Attention women: New research reveals the surprising, hidden cause of back pain

Plus 3 other ways this stealth culprit puts your health directly in the crosshairs

If you caught my new and improved “Desert Island” list last month, then you already know I don’t think there’s a person alive who wouldn’t benefit from a daily dose of vitamin D3.

Still, there are some groups who need to pay extra close attention to their levels of this essential nutrient. And not just for the reasons you might expect—like immune health and cancer prevention.

In fact, if you’re a postmenopausal woman, vitamin D deficiency carries particularly insidious consequences…

Severe deficiency, severe pain

Chinese researchers looked at just over 230 postmenopausal women visiting a spinal surgery unit for lower back pain. MRIs revealed that all the women suffered from lumbar disc degeneration to some degree—whether it was herniation, spinal stenosis, or spinal instability.

Meanwhile, blood tests showed that a whopping 75 percent of the women also had vitamin D deficiency—with an average vitamin D level of 19.38 ng/mL. Plus, another 13 percent tested with severe deficiency—that is, a level of 10 ng/mL or lower.

As you’ll recall, the threshold for sufficiency is a level of 30 ng/mL—but that’s actually a bare minimum by my standards. And unsurprisingly, only 12.5 percent of the women in this study even had levels this high.

As a result, these women also suffered a significantly higher likelihood of moderate to severe lower back pain—and more severe lumbar disc degeneration.

But this shouldn’t be too surprising, either. Vitamin D has profound effects on nerve sensitivity, muscle strength and mass, and inflammation—all of which can contribute to back pain at any age.

It’s an even bigger concern, however, when you consider the fact that previous research has already linked menopause itself with lumbar disc degeneration.

In fact, in another study that appeared in the journal Menopause back in 2017, researchers looked at data from both women and men. They found that, after menopause, women were much more likely to have severe disc degeneration than men of the same age. They also had it worse than pre- and perimenopausal women!2

But of course, that’s not even the scariest part of this story…

When disability leads to death  

In a study published just last year in the Journal of General Internal Medicine, researchers at Boston Medical Center followed more than 8,000 older women for an average of 14 years. The goal was to assess the role chronic back pain has on disability and mortality rates later in life. And their findings were disconcerting, to say the least.

The researchers took baseline back pain measurements, and then followed up two years later to measure pain again. After four years, they questioned subjects about their daily living activities, and observed them in action.

Overall, women who reported regular, unrelenting back pain were 24 percent more likely to die during the study than the pain-free women.3

That’s right—back pain raised mortality risk by nearly a quarter. And close to half of this effect could be traced back to difficulty with daily activities, like walking and meal prep. Meanwhile, struggles with walking speed and frequent standing up from a sitting position accounted for the remaining increase in risk.

And if nothing else, these findings are a wake-up call to anyone suffering with back pain… but especially for older women.

The risks reach way beyond back pain

Even if you don’t struggle with pain, you should know that the risks of low vitamin D levels after menopause don’t begin and end with your back.

Yet another study showed that postmenopausal women with low vitamin D are also at significantly higher risk of metabolic syndrome. Not to mention a couple of other cardiovascular red flags, including high triglycerides and low levels of protective HDL (“good”) cholesterol.4

Maybe I’m stating the obvious here, but this is a major problem. And not just because D deficiency is so common among the general population. But because—thanks to steep declines in estrogen—postmenopausal women already face an elevated risk of metabolic syndrome (and by extension, heart disease).

This study defined vitamin D deficiency as levels below 20 ng/mL, and insufficiency as any level between 20 and 29 ng/mL. So levels 30 ng/mL or higher were, once again, deemed sufficient. (Still, if even levels that low are enough to ward off disease, it just makes the case for adequate vitamin D levels that much stronger.)

Specifically, more than 57 percent of the women with vitamin D levels below 30 ng/mL had metabolic syndrome—compared with 40 percent of the women who met this study’s criteria for sufficiency.

As a reminder, metabolic syndrome is a cluster of at least three out of five dangerous cardiometabolic criteria—high waist circumference, elevated triglycerides, low HDL cholesterol, high blood pressure, and high blood sugar.

And low vitamin D levels were linked with several of these individual risk factors, too—including high total cholesterol, high triglycerides, and high insulin levels (pointing to diabetes-fueling insulin resistance).

All in all, deficient vitamin D levels raised a woman’s odds of high triglycerides by 55 percent. And odds of low HDL cholesterol by 60 percent. Plus, the lower the vitamin D level, the more metabolic syndrome boxes these postmenopausal women were likely to check.

Don’t be afraid to aim high

The bottom line: If you’re a postmenopausal woman, you need to get serious about getting more vitamin D—starting today. I’ve shared my recommendations here a number of times. But here’s a quick recap…

You should be taking at least 2,000 to 5,000 IU of vitamin D3, year-round. But that dosage may require some adjustment—especially in the dead of winter, when you aren’t able to absorb as much vitamin D from regular sun exposure. I personally take 10,000 IU per day myself, year-round. And as long as your vitamin D blood levels are screened regularly, that’s a perfectly safe—and in many cases, necessary—dosage to get you where you need to be. (I recommend having your levels checked every six months.)

Just keep in mind that what most doctors and lab reports consider “good enough” is by no means optimal. As always, I recommend you aim for a sweet spot between 80 and 100 ng/mL… and accept nothing less.


  1. Xu H-W, et al. “Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study.” Menopause. 2020 May;27(5):586-592.
  2. Lou C, et al. “Association between menopause and lumbar disc degeneration: an MRI study of 1,566 women and 1,382 men.” Menopause. 2017 Oct;24(10):1136-1144.
  3. Roseen EJ, et al. “Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.” J Gen Intern Med. 2019 Jan;34(1):90-97.
  4. Schmitt EB, et al. “Vitamin D deficiency is associated with metabolic syndrome in postmenopausal women.” Maturitas. 2018 Jan;107:97-102.