<s>[INST] After two years of suffering many symptoms including extreme fatigue, nausea, bone pain, a fractured ankle, etc., I was finally diagnosed with hyperparathyroidism and had the adenoma and parathyroid gland removed. I have felt great since then, until the past two months. I had bloodwork and learned that the serum calcium level is normal, vitamin D still low, and the PTH was at 89 in March. Now, I am suffering from the same bone pain as I did before surgery. What in the world? [/INST] Hi there. Low vitamin D means that the calcium is not able to reach your bones and hence you experience bone weakness symptoms of bone pain and lethargy. I suggest you consult an Endocrinologist to assess other laboratory parameters like PTH level. In some cases Salmon calcitonin nasal sprays help to reduce bone pain, after consulting with your Endocrinologist. Also do daily brisk walking exercise for 45 minutes. </s>