Vitamin D deficiency in infants causes development of rickets in them. Such children exhibit peculiar characteristics of delayed walking, and prefer prolonged periods of sitting. In older children, walking becomes painful and in severe cases, bow legs may develop. In adolescent girls, the pelvic bones flatten, which in turn causes narrowing of the birth canal. Vitamin D deficiency is the major and common cause of nutritional rickets.

In adults, vitamin D deficiency may precipitate as osteomalacia. Affected adults complain of muscle aches and pain. Such individuals are also prone to frequent fractures due to poorly mineralized skeletal matrix [7].

• Fishing

  Some dietary sources such as fish oils and salted fish also contain vitamin D3. Vitamin D is important for optimal functioning of various body organs. [symptoma.com]

  We report the case of a 14-year-old girl with severe AD and fish allergy since early childhood. She lived at high latitude (with less sun exposure) and, because of her atopic disorders, avoided sunlight and fish. [ncbi.nlm.nih.gov]

  This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, fortified milk, and beef liver. Your exposure to sunlight is limited. [webmd.com]

  If you can’t get outside, sit by an open window or door for a few minutes, because most windows block the part of the sunlight needed to ignite vitamin D production. 3) Go fish. Many types of fish are a good source of vitamin D. [arthritis.org]

• Weakness

  All had generalized bone pain and tenderness, muscle weakness, stooping posture, difficulty walking, and waddling gait due to severe proximal muscle weakness for a period of 2 to 5 years. [ncbi.nlm.nih.gov]

• Falling

  Muscle weakness below a certain threshold affects functional ability and mobility, which puts an elderly person at increased risk of falling and fractures. [ncbi.nlm.nih.gov]

  Vitamin D Deficiency and Risk of Hip Fractures Over 90% of fractures occur after a fall and fall rates increase with age and poor muscle strength or function. [japi.org]

  Vitamin D treatment was associated with a nonsignificant reduction in the risk for 1 or more falls and a significantly reduced overall burden of falls, which is measured by the number of falls per person. [annals.org]

  […] effect on proximal muscle strength, thus decreasing fall risk. [aafp.org]

• Fatigue

  All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. [ncbi.nlm.nih.gov]

  For more information on how to reduce fatigue, consider reading about the 11 best vitamins and supplements to boost energy. Summary Excessive fatigue and tiredness may be a sign of vitamin D deficiency. [healthline.com]

  “A lot of people thought that if they were fatigued or sad or they did not feel well, they might be vitamin D deficient.” In 2007, Dr. [nytimes.com]

• Weight Loss

  We present a case of a 30-year-old woman presented with muscle weakness, weight loss, hypercalcaemia and a pathological fracture, eventually with rapidly progressive musculoskeletal disease. [ncbi.nlm.nih.gov]

  This weight-loss surgery removes part of the stomach and/or the intestines. Reducing the size of these organs lowers the amount of vitamin D-containing nutrients that can be absorbed. Obesity. [my.clevelandclinic.org]

  Are you fed up hearing that weight loss is key to fertility boosting? New research tells us why it works. [helenatubridy.com]

  The benefits of vitamin D, backed up by tons of research, ring loud and clear: strong bones, improved mood, even more efficient weight loss. But signs that you're low on the nutrient are a bit quieter. [womenshealthmag.com]

• Nausea

  Nausea during pregnancy Research published in the American Journal of Obstetrics and Gynecology concluded that pyridoxine can reduce the severity of nausea in early pregnancy. However, more high-quality studies are necessary to confirm this. [medicalnewstoday.com]

  Getting too much vitamin D (typically from supplements) can cause a decrease in appetite, nausea, and even vomiting. (And no, that's not why the Gallon Challenge causes vomiting too.) Originally published July 2012. Updated February 2016. [greatist.com]

  Symptoms of vitamin D toxicity include nausea, vomiting and weakness. Too much vitamin D can cause your calcium level to increase and lead to mental confusion and heart arrhythmias. [parentgiving.com]

  Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. Excess vitamin D can also damage the kidneys. Too much vitamin D also raises the level of calcium in your blood. [medlineplus.gov]

• Heart Disease

  Heart Disease and Stroke If sun exposure reduces blood pressure, it may also be able to prevent heart disease and stroke. [ 4 ] High blood pressure is a huge risk factor for these types of health conditions, both of which account for 30 percent of annual [globalhealingcenter.com]

  Lack of vitamin D is linked to rickets (soft, weak bones) in children and thinning bones in the elderly, but scientists also believe it may play a role in heart disease, diabetes and cancer. [scientificamerican.com]

  V itamin D Deficiency and Heart Disease Numerous studies have shown an association between low vitamin D blood levels and heart disease and related complications, according to a review published in January 2014 in Circulation Research, but science has [everydayhealth.com]

• Osteoporosis

  This does not mean that patients with osteoporosis should undergo routine vitamin D testing. [nos.org.uk]

  Mayo Clinic Proceedings. 2010;85(8):752-758 National Osteoporosis Sociaety (NOS) 2018. [gpnotebook.co.uk]

