Vitamin D Deficiency
(Hypovitaminosis D)
Definition
Vitamin D deficiency describes low levels of vitamin D in the blood. This condition can lead to a condition known as rickets in children. In adults it can lead to osteomalacia . These are two forms of bone diseases that weaken bones. It is important to contact your doctor if you think you have vitamin D deficiency.
Weakened Bone
Causes
Vitamin D deficiency can be caused by:
- Inadequate intake of vitamin D in the diet
- Limited exposure to sunlight
- Kidney disease
- The inability to absorb vitamin D from the digestive tract
-
Medications that interfere with vitamin D use by the body, such as:
- Prednisone drugs
- Weight-loss drug orlistat
- Cholesterol-lowering medications such as cholestyramine
- Anti-seizure medications such as phenobarbital and phenytoin
Risk Factors
The following factors may increase your chance of developing vitamin D deficiency:
- Lactose intolerance
- Strict vegetarianism
- Infants fed only breast milk without vitamin D supplementation
- Syndromes that cause fat malabsorption, like celiac sprue or Crohn's disease , cystic fibrosis , pancreatic or liver disease
- Kidney disease
- Obesity
- Darkly pigmented skin
- Limited sun exposure
Symptoms
Symptoms include:
- Diffuse bone and muscle pain
- Muscle weakness
- Hip pain
- Fractures
- Difficulty walking, walking up stairs, and getting out of a chair
- Falls
- Some research also shows that vitamin D deficiency may also be related to depression
Diagnosis
Your doctor will ask about your symptoms and medical history. Tests may include the following:
- Blood tests to check vitamin D levels and kidney function
- Bone tests
Treatment
Talk with your doctor about the best plan for you. Treatment options include:
Vitamin D Supplementation
High doses of vitamin D are given for 6-12 weeks. This is followed by a lower dose of the vitamin. The doses are continued until blood levels return to normal.
Calcium Supplementation
Calcium plus vitamin D supplements may be given to increase D levels. This can also improve bone strength in older women with low vitamin D.
Light Therapy
Exposure to sunlight or UV radiation can increase D levels. Vitamin D3 is produced in the skin when it is exposed to these light sources.
Prevention
To help reduce the chances of getting vitamin D deficiency, eat a healthy diet. Foods are not naturally high in vitamin D. Many foods are enriched with vitamin D, such as milk, some fruits and juices, some flours and cereal products.
Additionally, the following groups of people should talk with their doctor about whether they need a daily vitamin D supplement:
- Infants who are exclusively breastfed
- People aged 50 and older
- People living in northern latitudes (eg, New England, Alaska)
- Women who wear robes and head coverings
- People working in occupations that prevent sun exposure
- People with darker skin (eg, African Americans)
- People who are obese
- People with fat malabsorption (eg, pancreatic enzyme deficiency, Crohn's disease, cystic fibrosis , celiac disease, liver disease, surgical removal of part or all of the stomach or intestines)
RESOURCES:
Celiac Sprue Association
http://www.csaceliacs.org/
Nemours Foundation
http://kidshealth.org/
Office of Dietary Supplements
http://ods.od.nih.gov/
CANADIAN RESOURCES:
Canadian Pediatric Society
http://www.cps.ca/
Health Canada: Food and Nutrition
http://www.hc-sc.gc.ca/
References:
Allain TJ, Dhesi J. Hypovitaminosis D in older adults. Gerontol . 2003;49: 273-8.
Dietary supplement fact sheet: vitamin D. Office of Dietary Supplements website. Available at: http://ods.od.nih.gov/factsheets/vitamind.asp#h4. Accessed March 16, 2008.
Pfeifer M, Begerow B, Minne HW. Vitamin D and muscle function. Osteoporosis Int . 2002;13:187-94.
Plotnikoff, GA, Quigley, JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78:1463.
Tangpricha V, Pearce EN, Chen TC, et al. Vitamin D insufficiency among free-living healthy young adults. Am J Med . 2002;112:659-62.
Vitamin D deficiency in adults. DynaMed website. Available at: http://dynamed102.epnet.com/Detail.aspx?id=113821. Accessed March 16, 2008.
Last reviewed January 2009 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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