Can Vitamin D Deficiency Produce an Unusual Pain Syndrome?-Reply

In Reply.—  The letter by Reginato and Flasca reemphasizes some points in our article¹ and provides the opportunity to elucidate some areas that we neglected in the manuscript due to space limitations of the ARCHIVES. It would come as no surprise to find that some of the vitamin D deficient subjects also had some degree of osteomalacia. Looser zones appear in late stages of osteomalacia and are rarely seen in our population, and this is consistent with the findings of others.² At the levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in our subjects, osteomalacia is also relatively uncommon.³ This diagnosis, of course, is dependent on a biopsy specimen that, as we noted in our article, was not obtained. Our experience has been that the frail, older patients and their family members are unwilling to provide informed consent. A biopsy would expose the patients to significant discomfort even