Vitamin D deficiency differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Sadaf Sharfaei M.D.[2]

## Overview

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Vitamin D deficiency must be differentiated from other diseases that cause generalized muscle and bone pain, such as fibromyalgia, chronic fatigue syndrome, polymyalgia rheumatica, and osteoarthritis.

## Differentiating vitamin D deficiency from other diseases

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Vitamin D deficiency must be differentiated from other conditions that may cause generalized muscle and bone pain. The following table summarizes different diagnoses and how to differentiate them.[1][2][3][4]

Disease  | Differentiating signs and symptoms  | Diagnostic findings

|
|

Vitamin D deficiency |

* Nonspecific musculoskeletal pain
* Muscle weakness
* Symmetric low back pain
* Throbbing bone pain

* Low serum 25(OH)D level
* High PTH level

Fibromyalgia |

* Symptoms have been present at a similar level for at least 3 months.
* Chronic musculoskeletal pain with multiple tender points
* Stiffness, numbness, and fatigue
* Headaches
* Sleep disorder

* All lab tests are normal

Chronic fatigue syndrome | Fatigue plus 4 of the following symptoms:

* Short-term memory loss
* Sore throat
* Tender lymph nodes in the neck or armpit
* Muscle pain
* Joint pain without swelling or redness
* Headaches
* Insomnia
* Malaise

* Diagnosis of exclusions
* Symptoms must present for more than 6 months

Polymyalgia rheumatica |

* Older at onset
* Generalized stiffness

* An elevated erythrocyte sedimentation rate (ESR)
* An elevated C-reactive protein (CRP)
* Response to corticosteroids

Osteoarthritis |

* Localized joint pain
* Restricted to affect joints
* Older at onset

* X-ray of the involved joints demonstrate degenerative changes

## References

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1. ↑ Holick, Michael F. (2007). "Vitamin D Deficiency". New England Journal of Medicine. 357 (3): 266–281. doi:10.1056/NEJMra070553. ISSN 0028-4793.
2. ↑ Holick MF, Chen TC (2008). "Vitamin D deficiency: a worldwide problem with health consequences". Am. J. Clin. Nutr. 87 (4): 1080S–6S. PMID 18400738.
3. ↑ Goldenberg, Don L. (2004). "Management of Fibromyalgia Syndrome". JAMA. 292 (19): 2388. doi:10.1001/jama.292.19.2388. ISSN 0098-7484.
4. ↑ Hollander AP, Dickinson SC, Sims TJ, Brun P, Cortivo R, Kon E, Marcacci M, Zanasi S, Borrione A, De Luca C, Pavesio A, Soranzo C, Abatangelo G, Schmoldt A, Benthe HF, Haberland G, Nakaya N, Sugano N, Nishi A, Tsukada K, Frankle RT, Stein JM, Katz B, Miledi R (2006). "Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees". Tissue Eng. 12 (7): 1787–98. doi:10.1089/ten.2006.12.1787. PMID 16889509.

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