Osteoarthritis, the most prevalent form of arthritis remains relatively impervious to any desired reversal or cessation of its immense progressive impacts on function and life quality in the older adult population. Moreover, even if available, drug treatments may not be indicated, efficacious, or safe and commonly fail to alter the disease directly including joint tissue damage, inflammation, and muscle pathology. At the shoulder, osteoarthritis, which commonly implicates some degree of rotator cuff tendon derangement, commonly induces the onset and progression of debilitating upper arm mobility impairments and dysfunction. Although surgery can help to some degree, this may not be suitable for those in advanced years, or universally successful. Building on a prior in-depth overview on this topic, here we present a synthesis of some data that discuss a possible role for vitamin D supplementation as one non drug non-surgical intervention that may help mitigate the severity of shoulder osteoarthritis and any associated supportive tissue damage, even in later life but this is not affirmed to date. We conclude however, this issue is a promising one, thus should be intently explored to prevent overlooking a promising non-narcotic osteoarthritis pain and inflammatory moderator and one with tendon and bone regeneration capacities that could foster shoulder stabilizing and mobility functions as well as prevent their demise quite markedly, safely, and at low cost.
Keywords: Aging, Joint, Osteoarthritis, Pain, Rotator cuff, Shoulder, Tendon, Vitamin D
Osteoarthritis a widespread highly disabling joint disease affecting many older adults remains an immensely costly public health challenge with few means of mitigation.1-3 A commonly progressive disease that affects multiple joint tissues, such as those at the shoulder, including the cartilage shock absorbing tissue lining the shoulder and those vital tendons that attach the shoulder muscles and move and stabilize the joint,4 but commonly elicit progressive dysfunction of the upper arm, immense pain, stiffness or instability when damaged. Unfortunately with no universally agreed upon or intervention approach to prevent osteoarthritis and mitigate its disability, as at other joints, the development of upper limb dysfunction maybe overwhelming and render self-care as well as supportive care in the most affected cases, highly challenging at best.5
In addition to negatively impacting the goal of independent living, the ability of the older adult with shoulder osteoarthritis to attain a high life quality may be permanently jeopardized. As a result, they may become anxious and depressed and unwilling to move the arm even if help is provided, for example in dressing, food preparation, eating, drinking, or bathing activities. At the same time and with no respite, osteoarthritis disturbances may set the stage for a high presence of negative biochemical pro oxidant intracellular chemical processes termed reactive oxygen species and possibly poor tendon to bone healing processes that can effect affect joint loading adversely,4,6 joint proprioception,7,8 and joint stability, as well as fostering low levels of physical performance9 especially in cases with major tears of the cuff10 or osteoporosis or low bone mass.11 Alone or in combination, these adverse biological processes are potentially magnified with increasing age and may especially impact inherent aspects of structural joint integrity, alongside diverse mobility and stability functions regressively and progressively. Indeed, these interactive processes alone may serve to induce an unstoppable degree of local joint attrition, plus joint stiffness or excess laxity, pain, signs of chronic joint inflammation, muscle mass declines, muscle fat encroachment, and multiple functional limitations plus cumulative degrees of structural bone, cartilage, muscle, and soft tissue damage.
In sum, osteoarthritis a highly disabling painful musculoskeletal disease affecting multiple tissues of one or more freely moving joints in persons over 55 years of age no matter where they reside has been and remains an immensely costly public health challenge, especially if the shoulder joint is affected.11 In particular the disease fosters functional disability that is not readily reversed and affects many functions and social roles of daily living and may involve a breakdown in bone and cartilage structures, as well as the surrounding muscles, ligaments, and tendons.
Unfortunately, while several pharmacologic and surgical approaches prevail, many may be unsafe for an older adult to pursue or less than life changing. In this regard, vitamin D an essential nutrient or sunlight derived vitamin with bone building, immune boosting and health promotion attributes appears to be of some import as an adjunctive preventive and remedial strategy in adults in general, and in cases as well as those suffering shoulder osteoarthritis and who are prone to falling.9,12-16
Applied in the realm of osteoarthritis care and protection, vitamin D supplements appear of high relevance in efforts to minimize the magnitude and intensity of any prevailing joint destruction processes and pain that emerges over time in older adults who are vitamin D deficient. In particular, unlike its optimal presence that has bone healing properties and others, a deficient state may hamper this enormously and may help prevent associated or excess cartilage tissue regeneration/repair, while fostering adversely impacting collagen synthesis, as well as tendon healing.
