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

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

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.

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

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