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Vitamin D Deficiency

(Hypovitaminosis D)

Definition

Vitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's liver and fatty tissues. Vitamin D acts as both a vitamin and a hormone. Two of the main sources of vitamin D are food and sunlight. The ultraviolet rays of the sun react with cholesterol present on the skin and create previtamin D3. This compound goes through a series of reactions involving the kidneys and the liver. The final product is vitamin D.
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
Weakened bone at hip
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Causes

Vitamin D deficiency can be caused by:
  • Inadequate intake of vitamin D in the diet
  • Lack of sunlight due to:
    • Having a darker skin color
    • Wearing clothes that cover most of the skin
    • Living in northern latitudes during the winter
    • Not being exposed to direct sunlight—Sunlight through windows, clothes, or sunscreen-covered skin is not enough for the body to synthesize vitamin D.
  • Conditions and procedures that affect the body’s ability to absorb vitamin D from the digestive tract (such as celiac disease , inflammatory bowel disease , bariatric surgery)
  • Conditions or medicines that affect the process of converting vitamin D to a form that the body can use, such as:
    • Anti-seizure medicines such (such as phenobarbital, phenytoin, carbamazepine)
    • Other medicines (such as rifampin, isoniazid, theophylline)
    • Severe liver disease
    • Chronic kidney disease
    • Vitamin-D dependant rickets (an inherited condition)
    • Hypoparathyroidism (underactive parathyroid)
    • Nephrotic syndrome (kidney condition)
    • Peritoneal dialysis

Risk Factors

Risk factors include:
  • Limited sun exposure
  • Darker skin color
  • Kidney disease
  • Restricted activity (such as due to hospitalization)
  • Injury due to a severe burn
  • Malabsorption disorder (such as celiac disease)
  • Obesity
  • Certain types of diets (such as macrobiotic diet)
  • Liver conditions
  • Babies who are breastfed or do not consume enough formula that is fortified with vitamin D
Wearing sunscreen may be a risk factor for vitamin D deficiency. But, organizations like the American Academy of Dermatology (AAD) recommend that you use sunscreen to protect your skin from UV exposure, a known risk factor for skin cancer.

Symptoms

If your vitamin D deficiency is mild to moderate, you may not have any symptoms. If you have a severe deficiency, you may experience:
  • Bone and muscle pain
  • Muscle weakness
  • Hip pain
  • Fractures
  • Difficulty walking, walking up stairs, and getting out of a chair
  • Falls

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 prevent vitamin D deficiency, take these steps:
  • Eat a healthy diet. Foods are not naturally high in vitamin D. Many foods are enriched with vitamin D, such as milk, juices, and cereal.
  • Take a vitamin D supplement if recommended by your doctor. Your baby may need a supplement if he is breastfed or does not consume enough formula that is fortified with vitamin D. Children may also need to take a supplement if they are not getting enough vitamin D in their diets.
  • Follow your doctor’s guidelines on getting enough sun exposure.
  • If you or a family member has any of the above risk factors, talk to the doctor about other ways to avoid becoming deficient in vitamin D.

RESOURCES

Celiac Sprue Association http://www.csaceliacs.org

Office of Dietary Supplements http://ods.od.nih.gov

CANADIAN RESOURCES

Canadian Pediatric Society http://www.cps.ca

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

References

Allain TJ, Dhesi J. Hypovitaminosis D in older adults. Gerontol. 2003;49: 273-278.

American Academy of Dermatology. Position statement on vitamin D. American Academy of Dermatology website. Available at: http://www.aad.org/Forms/Policies/Uploads/PS/PS-Vitamin%20D.pdf. Published June 19, 2009. Accessed August 3, 2010.

Calvagna M. Vitamin D. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated April 5, 2010. Accessed July 13, 2010.

Dietary supplement fact sheet: vitamin D. Office of Dietary Supplements website. Available at: http://ods.od.nih.gov/factsheets/vitamind.asp#h4. Accessed Accessed March 16, 2008.

DynaMed Editorial Team. Vitamin D deficiency in adults. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 3, 2010. Accessed August 13, 2010.

Pfeifer M, Begerow B, et al. Vitamin D and muscle function. Osteoporosis Int. 2002;13:187-194.

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, et al. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002;112:659-662.

Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-1152.

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