GPs can do very positive things for some patients with aches and pains as many such patients are Vitamin D deficient. Vitamin D deficiency commonly presents with widespread aches, weakness, and tiredness, and can also present with focal symptoms. If a patient has several musculoskeletal diagnoses over time (for example plantar fasciitis, hip pain, back pain, and knee pain) then Vitamin D deficiency should be suspected. Deficiency can be confirmed biochemically by checking Vitamin D levels. Expert consensus suggests that optimal Vitamin D status requires serum levels of 25 OH Vitamin D of 75 nmol/l (that is, 30 mg/l) or more (repeat levels 3 months after initial treatment to ensure patients are replete). Recent work shows ‘no credible evidence’ for hypercalcaemia at treatment doses of Vitamin D.1 Treatment must be with adequate doses (for example, 400 000 iu in the first 2 weeks and then 20 000 weekly) as low dose supplements containing calcium will not restore Vitamin D levels, nor give symptom relief. This condition is common in all ethnic groups, especially in the north and west of the country, and is often forgotten or missed.
I received this comment recently, after treatment (of a white middle-aged man). ‘I feel 10 years younger with fewer aches and pains. Mood and energy levels are much improved. I can get about to go fishing much more easily’. Many patients have similar positive experiences.
Moreover, treatment may improve general health as it is now well recognised that Vitamin D deficiency is a risk factor for many other conditions including cardiovascular disease, diabetes, cancer, and infections.2
Finally, patients may approach exercise with more equanimity if the hopeful phrase ‘wear and repair’ is used instead of the sinister ‘wear and tear’.
- © British Journal of General Practice, 2010.