Can Vitamin D Deficiency Produce an Unusual Pain Syndrome?

To the Editor.—  Gloth et al¹ presented five patients with unusual leg pain in the presence of abnormal serum vitamin D levels, which resolved rapidly after vitamin D supplementation. Several of these patients had diffuse demineralization and risk factors for developing osteomalacia, but no systematic efforts to document characteristic Looser zones in the pelvis or shoulder girdle were reported. Also, results of leg roentgenograms that could have shown localized bone demineralization were not reported.Peripheral bone manifestations with excruciating bone pain and features of causalgia, "algodystrophy," regional painful osteoporosis, or reflex sympathetic dystrophy as a result of osteomalacia have been described previously in both the American and the European literature.^2,3 We have seen this syndrome both in sporadic cases of osteomalacia and in the elderly in whom the syndrome is misdiagnosed as part of generalized "senile osteoporosis" as well as in younger patients living in the Chilean Patagonia