Prescribing trends and clinical impact of calcium salt supplements in musculoskeletal pain: evidence from a multi-center retrospective analysis in India (TRACE study)

BMC Musculoskelet Disord. 2026 Mar 31. doi: 10.1186/s12891-026-09503-8. Online ahead of print.

Background

Vitamin D₃ deficiency is highly prevalent in India and frequently linked, nonspecific musculoskeletal pain. Adequate calcium and vitamin D₃ intake is essential for maintaining bone integrity and neuromuscular function, as vitamin D₃ facilitates calcium absorption and metabolism. However, real-world data on calcium carbonate-based supplementation practices and related clinical outcomes remain limited. The purpose of this study was to explore the real-world prescription trends and corresponding clinical and biochemical changes observed among patients with musculoskeletal pain.

Method

This retrospective, observational, multicentre chart review study analyzed data from 660 patients across 128 centres in India between December 2023 and February 2024. Data on demographics, clinical characteristics, pain parameters, prescription trends, and serum biochemical indices were extracted from available medical records. The study protocol received approval from an independent ethics committee prior to data collection. Statistical analyses were conducted using SPSS v29.0.1.0, with a significance level set at p < 0.05.

Result

Among 660 patients (52.73% female; mean age: 48.69 ± 12.70 years), diabetes (78.94%) and hypertension (39.70%) were the most frequent comorbidities. Joint pain (24.83%) and osteoarthritis (20.20%) were the leading clinical conditions. Vitamin D₃ deficiency (< 20 ng/mL) was noted in 26.36% of patients. The most prescribed formulation was calcium carbonate (500 mg) with vitamin D₃ (2000 IU), vitamin B₁₂, L-methyl folate calcium, and pyridoxal-5-phosphate (63.48%). After three months of supplementation, significant improvements were observed in biochemical parameters serum calcium (+ 16.36%), vitamin D₃ (+ 58.76%), and intact Parathyroid Hormone (-27.09%) (all p < 0.0001) along with notable reduction in pain scores. No adverse events were documented in the available medical records.

Conclusion

In this real-world cohort, patients who received multi-nutrient calcium–vitamin D₃ based supplementation demonstrated improvement over time in pain scores and biochemical parameters. These formulations were well-tolerated and associated with favorable clinical changes in individuals with vitamin D₃ deficiency. However, given the retrospective, pre-post observational design without a comparator group, the observed improvements potentially reflect both the effect of supplementation and other concurrent routine clinical factor. Further large-scale, prospective controlled studies are required to confirm these associations and clarify potential therapeutic impact.

Clinical trial registry of India study registration number

CTRI/2023/12/060701, Registered on: 22/12/2023.

PMID:41917886 | DOI:10.1186/s12891-026-09503-8