Vitamin D Deficiency

What is Vitamin D Deficiency?

Vitamin D Deficiency, also known as Hypovitaminosis D, is a condition when the levels of vitamin D are less than a normal level of 20-50ng/ml of blood. Vitamin D is essential for maintaining calcium balance in the body and aids in bone development and strength. Vitamin D Deficiency can lead to an imbalance in calcium metabolism and weak bones in children and adults.

Is Vitamin D deficiency condition a Medical emergency?

Vitamin D Deficiency is not a medical emergency.

Causes

Vitamin D is essential for maintaining normal calcium balance and bone metabolism. Deficiency leads to reduced absorption of calcium and phosphorous from the intestines, which leads to secondary hyperparathyroidism, which causes the increased absorption of calcium from the bones to maintain the blood calcium levels. The increased absorption of calcium results in the weakening of bones. It can result from:

• Decreased dietary intake or absorption
  • Celiac disease
  • Gastric bypass surgery
  • Inflammatory bowel disease
  • Chronic pancreatic insufficiency
  • Cystic fibrosis
  • Short bowel syndrome
  • Low dietary intake: More common in infants and the elderly age group
• Decreased exposure to the sun
  • Spending more time indoors
• Decreased availability of active vitamin D
  • Chronic liver disease
  • Renal failure
  • Hyperparathyroidism
  • 1-Alpha Hydroxylase deficiency
• Increased metabolism of vitamin D:
  • Due to drugs and medications such as phenobarbital, dexamethasone, carbamazepine, clotrimazole, spironolactone, etc
• End organ resistance as seen in hereditary vitamin D-resistant rickets

Risk factors

Factors that increase the risk of Vitamin D deficiency include:

• Age: More common in the very young and the elderly age group
• Obesity
• Dark-skinned population

Symptoms & signs

Vitamin D deficiency may not present with any symptoms in a majority of cases, although the effects of its deficiency may be noticeable earlier in children. Some of the signs and symptoms include:

• Bone pain
• Joint pain
• Muscle aches
• Tiredness
• Muscle twitching
• Easy fracture from falls
• Bowing of legs in children (Rickets)
• Tooth loss

Investigations

Investigations that are advised for the evaluation of the condition include:

• Laboratory tests:
  • Serum 25 Hydroxy vitamin D levels
  • Serum parathyroid hormone (PTH) levels

Diagnosis

A diagnosis of Vitamin D deficiency is established based on medical history, clinical evaluation, and results of the investigations done.

Course & stages

It may be staged as:

• Mild deficiency: 25 hydroxyvitamin D less than 20ng/ml
• Moderate deficiency: 25 hydroxyvitamin D less than 10ng/ml
• Severe deficiency: 25 hydroxyvitamin D less than 5ng/ml

Treatment options

The treatment aims to restore the levels of vitamin D to acceptable normal levels to reduce the risk of further bone damage.

Medical management

Medical management of Vitamin D deficiency include:

• Vitamin D3 supplementation:
  • Initial supplementation for 8 weeks with either 6,000 Units daily or 50,000 Units weekly
  • Once serum maintenance levels of 25-30ng/ml are reached, a maintenance dose of 1,000-2,000 units daily is given
• A higher daily dose may be required for the first 8 weeks in individuals at a greater risk of Vitamin D Deficiency

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that can be taken to prevent Vitamin D deficiency include:

• Getting adequate exposure to the sun
• Ensuring intake of food rich in vitamin D, such as fish or foods and drinks fortified with vitamin D, such as milk, orange juice, cereals, etc.
• Multivitamin tablets with vitamin D

Complications

Some complications of the condition include:

• Rickets in children
• Osteomalacia in adults
• Increased risk of falls
• Increased risk of hip fractures
• Osteoporosis
• Increased risk of type 1 and 2 diabetes
• Increased risk of preeclampsia
• Increased risk of schizophrenia
• Increased risk of COVID -19
• Increased risk of invasive cancer
• Increased risk of cardiovascular disease

Prognosis

The prognosis is generally very good when it is identified and managed properly. Untreated Vitamin D deficiency can increase the risk of a number of illnesses, along with decreased bone health.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if symptoms of tiredness, bone pain, or muscle pains are present.

Indications for hospitalization if required

Hospitalization is not required.

Screening methods

Individuals at a high risk of Vitamin D deficiency are advised to check their vitamin D levels once every 6 months. Individuals who have been treated with vitamin D supplementation should also get regularly tested to ensure that their vitamin D levels are being maintained.

Suggested clinical specialist/ Departments to consult for this condition

• General Medicine