In the face of few safe cost effective options and an escalating aging populations who may suffer from shoulder osteoarthritis, including associated joint inflammation, instability, declining joint range of motion, muscle mass losses, and bone attrition, it is probable, albeit unproven, that the presence of adequate vitamin D levels may tip the balance towards collagen production, essential for tendon repair in the case of a damaged shoulder rotator cuff.16 Other data reveal some anti-inflammatory impacts that may slow the disease process, and reduce pain, while promoting the structural and functional properties of the cartilage lining of an osteoarthritis affected joint, and its surrounding muscles, tendons, nerve supply, and underlying bone in a positive way.17-22
Alternately, a persistent state of vitamin D insufficiency or deficiency is that its deficit may not only influence shoulder osteoarthritis development processes, but its chronicity and tendon attrition status. In addition, its deficiency can be expected to negatively impact overall health, plus cartilage, and bone integrity and repair mechanisms, but it may hamper attainment of desirable levels of skeletal muscle mass or muscle regeneration. Although many cases of shoulder osteoarthritis in young adults arise from trauma, it is the older adult with often no known cause who has fewer treatment options or adaptive regeneration capacities that deserves more attention in our view.
This mini review follows others that have been conducted over time so as to update the extent of support for the idea that vitamin D, an established mediator of tissue biology, growth, and development with powerful antioxidant and anti-inflammatory properties may be an influential modifiable factor in the context of efforts to minimize, modulate or mediate osteoarthritis pain in general, and more specifically at the shoulder joint where the rotator cuff tendons are highly problematic to treat or repair especially in the older adult. A secondary aim was to establish whether further research is warranted in this realm given the burden of the disease alone and the purported role vitamin D plays in collagen synthesis and many key enzymatic essential life-affirming biological, metabolic, genetic, molecular, and neurological processes implicated in osteoarthritis and tendon maintenance and repair. Region specific data appear of high import here as opposed to more general facts, and the shoulder, a non-weight bearing joint and its osteoarthritis disease trajectory may not be analogous to that occurring at one of the weight bearing joints. Vitamin D is a possible low-cost alternative to shoulder surgery, poor surgical outcomes, neuropathic pain, progressive tendinopathy pathology and health costs thus favored by those who have socioeconomic hardships and disabling functional abilities that limit exercise participation and possible access to a provider.
Tested is the idea that the presence of adequate vitamin D has a distinct bearing on directing potential cartilage healing opportunities in osteoarthritis, as well as the pain experience and in shoulder osteoarthritis may influence the healing potential of the surrounding soft tissues and joint stabilizers, but fails to preserve the older adult shoulder osteoarthritis if insufficient as outlined in Figure 1.
To achieve these abovementioned review aims, available documents housed on PUBMED between January 2000 - August 2025 using the key terms Vitamin D and Osteoarthritis/Rotator Cuff/Shoulder/Tendon. More specifically, PUBMED the predominant medically oriented repository was used alongside Google Scholar to provide a global overview of vitamin D related osteoarthritis associations and more specifically shoulder osteoarthritis research pertaining to the problem of rotator cuff tears that can foster immense disability or arise as a consequence of chronic injury and one of limited reparative potential worsened by age.
The currently published works listed were duly scanned for salience by the author and the selection process was made on the basis of time and relevance to all stages of possible shoulder lesion injuries and osteoarthritis shoulder joint degeneration.
