In June 2010, a 63 year old male with multiple myeloma presented with multiple falls and reactivation of herpes zoster. The patient was previously diagnosed with solitary plasmacytoma in 2001, which then progressed to smoldering myeloma in 2004. In 2007 the indolent version of his myeloma transformed to a more aggressive form of myeloma with non-specific musculoskeletal chest pain, anorexia, weight loss, and tumour-lysis requiring hospital admission and plasmapheresis. The patient was treated by Vincristine, Adriamycin, Dexamethasone and completed six induction cycles with an autologous stem cell transplant in June 2008 with high dose Melphalan. In 2009, the patient was treated with Lenalidomide and Dexamethasone salvage; however his disease was resistant to most standard immonumodulatory agents. Salvation presented itself in the form of a phase II study in investigating the role of Bortezomib with a new agent Vorinostat a histone deacetylase inhibitor in heavily pre-treated myeloma. The patient began therapy with Bortezomib in early march 2010. However, in June 2010 the patient was admitted after multiple falls and zoster reactivation including ophthalmic zoster of the right first and second trigeminal branches. Despite of all the above management, there was a continuing downturn in his overall performance status over the period of 1 to 2 years with generalized musculoskeletal pain, worse on activity and weight bearing, and muscle weakness. His overall functional ability deteriorated markedly such that he became a major falls risk and suffered four falls whilst in hospital. On examination he was pale with a depressed affect. The patient had resting tremor, generalized bony tenderness (worse on movement and weight bearing), muscle weakness, and a waddling gait. His bone studies showed features of osteomalacia with an elevated alkaline phosphatase at 270 U/L, very low Vitamin D level of less than 20 nmol/L, and a high intact parathyroid hormone at 16.0 pmol/L. The patient was commenced on 3000 units of Vitamin D supplementation and physiotherapy. After 4 months, although his multiple myeloma deteriorated, there was a significant decrease in his generalized musculoskeletal pain. His bloods showed a normalized level of Vitamin D of 109 nmol/L and decrease in alkaline phosphatase to 182 U/L. He is currently undergoing palliative rehabilitation.