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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
    Copyright © Nucleus Medical Media, Inc.
  • 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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