother 36:707–712CrossRefPubMedGoogle Scholar
  32. 32.
    Fishbain D (2000) Evidence-based data on pain relief with antidepressants. Ann Med 32:305–316CrossRefPubMedGoogle Scholar
  33. 33.
    Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O'Neill T (2005) An excess of widespread pain among South Asians: are low levels of vitamin D implicated? Ann Rheum Dis 64:1217–1219CrossRefPubMedGoogle Scholar
  34. 34.
    Lotfi A, Abdel-Nasser AM, Hamdy A, Omran AA, El-Rehany MA (2007) Hypovitaminosis D in female patients with chronic low back pain. Clin Rheumatol 26:1895–1901CrossRefPubMedGoogle Scholar
  35. 35.
    Hicks GE, Shardell M, Miller RR, Bandinelli S, Guralnik J, Cherubini A, Lauretani F, Ferrucci L (2008) Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti Study. J Am Geriatr Soc 56:785–791PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    McBeth J, Pye SR, O'Neill TW, Macfarlane GJ, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Wu FC, EMAS Group (2010) Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study. Ann Rheum Dis 69:1448–1452CrossRefPubMedGoogle Scholar
  37. 37.
    Atherton K, Berry DJ, Parsons T, Macfarlane GF, Power C, Hyppönen E (2009) Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey. Ann Rheum Dis 68:817–822CrossRefPubMedGoogle Scholar
  38. 38.
    Schreuder F, Bernsen RM, van der Wouden JC (2012) Vitamin d supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med 10:547–555PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Garnero P, Vergnaud P, Hoyle N (2008) Evaluation of a fully automated serum assay for total N-terminal propeptide of type I collagen in postmenopausal osteoporosis. Clin Chem 54:188–196CrossRefPubMedGoogle Scholar
  40. 40.
    Garnero P, Borel O, Delmas PD (2001) Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clin Chem 47:694–702PubMedGoogle Scholar
  41. 41.
    Wahner HW, Looker A, Dunn WL, Walters LC, Hauser MF, Novak C (1994) Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers. J Bone Miner Res 9:951–960CrossRefPubMedGoogle Scholar
  42. 42.
    Avon Stetten E, Ouellet H, Wilson KE et al (1998) European Caucasian female reference data values for the Sahara clinical bone sonometer. Bone 23(Suppl 5):S637, AbstractGoogle Scholar
  43. 43.
    Marín F, Vila J, González-Macías J, on behalf the ECOSAP project investigators (2003) Quantitative bone ultrasound: impact of the application of two different reference databases to a population of 5195 postmenopausal women. Med Clin (Barc) 121:250–252Google Scholar
  44. 44.
    El Maghraoui A, Tellal S, Achemlal L, Nouijai A, Ghazi M, Mounach A, Bezza A, el Derouiche M (2006) Bone turnover and hormonal perturbations in patients with fibromyalgia. Clin Exp Rheumatol 24:428–431PubMedGoogle Scholar
  45. 45.
    Sprott H, Müller A, Heine H (1997) Collagen crosslinks in fibromyalgia. Arthritis Rheum 40:1450–1454CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • F. Mateos
    • 1
    Email author
  • C. Valero
    • 1
  • J. M. Olmos
    • 1
  • B. Casanueva
    • 2
  • J. Castillo
    • 3
  • J. Martínez
    • 1
  • J. L. Hernández
    • 1
  • J. González Macías
    • 1
  1. 1.Department of Internal MedicineUniversity Hospital Marqués de Valdecilla. University of Cantabria. RETICEF. IFIMAVSantanderSpain
  2. 2.Rheumatology. IMQSantanderSpain
  3. 3.Centro de Salud “José Barros”. CamargoUniversity of CantabriaSantanderSpain

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