Abstract
BackgroundHypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D.MethodsDesign: A pre- and post-intervention observational study.Setting: A network comprising an academic primary care centre and nurse practitioners.Participants: Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH) vitamin D <21 nmol/l).Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only.Main outcome measures: We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis.Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0.ResultsPrior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%). The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20). Twenty-two patients (66.7%) responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08) six months before diagnosis to 0.39 (SD 0.83) after (P = 0.027). The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD 1.5) to 0.85 (SD 1) (P = 0.001).ConclusionHypovitaminosis D in female asylum seekers may remain undiagnosed, with a prolonged duration of chronic symptoms. The potential pitfall is a diagnosis of somatisation. Treatment leads to a rapid resolution of symptoms, a reduction in the use of medical services, and the prescription of analgesic drugs in this vulnerable population.
Highlights
Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations
Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%)
This disorder remains widely underconsidered according to more recent studies, with one reporting a mean period of 59.2 months of complaints before the diagnosis was established [6], and another reporting a prevalence of 78% of hypovitaminosis D in an Indo-Asian population attending a rheumatology clinic in the UK [7]
Summary
Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. Hypovitaminosis D and osteomalacia have been reported in the immigrant Indo-Asian population in the UK since the 1960's [2,3,4,5] This disorder remains widely underconsidered according to more recent studies, with one reporting a mean period of 59.2 months of complaints before the diagnosis was established [6], and another reporting a prevalence of 78% of hypovitaminosis D (versus 58% in controls) in an Indo-Asian population attending a rheumatology clinic in the UK [7]. We have previously reported eleven cases of symptomatic hypovitaminosis D in female asylum seekers [9]
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