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

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Abstract
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. 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 …