Vitamin D Deficiency, Prevention and Treatment

CASE A 35 year female born and residing in Esfahan presents to the physician due to fatigue and sense of weakness. The patient refers that she has been having bilateral low back pain accompanied by throbbing bone pain in the lower extremities since 5 months ago. In past history menses is regular and 3 pregnancy followed by lactating the newborns. The patient denies use of any medication, except regular use of sunscreen. She also denies history of DM. In the physical examination: BP: 120/80 BMI: 30 Kg/M2 Cranial nerves are intact Examination of nerves system is within normal limit There is no proximal myopathy. Laboratory examination revealed: • TSH and T4 within normal limits • Serum calcium 9.5 mg/dl (8.5-10.5) • Phosphate: 3.5 mg/d (2.5-4) • Albumin: 4 g/dl • 25(OH) D: 4 ng/ml • PTH: 84 Pg/ml (8-51).