Original ArticlePrevalence of Severe Hypovitaminosis D in Patients With Persistent, Nonspecific Musculoskeletal Pain
Section snippets
Study Population
Six broad categories of ethnic groups were divided into immigrant and nonimmigrant populations. The immigrant ethnic groups considered in this study are East African (primarily Somalian), Hispanic (primarily Mexican), and Southeast Asian (primarily Hmong, Cambodian, or Laotian). The Southeast Asian patients began translocating to Minnesota in 1975, most of whom arrived from refugee camps. The East African and Hispanic patients began arriving in Minnesota in 1995. The nonimmigrant ethnic groups
RESULTS
The prevalence of hypovitaminosis D was unexpectedly high in this population of nonelderly, nonhousebound, primary care outpatients with persistent, nonspecific musculoskeletal pain refractory to standard pharmaceutical agents. Of all patients, 93% (140/150) had deficient levels of vitamin D (mean, 12.08 ng/mL; 95% confidence interval [CI], 11.18-12.99 ng/mL). Among the immigrant populations in this study, 100% of the East African (n=34), 100% of the Hispanic (n=5), and 89% (39/44) of the
DISCUSSION
Severe hypovitaminosis D is not asymptomatic. Before the clinical presentation of osteomalacia bone pain, severe hypovitaminosis D results in a syndrome of persistent, nonspecific musculoskeletal pain, which has been well documented in European immigrants8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and recently in residents of Saudi Arabia.24 In all such studies, women have been particularly at risk.
This study shows that in the United States, the risk of severe hypovitaminosis D extends beyond
CONCLUSION
These results support screening of all outpatients with persistent, nonspecific musculoskeletal pain for hypovitaminosis D. These patients are at high risk for the consequences of unrecognized and untreated hypovitaminosis D, and this risk extends to those now considered at low risk, including nonelderly, nonhousebound, or nonimmigrant persons of either sex. Nonimmigrant women of childbearing age may be at particularly high risk for misdiagnosis or delayed diagnosis. Because osteomalacia is a
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For editorial comment, see page 1457.