Book Overview

Global Problem It has been estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency 7–12, 15–22. According to several studies, 40 to 100% of U.S. and European elderly men and women still living in the community (not in nursing homes) are deficient in vitamin D. Indian Pattern Vitamin D deficiency was considered to be rare in India because of its sunny environment.133 However, studies from different parts of the country have shown similar hypovitaminosis D among all age groups including school children, pregnant women and their neonates.129,134 Presence of melanin, poor sun exposure, vegetarian food and lack of vitamin D food fortification program explain the high prevalence of vitamin D deficiency in urban Indians. Though more than 60% of Indian population live in rural area, there is limited information on their Vitamin D status. The discovery that most tissues and cells in the body have a vitamin D receptor and that several possess the enzymatic machinery to convert the primary circulating form of vitamin D, 25–hydroxyvitamin D, to the active form, 1,25– dihydroxyvitamin D, has provided new insights into the function of this vitamin. Of great interest is the role it can play in decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease. Hypovitaminosis D has been reported in populations with several different types of chronic musculoskeletal pain such as osteoarthritis, rheumatoid arthritis, osteoporosis, soft tissue rheumatism, musculoskeletal pain, and arthralgia 9, 17, 19–23. The reported musculoskeletal manifestations are diffuse muscle pain and weakness, muscle fatigue, paraesthesia, arthralgia, and deep bone pain. These myopathy and arthralgia symptoms are non–specific and difficult to link to a specific diagnosis that may lead to other diagnoses such as fibromyalgia, polymyalgia and non–specific rheumatic diseases 14. The Global musculoskeletal burden is ever increasing due to increased longevity and increased prevalence of Obesity. Musculoskeletal symptoms arising from disturbances in soft tissue, without evidence of inflammatory arthritis, are extremely common in clinical practice. The causes are protean and it is well–nigh impossible to the physician to pinpoint the exact cause in majority of the patients.