The impact of vitamin D and vitamin B12 on bone mineral density and musculoskeletal pain in patients with osteoporosis

Osteoporosis is a major cause of bone fragility and musculoskeletal pain, conditions that substantially reduce quality of life. Vitamin D plays a central role in calcium homeostasis and bone mineralization, while Vitamin B12 deficiency has been associated with impaired bone health and neuromuscular symptoms. However, their combined impact on Bone Mineral Density (BMD) and pain remains incompletely understood. We conducted a cross-sectional study at the Rheumatology Clinic of the University Clinical Center of Kosova (January 2022–August 2024). A total of 136 patients (aged 18–75 years) with chronic musculoskeletal pain underwent Dual-Energy X-Ray Absorptiometry (DEXA) to assess BMD in the lumbar spine and femoral neck. Serum 25-hydroxyvitamin D and Vitamin B12 levels were measured, and pain intensity was evaluated using the Visual Analog Scale (VAS). Osteoporosis was highly prevalent, affecting 59.6% of patients in the right femur, 65.4% in the left femur, and all patients in the spine. Patients with lower Vitamin D levels reported significantly higher pain scores (r = -0.55, p < 0.01), while elevated Vitamin B12 levels showed a positive correlation with pain (r = 0.59, p < 0.01). BMD values in all skeletal sites were negatively correlated with pain severity, with the strongest association observed in the spine (r = -0.73, p < 0.01). Vitamin D deficiency was strongly associated with both lower BMD and greater musculoskeletal pain, whereas Vitamin B12 variations showed complex correlations requiring further study. Early detection of osteoporosis and systematic monitoring of vitamin status may support more effective management of pain and bone health in affected patients.