As of August 20 2025, only a small number of relevant studies on vitamin D-osteoarthritis links were observed especially as regards the disease at the shoulder, where it is common. What is more limiting in our view is even when combined with prior data these current reports remain challenging to unify, and even in comparable studies yield no firm agreement in any sphere and largely discuss surgical remedies not its possible mediators or moderators. This renders it impossible to discern a consistent role for non-pharmacologic approaches, including a role for vitamin D in either a preventive or a therapeutic role. It is equally difficult to aggregate current data in any sphere with confidence not only due to their scarcity, but their small samples, diversity, questionable measurement approaches and unknown measurement properties are all prevalent design issues and confounders.
In addition, those that have emerged in the lab or through tissue sampling, imagery and secondary subjective oriented reports may not offer insights or replicate human osteoarthritis as it occurs at the shoulder in the older person at all accurately. Alternately, clinical observation may not be observed in the lab. Moreover, to date, no consistent aspect of vitamin D is addressed, and its mode or terminology is quite inconsistent and appears to be arbitrary.
In this regard, vitamin D activated into a form known as 1α,25(OH)2D regulates myriads of cellular functions through its nuclear receptor, vitamin D receptor, including vitamin D metabolizing enzymes and receptors located and expressed in adipose tissues a common osteoarthritis determinant.29
However, most of this remains controversial as it is unclear what instruments and outcomes reported in current research are reliable, valid and sensitive to change. Why some do demonstrate favorable muscle-based vitamin D impacts not others are unclear at best24 and may stem from in vitro studies in skeletal muscle cells derived from mice not humans. Nonetheless, a human study has shown vitamin D does play a role in regulating myoblast growth, size, and gene expression as well as skeletal muscle function.24
On the other hand, Chen30 report vitamin D deficiency is not correlated with clinical function scores and re-tear rate of shoulder tendons attached to muscle, however they show it is associated with early postoperative pain and rotator cuff healing quality.
Moreover, unraveling all the varied magnitudes and modes of measures employed alongside those of pain alone may be hard to unify without further advanced study. At present, however, surgical repair of the torn rotator cuff while helping to relieve the pressure on the rotator cuff tendon and decrease its adverse symptoms may fail to advance tendon-to-bone healing, and signify a high failure rate due to multiple persistent vitamin D deficits,32 unresolved inflammatory processes as well as ongoing or aggravated degrees of sarcopenia.33 However, higher vitamin D levels are associated with lower rates of rotator cuff lesions and possible lower re-tear rates33,34 and a lower rate of all-cause revisions for total shoulder arthroplasty.35
In one controlled study36 using advanced vitamin D assays and other measures vitamin D receptor gene expression in the deltoid muscle was notably significantly lower in the vitamin D deficiency group than the control group. Also observed were lower deltoid muscle, myoDgene expression levels and higher atrogin levels in the vitamin D deficiency group. The expression of inflammation-related genes (interleukin (IL)-1β and IL-6) was significantly higher in the vitamin D deficiency group, in both the deltoid and supraspinatus muscles.
Another report9 has implied vitamin D deficiency caused by chronic disease, poor nutrition, and inadequate sun exposure may not only affect bone quality, but exacerbate a prevailing chronic rotator cuff tear linked to reduced anchor pullout strength and high re-tear rates after repair especially in older patients with larger tear size and bone attrition or structural damage. Poor results may also be due to a deficit in its anti-inflammatory and metabolic bone mediating linkages.
It is also suggested that vitamin D significantly reduces cartilage cell death and alleviates cartilage extracellular matrix degradation, a hallmark of osteoarthritis pathology37 In addition the mechanism underlying vitamin D cell death impacts appears to foster the maintenance of cartilage homeostasis.38 Subject to further study, it is further proposed vitamin D injections may prove beneficial in efforts to foster cartilage repair.39 As well, used in tandem with curcumin-a common spice used in the East, both compounds tend to attenuate the expression of pro inflammatory cytokines implicated in osteoarthritis.40
Unsurprisingly, even in the absence of robust data, a call has been made regarding the importance of monitoring and maintaining adequate vitamin D levels in older populations,41 as well as tending to affirm a role for vitamin D in the osteoarthritis disease and treatment realm.42 Furthermore, a recent report showed various vitamin D analogues have effects similar to those of glucocorticoids.43 Additionally, vitamin D can regulate cartilage cell death processes, plus the functionality and survivability of damaged cartilage cells that play an important role in the development and progression of shoulder joint diseases and their physical performance declines.10,44-46
In those cases, with rotator cuff shoulder tears associated with osteoarthritis vitamin D receptor proteins in the rotator cuff do show a close association with serum vitamin D levels,47 as well as pain and function.48,49 A further finding is that of a negative correlation between serum vitamin D levels and various parameters, including tear size, fatty infiltration, cartilage thickness, and the severity of rotator cuff tears within the elderly urban Thai population.
