title: Diffuse muscoskeletal pain and proximal myopathy: do not forget hypovitaminosis D.
abstract: A 20-year-old vegetarian man was admitted to our hospital complaining of muscle weakness and gait disturbances of 4 years duration. For the past 5 years, he had major depression and had confined himself at home. He exhibited tenderness upon palpation of the chest, sternum and proximal muscles. Hypocalcemia, hypophosphatemia, vitamin D deficiency, increased levels of alkaline phosphatase, and intact parathyroid hormone were noted. An x-ray skeletal survey revealed generalized osteopenia, multiple vertebral and costal fractures, and a pelvis deformed into the shape of a triangle. A diagnosis of osteomalacia secondary to vitamin D deficiency from lack of exposure to sunlight and to inadequacy of the diet was made. The patient was started on a treatment with 20,000 IU of vitamin D3 once a week plus 1 g/d of calcium. Eight months later, gait disturbances have significantly improved and laboratory findings have all normalized.
authors.affiliation: Department of Clinical and Experimental Medicine, Institute of Internal Medicine, Angiology and Arteriosclerosis Diseases, University of Perugia, Perugia, Italy. glfabbriciani@tiscali.it
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Fabbriciani
authors.forename: Matteo
authors.initials: M
authors.lastname: Pirro
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.forename: Andrea
authors.initials: A
authors.lastname: Cecchetti
authors.forename: Laura
authors.initials: L
authors.lastname: Callarelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rinonapoli
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Scarponi
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D017610:Calcium Compounds / Q000627:therapeutic use; D014676:Diet, Vegetarian / Q000009:adverse effects*; D019587:Dietary Supplements; D006801:Humans; D008297:Male; D018908:Muscle Weakness / Q000209:etiology*; D010018:Osteomalacia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D010146:Pain / Q000209:etiology*; D013472:Sunlight; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications* / Q000628:therapy; D055815:Young Adult
chemical_list: D017610:Calcium Compounds; D014807:Vitamin D