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J Musculoskelet Med. 2009 Oct;26(10):389-396.

Recognizing the musculoskeletal manifestations of vitamin D deficiency.

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Ms Jones is a first-year medical student at the University of Wisconsin School of Medicine and Dr Hansen is assistant professor of medicine, division of rheumatology, department of medicine, at the University of Wisconsin School of Medicine and Public Health in Madison.


A disruption in any part of the vitamin D physiological pathway can result in vitamin D deficiency, which may lead to bone pain, muscle weakness, falls, low bone mass, and fractures. Recognizing the signs and symptoms helps physicians make a proper diagnosis and prescribe appropriate treatment. Physicians should suspect osteomalacia in patients who have prolonged vitamin D deficiency, a low serum calcium level, or a low serum phosphorus level. Patients with cystic fibrosis are at increased risk for deficiencies in fat-soluble vitamins, including vitamin D. Secondary hyperparathyroidism can develop in patients with chronic kidney disease as a result of low 25-hydroxyvitamin D levels or impaired conversion to 1,25-dihydroxyvitamin D. Patients may experience abnormal vitamin D metabolism as a result of taking anticonvulsants and other medications.


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