Do you know anyone with osteomalacia?

Posted on: November 11, 2015   by  John Cannell, MD

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Dear Dr. Cannell:

I consider my vitamin D story nothing less than miraculous. Last year, beginning in September, I began having unusual pain in my legs. Not only was the pain difficult to deal with on a daily basis, but there was also a tremendous amount of fatigue in my legs. I’ve always walked 3 miles a day, but suddenly I was barely able to walk through the grocery store and had difficulty climbing stairs.

A month later, I began having pain in my arms. My physician couldn’t diagnosis any specific issues, but she didn’t order a blood test to check my vitamin D level. Over the next few months, the pain in my arms and legs continued to worsen to the point that I had trouble dressing myself. I was taking large doses of Ibuprofen every day, just to manage the pain. In late January, a friend of mine happened to mention that she was recently diagnosed with a vitamin D deficiency. As she was telling me all of the symptoms she experienced, I knew I had found my answer.

My first blood test showed my level to be 12 ng/ml. I began taking 10,000 IUs of vitamin D3 as well as K2, magnesium and calcium. It took a few months, but the pain and weakness began to subside. I joined the Vitamin D study, and at 3 months my level was 35 ng/ml. At nine months, I’m basically pain free, and my most recent test result was 41 ng/ml. I will continue at the dosage I’m taking now until I reach at least 60 ng/ml!

I’m fair-skinned and live in Minnesota where we don’t get enough sun half of the year. This will be my regimen for the rest of my life. I’m such a believer in the benefit of vitamin D and what being deficient does to your body and your health. It’s become a mission to tell anyone I know who is having pain or weakness to be checked, and don’t settle for not getting answers. Thank you for the resources and information you provide!

Sincerely,

Rebecca

Dear Rebecca:

It sounds like you had osteomalacia, or adult rickets. The pain originates from the exterior lining of your bones, but it radiates throughout the legs and arms. It took two months for your symptoms to improve, because you were not started on a loading dose of vitamin D.

The muscle weakness you experienced was also from your low vitamin D level and is one of the lesser-known symptoms of osteomalacia. Often, difficulty climbing stairs is the first symptom of muscle weakness as osteomalacia results in reduced strength of the large proximal muscles (ones closest to the torso).

The symptoms of osteomalacia you had are by far the exception, not the rule. In a German study evaluating autopsies of subjects who died from other causes, bone biopsies showed that 25% of these individuals had osteomalacia!

Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, Proksch N, Pastor F, Netter C, Streichert T, Püschel K, Amling M. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010 Feb;25(2):305-12.

The majority of people with low vitamin D levels and osteomalacia have no symptoms, at least that we know of. In a recent large cross-sectional study, researchers found that although the majority of vitamin D deficient individuals did not experience any symptoms, the most common symptom present was muscle weakness, but not pain or fatigue.

Merlo C, Trummler M, Essig S, Zeller A. Vitamin D Deficiency in Unselected Patients from Swiss Primary Care: A Cross-Sectional Study in Two Seasons. PLoS One. 2015 Sep 15;10(9):e0138613. doi: 10.1371/journal.pone.0138613.

I’m so glad you are better. It shows that people who do their own research on health– instead of just relying on doctors – are more likely to find the cause of their problems.

Sincerely,

John Cannell, MD

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