  Both PHPT and VDD contributed to severe osteoporosis, which could be exacerbated by not attaining his peak bone mass and by immobilization because of a fragile fracture with delayed healing. [ncbi.nlm.nih.gov]

  In addition, the optimal standard of care for osteoporosis should encompass adequate calcium and vitamin D intake. [doi.org]

• Muscle Weakness

  All had generalized bone pain and tenderness, muscle weakness, stooping posture, difficulty walking, and waddling gait due to severe proximal muscle weakness for a period of 2 to 5 years. [ncbi.nlm.nih.gov]

• Bone Pain

  METHODS: Patients with leg pain, defined as local pain and tenderness over tibial bones for ≥ 6 weeks were consecutively selected. Secondary causes of pain were excluded by appropriate clinical, radiological and laboratory examinations. [ncbi.nlm.nih.gov]

  Common vitamin D deficiency symptoms include: Bone Pain Back Pain Weakness in the muscles Frequent infections Fatigue Slow-healing wounds Hair loss Cramps and muscle pain Further Reading:- [byjus.com]

• Proximal Muscle Weakness

  We report a four-year-old African boy referred for proximal muscle weakness, fatigability and episodic limb pain. [ncbi.nlm.nih.gov]

  Children with established vitamin D deficiency present with features of rickets (skeletal abnormalities, developmental delay, failure to thrive), whereas adults present with signs and symptoms of osteomalacia (bone pain and tenderness, proximal muscle [bestpractice.bmj.com]

  Common manifestations of vitamin D deficiency are symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia. [aafp.org]

• Rachitic Rosary

  Rachitic rosary — Beadlike bumps present at the junction of the ribs with their cartilages—often seen in children with rickets. [medical-dictionary.thefreedictionary.com]

  rosary and Harrison’s sulcus, extending from the costal cartilage transversely outward to the axilla. [news-medical.net]

  Costochondral thickening can look like beadlike prominences along the lateral chest wall (rachitic rosary). [msdmanuals.com]

• Fear

  The sun is both loved and feared, and many people either worship its life-giving warmth or shun it altogether. As fear of skin cancer related to UV exposure became widespread, individuals around the globe began shying away from natural sunlight. [globalhealingcenter.com]

  […] osteomalacia in adults, this condition, which causes poor growth and bone deformities such as bow legs, was pretty much wiped out in the Western world, but is making a comeback in today’s children, partly due to them staying indoors more, as well as our fear [home.bt.com]

  Some patients stop taking calcium + vitamin D supplements due to fears about side effects including cardiovasular problems. [nos.org.uk]

  A fear of skin cancer and premature aging has driven many of us indoors, and made us smear on a thick layer of sunscreen whenever we are exposed to the sun. [yourcareeverywhere.com]

  However, due to fear of developing skin cancer most people avoid the sun exposure. To prevent vitamin D deficiency, one should spend 15 to 20 minutes daily in the sunshine with 40% of the skin surface exposed. [ncbi.nlm.nih.gov]

• Kidney Failure

  Immune system degeneration, neurological system disorders, cancer, arthritis, diabetes, multiple sclerosis, obesity, cardiovascular disease, kidney failure, and even reproductive system disorders, the list goes on and on. [geoengineeringwatch.org]

  failures, psoriasis and hypertension. [english.alarabiya.net]

  Because the calcium level is high, calcium may be deposited throughout the body, particularly in the kidneys, blood vessels, lungs, and heart. The kidneys may be permanently damaged and malfunction, resulting in kidney failure. [merckmanuals.com]

• Headache

  We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. [ncbi.nlm.nih.gov]

• Tingling

  Signs and symptoms of vitamin B6 deficiency include: Peripheral neuropathy with tingling, numbness, and pain in the hands and feet Anemia Seizures Depression Confusion Weakened immune system It can lead to a pellagra-like syndrome, with seborrheic dermatitis [medicalnewstoday.com]

• Lethargy

  Sign 2: Consistent Low Mood There's strong evidence linking low vitamin D levels with seasonal affective disorder, a mood disorder that affects people during cold and dark seasons, and produces despondency, lethargy and anxiety. [bustle.com]

  Subtle manifestations of vitamin D deficiency in childhood may occur before the actual bone signs, and include: lethargy irritability growth failure hypocalcemic seizures frequent respiratory symptoms Rickets may manifest in one of two ways: Symptomatic [news-medical.net]

Serum levels of 25(OH) D less than 15 or 20 ng/mL are defined as vitamin D deficiency. Whereas, levels below 30mg/mL are considered to be insufficient levels of vitamin D. When the serum level of 25(OH) D is above 30ng/mL, then maximum intestinal absorption of calcium occurs. On the other hand, when the levels begin to fall below 30ng/mL, then the levels of parathyroid hormone get elevated. This is considered to be another important marker for vitamin D deficiency [8]. It indicates an inverse relationship between parathyroid hormone and 25(OH) D. Measuring the serum 25(OH) D levels is the best method to determine vitamin D deficiency.