Oh50 have noted that in general, a lower serum level of vitamin D is related to higher fatty degeneration in the muscles of the rotator cuff for supraspinatus, infraspinatus and subscapularis muscles, respectively in their group 1, multivariate linear regression analysis revealed that the serum level of vitamin D was found to be an independent variable for fatty degeneration of the supraspinatus and infraspinatus muscles.
Others in addition imply a favorable role for vitamin D in averting osteoarthritis and/or its severity and disease duration51 and that low vitamin D levels may be correlated with its severity and progression.52 Its influences on cell signaling pathways involved in cartilage cell degradation and inflammation as well as osteoarthritis clinical signs, even if not causally linked appear of high clinical import.53,54 Other observations are included in Table 1 below.
In short, the specific effect of vitamin D on tendon repair shows promises, thus far, and may increase both the quality and speed of post injury and surgical procedural healing. At the same time, biological augmentation with vitamin D has been shown in animal models to improve cartilage organization and strengthen postsurgical tendon-to-bone scars, when compared to vitamin D-deficient subjects.6 Vitamin D is also an important regulator of matrix metalloproteinase inflammatory substances, varying inversely with the inflammatory factor, and a key deterrent to optimal tendon-to-bone healing as well as muscle healing of the rotator cuff muscles and the strength of this tendon-to-bone healing process.6 Those 1 billion people worldwide with deficient vitamin D and lifestyles or health conditions that keep them indoors may be most affected, regardless of age.56
Osteoarthritis, a highly disabling joint disease and one where any form of palliative or reparative treatment that can safely reduce pain, would be highly prized, remains largely dependent on an array of pharmacologic and/or surgical interventions of varying degrees of efficacy and effectiveness with respect to the damaged or degraded shoulder joint. In this regard, despite considerable background research on the importance of overall health as a scaffold for preventing joint injury and fostering recovery from shoulder trauma and arthritis, and knowledge vitamin D is of key related importance plus an essential vitamin with diverse biologic influences in the realm of understanding shoulder osteoarthritis pain and its possible reduction or prevention in the older adult population.
As per Daher56 vitamin D, essential for the homeostatic regulation of calcium is involved in bone mineralization, nerve transmission, and muscle contraction and shows a deficiency prevalence from 8.3% to 71% in patients with rotator cuff tears. Other key attributes of import are its.
- i. Anti-inflammatory actions
- ii. Bone growth and metabolic actions
- iii. Healing actions
- iv. Muscle function, growth, homeostasis56
Its presence may influence pain and function, radiographic disease progression, quality of life.23
Specifically, in terms of its impacts on daily living alone, and its relentless presence at night, more study of this arthritis condition where the pathology is not uniform and may leave sizeable numbers of aging adults more infirm than not is desirable. Reflecting a patchwork of interesting studies but with no seemingly consistent underlying hypothesis, shoulder osteoarthritis in particular is very poorly studied in the non-invasive disease management realm and where more often than not the tendons attaching key muscles to the shoulder joint surface are torn and do not repair to any degree and may mar surgical as well as conservative success.
In the interim Chevally57 propose that considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration. Moreover, multiple preclinical studies strongly support the possibility of vitamin D as an adjunct for alleviating, minimizing, ameliorating, or reversing osteoarthritis cartilage damage, as well as having the ability to prevent the rate of osteoarthritis progression, including decreases in the expression of damaging pro-inflammatory cytokines and excess skeletal muscle atrophy.
