Patients with vitamin D deficiency can present with nonspecific bone pain and findings on radionuclide bone scanning that may suggest metastatic malignancy. In this report, we present 4 such cases, in which clinicians initially pursued diagnoses of metastatic malignancy and did not consider vitamin D deficiency and osteomalacia in the differential diagnosis. Eventual recognition of vitamin D deficiency and provision of supplementation resulted in prompt resolution of symptoms for each patient. In appropriate cases, timely consideration of a diagnosis of vitamin D deficiency can mitigate the anxiety associated with undergoing an evaluation for cancer.