Osteomalacia in a night nurse.

A 41-year-old nurse, regularly employed on the night shift, complained of generalized bone pain and tenderness, pathologic pseudofractures, and the inability to walk. She assiduously avoided sunlight and dairy products and habitually ingested barbiturates. A low-serum 25-hydroxyvitamin D (25-OH-D) level reflected her low total body store of vitamin D. A biopsy revealed osteomalacia. Years of marginal dietary vitamin D intake, along with lack of sun exposure and habitual use of phenobarbital, were possible multifactorial causes of the osteomalacia. Her symptoms completely disappeared with vitamin D and calcium treatment. Although classical vitamin D deficiency is now rare in Western nations of the world, patients with generalized bone pain should be thoroughly investigated with respect to diet, medication, and occupational conditions contributing to osteomalacia.