However, this realm of investigation appears to warrant more careful attention, for example, in its deterministic roles, as well as in many studies that examine combinations of vitamin D and other modes of intervention or deduce its presence via recall of food intake impacts. Thus, what are vitamin D associated shoulder osteoarthritis risks and what works and why or fails to work to mitigate this cannot be readily discerned in our view. Almost all current researchers are however unified in calling for more carefully designed efforts to address documented design shortcomings in promising studies and to thereby foster the ability to resolve the presently divergent viewpoints concerning any clinically relevant or efficacy associated impacts as well as the safety of various vitamin D doses that may affect osteoarthritis pathology, healing, and pain.
Careful attention to assessing dose concentration relationships between vitamin D supplements, with and without any dietary sources, and medications that may impede vitamin D anabolic processes, and pain as well as functional correlates of various degrees of shoulder osteoarthritis can also help ensure that clinically meaningful relationships can emerge and will be robust.
In the interim, what we do know is that vitamin D is clearly an essential co-factor for fostering normal growth, and collagen synthesis, a major structural element of bone, articular cartilage, and its surrounding tissues, as well as for other vital physiological chondrocyte, and bone cell functions. It also appears deficient vitamin D levels are associated with pain provoking inflammation that often accompanies osteoarthritis.
Moreover, surgery for osteoarthritis or joint injuries may fail to be optimized and its potential to ameliorate sarcopenia a key shoulder arthritis determinant impaired at best. It is possible too that more attention to the notion that implies the presence of a persistent vitamin D deficiency is a potentially debilitating health factor that may inadvertently raise the risk for osteoarthritis joint damage will lower considerable suffering and health costs immeasurably.
Our limitation is clearly in what we have surveyed and analyzed, however, after surveying almost all related reports wherein most were located in the world’s leading data base of PUBMED-deemed reliable and peer reviewed- it appears safe to propose that persistent vitamin D deficits appear to have the potential to accelerate or magnify the risk of musculoskeletal injury, and any subsequent joint pain such as that occurring in most older adults suffering from osteoarthritis, as well as possibly influencing osteoarthritis risk and tendon vulnerability and healing potential. It may also be that an individual struggling with painful osteoarthritis who is under stress may suffer both macro and micro degrees of tendon joint damage and a possible increasing need for long-term vitamin D supplementation to minimize one or more of the health challenges shown in Figure 1 and others that can perpetuate a progressive state of debility and internal-shoulder cartilage injury and dysfunction if this factor is ignored.
In sum, there appears to be a valid need to generate more insight into how vitamin D may be an important readily available low-cost remediable osteoarthritis pathogenic and healing mediator. In particular, researching the association of vitamin D levels among distinctive osteoarthritis sub-groups such as cases with shoulder osteoarthritis of varying older ages and disease manifestations may prove especially insightful. After that, meticulously and rigorously designed studies to rule out competing hypotheses, and to avoid undesirable cross-sectional inferences that do not take into account the fact that reported vitamin D intake on a food survey delivered retrospectively may not be the same as actual time-based plasma levels are indicated. Since its effects may be both disease specific, as well as dose-dependent and take weeks or months to unfold and be influenced by gender among other factors such as age and health and disease status, more data as to the importance of these interactive factors are strongly advocated. It also appears that the efficacy of tailoring doses for reducing osteoarthritis pain and moderating its development as well as its adjunctive role in mediating pain holds promise and should be studied. Identifying and studying cellular and molecular levels of vitamin D and cartilage cellular impacts and its ability to foster muscle regeneration will likely offer great promise as well.
In the meantime, the creative and innovative results of Kim58 should be duly acknowledged as well replicated. This group developed a vitamin D delivery system with hyaluronic acid, which is one of the major components of the extracellular matrix that has anti-inflammation and wound-healing properties and could be a new regeneration technique for the treatment of tendinopathy and tendon restoration features.
