What role does vitamin D deficiency play in such post-fracture symptoms as pain, particularly in northern regions? — Erin Rysavy, PA-C, MPH, Sartell, Minn.

Nutritional osteomalacia (bone demineralization) can be the result of low vitamin D levels (<10 ng/mL) and causes bone pain, achiness and increased risk of fracture. The condition is often associated with such malabsorption conditions as celiac disease, intestinal bypass surgery, and Crohn’s disease; it can also be attributable to such endocrine conditions as hypophosphatemia and renal disease.

Osteomalacia is difficult to diagnose and can be mistaken for osteopenia, osteoarthritis, Paget’s disease and somatization. With regard to post-fracture pain, it would be helpful to know if the patient had been experiencing generalized bone pain or achiness prior to the fracture, which could be a sign that osteomalacia was the cause of both fracture and pain. — Rebecca H. Bryan, APRN, CNP (162-1)