A Chinese woman whose violent coughs reportedly resulted in 10 fractured ribs was shocked to hear that her bones had become fragile due to her excessive sunblock use, which caused a severe vitamin D deficiency.

The 20-year-old woman from Zhejiang province, in eastern China, first started experiencing coughing episodes after pulling out a straw mat to sleep on to combat heat during the night. She started coughing that very night, and although her doctor first diagnosed her with a case of allergic asthma, the violent coughs soon revealed an even bigger health concern. After a few days, after particularly violent coughing fits, Xiao Miao (a pseudonym used by Chinese media) experienced severe pain in the left side of her chest, which investigations revealed was caused by several broken ribs.

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Disturbed by the cause of Xiao Miao’s pain, doctors performed more tests which revealed that she had significantly lower bone density than the average Chinese female population, let alone women her age. She also had vitamin D deficiency and her blood calcium and blood phosphorus levels were critically low as well.

The 20-year-old woman told doctors that in an effort to prevent getting tanned, she would mainly stay indoors and used SPF50 sunscreen all year round, whenever she went out. China’s obsession with fair, almost pale white skin is well documented and dates back to ancient times, when it was associated with royalty and wealth. Peasants working in the fields all day would get tanned, while members of the upper class would be fair skinned.

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Xiao Miao’s doctor told Chinese reporters that her daily cosmetic habit was most likely the cause of her 10 rib fractures. He explained that people her age can absorb the necessary amount of vitamin D just by exposing their skin to sunlight for 20 minutes three times a week, but that because of her excessive sunblock usage, there wasn’t enough vitamin D synthesized.

As Asia One reports, the issue is somewhat controversial, because while some studies confirm the doctor’s statement, others show that sunscreen use does not impede the synthesis of vitamin D in the body.