Hypovitaminosis D-Related Myopathy in Immigrant Teenagers

Abstract

Introduction: Vitamin D deficiency resulting in a limb-girdle muscle weakness was diagnosed in three veiled immigrant teenage girls.

Patients: Three girls had a progressive muscle weakness and pain during a period varying from 6 months to two years. On examination limb girdle muscle weakness, predominantly of the lower extremities, without other neurological abnormalities was found. Serum examination showed a decreased level of vitamin D and phosphate and an increased alkaline phosphatase, and in two girls decreased calcium and increased parathyroid hormone levels were found. After supplementation with vitamin D, the pain subsided and muscle strength increased within weeks. Serum examination of the female relatives revealed eight persons with hypovitaminosis D, without any complaints.

Conclusions: Vitamin D deficiency can result in a limb-girdle myopathy in veiled immigrant teenagers in the Netherlands. Vitamin D supplementation leads to rapid recovery of the muscle strength. The female relatives of these patients should be examined too.

Key words

Myopathy - vitamin D - immigrant - veiled

References

• 1 Boland R. Role of vitamin D in skeletal muscle function.  Endocr Rev. 1986;  7 434-448
• 2 Compston J E. Vitamin D deficiency: time for action.  BMJ. 1998;  317 1466-1467
• 3 Cöster A, Ringe J D. Immigrantenosteomalazie. Zwei Fallvorstellungen mit Therapieverlauf.  Med Klin. 2000;  95 451-456
• 4 Fraser D R. Vitamin D.  Lancet. 1995;  345 104-107
• 5 Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H. et al . Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement.  Calcif Tissue Int. 2000;  66 419-424
• 6 Grootjans-Geerts I. Hypovitaminosis D: a veiled diagnosis. [Dutch].  Ned Tijdschr Geneeskd. 2001;  145 2057-2061
• 7 Holick M F. Sunlight “D”ilemma: risk of skin cancer or bone disease and muscle weakness.  Lancet. 2001;  357 4-5
• 8 Irani P F. Electromyography in nutritional osteomalacic myopathy.  J Neurol Neurosurg Psychiatry. 1976;  39 686-693
• 9 Ramsay I. Endocrine myopathies.  Practioner. 1982;  226 1075-1080
• 10 Ziambaras K, Dagogo-Jack S. Reversible muscle weakness in patients with vitamin D deficiency.  WJM. 1997;  167 435-439