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Education And Debate

Lesson of the Week: Hypovitaminosis D in immigrant women: slow to be diagnosed

BMJ 1996; 312 doi: (Published 02 March 1996) Cite this as: BMJ 1996;312:570
  1. Jeannine F J B Nellen, registrara,
  2. Yvo M Smulders, registrara,
  3. P H Jos Frissen, consultanta,
  4. Ed H Slaats, clinical chemista,
  5. Joseph Silberbusch, consultanta
  1. a Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, 1e Oosterparkstraat 279, PO Box 95500, 1090 HM Amsterdam, Netherlands
  1. Correspondence to: Dr Nellen.
  • Accepted 17 November 1995

Vitamin D deficiency in adults eventually leads to the osteomalacia syndrome, with its characteristic clinical features of bone pain, muscle weakness, and difficulty in walking. Even in moderate deficiency there is both biochemical and histological evidence of secondary hyperparathyroidism and increased bone remodelling. At this stage the characteristic symptoms of classic osteomalacia may still be absent, although irreversible cortical bone loss has already occurred. This is referred to as hypovitaminosis D osteopathy stage I.1

Hypovitaminosis D osteopathy should be considered in immigrant women with musculoskeletal pain

Hypovitaminosis D is common in western Europeans, especially in patients with malabsorption and in elderly people eating a deficient diet. An increased incidence of hypovitaminosis D osteopathy among immigrant women could be expected because of their low intake of calcium and vitamin D, minimal exposure to sunlight, skin pigmentation, and high parity.2 We report symptomatic hypovitaminosis D in six immigrant women, focusing on the time between the first consultation with a doctor and the establishment of the correct diagnosis.

Patients, methods and results

We diagnosed hypovitaminosis D osteopathy as musculoskeletal pain in the presence of an increased intact parathyroid hormone concentration, a decreased concentration of 25-hydroxycholecalciferol, and …

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