High-dose vitamin D as a potential adjunct therapy for tuberculosis spondylitis

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Created On: 12/03/2025

Tuberculosis continues to be a critical global health threat, with the spine being the site of involvement in nearly 50% of musculoskeletal cases.

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Key take away

High-dose vitamin D supplementation boosts treatment effectiveness, immune response, and pain management in tuberculosis spondylitis, without increasing adverse events.

Background

Tuberculosis continues to be a critical global health threat, with the spine being the site of involvement in nearly 50% of musculoskeletal cases. Emerging evidence links vitamin D deficiency to a heightened susceptibility to tuberculosis infection.

Moreover, vitamin D shows promising potential in bolstering the immune response in cases of tuberculosis spondylitis. Hence, this systematic review investigated the efficiency of Vitamin D supplementation on tuberculosis spondylitis.

Method

A literature search was performed using keywords related to "Vitamin D supplementation," "clinical outcome," "immune response," and "tuberculosis spondylitis" across five databases: PubMed, ProQuest, ScienceDirect, Scopus, and Cochrane Library. Eligible studies included randomized controlled trials, case-control studies, and cohort studies issued in the last ten years with full text available. Using the refined Jadad Scale, the risk of bias was assessed to ensure robust findings.

Result

Overall, 3 randomized controlled trials and 162 patients were included. High-dose vitamin D supplementation (5,000 IU and 10,000 IU) yielded remarkable results, markedly improving several clinical indicators. Serum vitamin D levels rose to 38.49 ng/mL, while immune markers (toll-like receptor 2 [TLR2], toll-like receptor 4 [TLR4]) depicted substantial improvement.

A reduction in inflammatory markers such as transforming growth factor-beta 1 (TGF-β1), interleukin-10 (IL-10), interleukin-17 (IL-17), interleukin-23 (IL-23), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) was reported. Furthermore, the high-dose vitamin D group displayed a striking increase in overall efficacy (95.65% vs. 80.43%), accompanied by pain reduction, enhanced spinal cord injury grade, and improved daily living activities. Importantly, no pivotal differences in adverse events were witnessed between the study groups.

Conclusion

Vitamin D use (5,000 IU and 10,000 IU) can remarkably boost the management of tuberculosis spondylitis. However, further studies are essential to fine-tune the ideal dosage and duration of supplementation for widespread clinical implementation.