As well this group found the effects of a compound called raloxifene along with vitamin D prevented a decrease in local bone mineral density of the greater tuberosity of the proximal humerus and enhanced tendon-to-bone healing of the rotator cuff.59
In accord with past research efforts, it seems reasonable to conclude that osteoarthritis pathology and its pain, whether at the knee joint or any other joints, such as the shoulder, may be influenced in multiple respects by the presence or absence of optimal vitamin D levels, even if not favorably viewed in this regard in all instances and where results may depend largely on the study design and disease status.60 Until more is known, however, it seems possible to avert the degree of projected future suffering and costs associated with shoulder osteoarthritis and its severity among older adults with this condition through careful thought and consideration of the individual situational needs for a greater degree of vitamin D supplemental use to increase reduced bone turnover, or as a pain-relieving, anti-inflammatory, and structural tendon augmenter.41.60 However, there is clearly a need to examine and analyze this set of ideas in a more substantive and robust manner, including the differential impacts of various dosages and forms of delivering vitamin D in various shoulder osteoarthritis subgroups of differing degrees and health status where indicated. These may include independent or comparable efficacy studies to examine the unique benefits and risks of –
- a. Vitamin D and shoulder injury risk and recovery
- b. Shoulder surgery need and outcomes versus vitamin D
- c. Oral vitamin D supplements and combinations of these versus intra-articular repair
- d. Vitamin D rotator cuff tendon repair, and enhanced gene/cell signaling potential
- e. Vitamin D dosages and pain links
- f. Exercise associated muscle recovery and adaptation and vitamin D
In the interim it appears outdoor exposure to sunlight if limited, a deficient food supply and frailty may require older affected adults to have access to extraneous sources of safe levels of vitamin D so they are able to maintain optimal levels thereof especially in the face of mobility challenges, severe stress, neuropathic type pain – and rotator cuff tendon tears that can all combine their destructive forces. In absence of any definitive preventive approach, supplementation of vitamin D where indicated may also help to slow down cartilage and tendon degeneration and inflammation in the presence of a diseased shoulder joint.61-64
As per Header and Babaei23 and Saengsiwaritt64 plus authors cited in Figure 1, given the multiple potential as well as substantiated skeletal and extra skeletal benefits of vitamin D as a supplement for many older people, the lack of solid support for osteoarthritis mitigation in this regard, especially for restoring the functionality and survivability of cartilage chondrocytes is noteworthy. and duly requires further study to more solidly elucidate upon multiple possible therapeutic implications that may be helpful albeit overlooked.63,64
In this realm, Patel60 further propose a cost-predictive model be forged to validate that applying the role of preoperative vitamin D supplementation as a mechanism to reduce tendon repair revision rates and lower the overall health care burden from arthroscopic rotator cuff lesions is efficacious and cost effective. What was observed recently by this group specifically, was that nonselective vitamin D supplementation appeared to be more cost-effective here than selective supplementation approaches, likely due to its lower cost compared to the added need for serum assays and would be valuable in many respects to affirm in light of the aging impacts on health costs due to neglect or oversight.
Based on our analysis and those of several learned bodies, it appears benefits other than pain such as cartilage repair, bone mass maintenance rather than loss, more successful wound healing, collagen production, tendon cells regeneration capacity, muscle atrophy prevention, enhanced muscle fat mass control, free radical scavenging, and the attenuation of ongoing or emergent anti-inflammatory processes may emerge.
In sum, alone or in combination vitamin D presence may 1) enhance overall older adults wellbeing and reduce undue physical as well as mental suffering, 2) offer a low cost widely available safe option for physically, and economically vulnerable older adults suffering from shoulder trauma or osteoarthritis or both 3) reduce cases of older adult sufferers requiring nursing home placements, narcotics, or daily services, 4) foster more rapid and overall surgical recovery rates and fewer complications and infections 5) engender fewer overall demands on health providers amidst shrinking resources and budgets, ) reduce the global burden of shoulder osteoarthritis while enhancing the ability of many elders to age ‘in place’.
Moreover, efforts to close the gaps in the literature highlighted above are likely to have multiple life affirming, independence and cost related implications for many, including excess surgical costs and need.
None.
This Research Article received no external funding.
Regarding the publication of this article, the author declares that he has no conflicts of interest.
