Eleven female asylum seekers from Bosnia, Afghanistan, Somalia, or Albania who were living in Switzerland presented with musculoskeletal pain associated with subnormal serum concentrations of 25-hydroxyvitamin D. Symptoms included bone pain, proximal muscle weakness, change in gait, or fatigue. In all cases, exposure to sunlight was minimal.
Treatment in most cases was 300,000 IU of vitamin D3 once a month intramuscularly, plus 1,000 mg/day of calcium and 800 IU/day of vitamin D3 orally. In most cases, symptoms disappeared within one to three months, although one patient needed seven months of treatment.
Numerous studies over the past ten years have shown that vitamin D deficiency is more prevalent than most doctors realize. Symptoms of vitamin D deficiency include musculoskeletal pain and weakness that may be confused with fibromyalgia or chronic fatigue syndrome. The main contributing factor to vitamin D deficiency is inadequate sunlight exposure. Some people purposely avoid the sun because of fears of skin cancer and photo-aging. Others fail to obtain adequate amounts of sunlight exposure because they spend most of their time indoors or because they live in areas where insufficient amounts of sunlight reach the earth's surface (e.g., northern latitudes or cities with tall buildings). Some women cover themselves for religious reasons.
Most people do not require a large amount of sun exposure to achieve adequate vitamin D status. According to Dr. Michael Holick, a vitamin D expert, exposure of the arms and legs or the hands, arms, and face to sunlight for five to 15 minutes, two to three times a week between 10 am and 3 pm during the spring, summer, and autumn is usually enough for adequate vitamin D production. People who are obese, elderly, or dark-skinned have a reduced capacity to synthesize vitamin D in the skin.
Vitamin D deficiency should be considered in patients with fatigue or musculoskeletal symptoms who do not obtain adequate sunlight exposure.
de lbrrente de la Jars G, Pecoud A, Favrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ. 2004;329:156-157.
Reprinted with exclusive permission from The Townsend Letter, Oct 2006.