Musculoskeletal pain in female asylum seekers and hypovitaminosis D₃

Introduction

Deficiency of vitamin D, which can lead to osteomalacia, is common in elderly patients in Western countries. However, it is still widely underdiagnosed in young immigrant women, even though the condition has been extensively reported in the immigrant Indo-Asian population in the United Kingdom since the 1960s.1–4 A recent study reports an average 59 months before diagnosis was established,5 and another study found a prevalence of 78% of hypovitaminosis D₃ (compared with 58% in controls) in an Indo-Asian population attending a UK rheumatology clinic.6 When recognised, hypovitaminosis D₃ is easily treatable. A study on osteomalacic myopathy in veiled Arabic women in Denmark found that muscle strength returned to normal (except in maximal voluntary contraction) after six months' treatment.7

We expected to see this disease in female asylum seekers, especially in those from societies with different customs regarding exposure to sunlight and diet. We report 11 cases of symptomatic hypovitaminosis D₃ in female asylum seekers (table 1). We focus on the pathology encountered by the primary care doctors caring for these 11 patients, the length of time between the appearance of symptoms, and the establishment of the diagnosis of hypovitaminosis D₃ as well as the women's response to treatment by the improvement of a wide range of clinical symptoms—bone pain, muscular weakness, and fatigue.

Case reports

The primary …