• Calcium Decreased

  Vitamin D supplementation combined with calcium decreased body sway and falls in a German study [ 5 ] and decreased hip as well as other non-vertebral fractures in French nursing home residents [ 9 ], whereas the results in more healthy elderly, living [doi.org]

Vitamin D deficiency is treated through administration of its supplements. The dosage schedule depends on the age of the individual, and extent of deficiency that has set in. A daily maintenance dose of vitamin D for children and adults is given to be about 600 – 2000 IU daily. For the deficient population, doses higher than the recommended limits are suggested to be taken on weekly basis with additional extra allowance to meet daily requirements.

It is necessary that the 25(OH) D levels are checked post supplementation program. This is required to know whether the levels have reached the normal levels or not. If the levels continue to remain low, then the method of UVB light therapy is used for improving the vitamin D status [9].

Timely initiation of treatment is necessary to prevent occurrence of hip and nonvertebral fractures. Individuals should be put on supplements of vitamin D, when the first signs of deficiency are noticed. Prolonged deficiency of vitamin D can cause onset of severe and debilitating conditions, such as fractures, rickets and osteoporosis. Several studies have also demonstrated a relation between low levels of circulating vitamin D, and increase risk of developing, diabetes mellitus, cardiovascular disease and cancer [6].

Vitamin D deficiency can occur due to the following factors:

• Lack of exposure to sunlight: Vitamin D is synthesized in the skin when exposed to sunlight. Individuals who stay indoors, or children who do not indulge in outdoor games, may develop vitamin D deficiency [2].
• Malabsorption: Individuals with malabsorption syndromes, such as celiac disease, cystic fibrosis, and short bowel syndrome, or those who have undergone resection of small intestine also develop vitamin D deficiency.
• Insufficient amounts of vitamin D in breast milk: Human breast milk does not contain adequate amounts of vitamin D. Therefore, infants who are exclusively breast fed are at risk of developing deficiency of vitamin D.
• Medications and drugs: Certain types of medications such as rifampin, dilantin and phenobarbital, are known to interfere with absorption of vitamin D causing its deficiency.

Vitamin D deficiency is a common phenomenon for the elderly population and those who are hospitalized. It has been estimated that in the US, about 60% of nursing residents and 57% of patients who were hospitalized developed vitamin D deficiency [3].

Seasonal variations also have an impact on the vitamin D status of individuals. A study carried out on healthy individuals of Boston revealed that, at the end of winter season, the individuals under study had insufficient levels of vitamin D [4].

Vitamin D primarily exists in 2 different forms, D2 known as ergocalciferol and D3 known as cholecalciferol. The D3 form is synthesized when the body is exposed to sunlight. Some dietary sources such as fish oils and salted fish also contain vitamin D3. Vitamin D is important for optimal functioning of various body organs. However, its most vital functioning is to promote the absorption of calcium and phosphate from the intestine, thereby maintaining optimal bone health. Therefore, deficiency of vitamin D causes poor bone health predisposing individuals to develop several bone disorders [5].

In order to avoid vitamin D deficiency from setting in, it is required that individuals get adequate exposure to sun. Children should be encouraged to indulge more in outdoor games. Infants who are exclusively breastfed should be started on vitamin D supplements after 2 months; this is so because breast milk does not contain adequate amounts of vitamin D. In addition, pregnant women should also be given vitamin D supplements, to prevent onset of its deficiency in the woman and the fetus. Elderly population who do not get enough sun exposure should also take daily of 10 micrograms of vitamin D [10].

Vitamin D deficiency is characterized by insufficient levels of vitamin D in body that can cause several debilitating conditions. Lack of intake, exposure to sunlight and, or, malabsorption can cause deficiency of vitamin D to set in. Vitamin D is vital for calcium and phosphorus homeostasis, as well as is important for maintaining skeletal health. Most often signs of mild vitamin D deficiency do not show up easily. However, in cases of severe deficiency, affected individuals often end up contracting bone diseases such as rickets and osteomalacia [1].

Definition

Vitamin D deficiency occurs due to lack of intake, sun exposure, or certain malabsorption syndrome. Infants who are only breast fed are also susceptible to develop deficiency of vitamin D.

Cause

Individuals who stay indoors, such as hospitalized patients, or nursing residents, do not get sufficient sun exposure. Lack of sun exposure can cause vitamin D deficiency to set in. In addition, malabsorption syndromes, such as celiac disease, cystic fibrosis and short bowel syndrome, can also increase the risk of developing vitamin D deficiency.

Symptoms

Symptoms of vitamin D deficiency in infants include delayed crawling and walking. Affected children prefer to sit rather than walk, and in severe cases can develop rickets. In adults, vitamin D deficiency manifests as development of osteomalacia.

Diagnosis

Serum level of 25(OH) D is assessed to diagnose vitamin D deficiency. Levels low than 15 or 20ng/mL confirms vitamin D deficiency.

Treatment

Treatment involves giving vitamin D supplements to the affected individuals. In case, when supplements do not work, then UVB light therapy can be considered.

1. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. Dec 2003;78(12):1457-9.
2. Gloth FM 3rd, Gundberg CM, Hollis BW, et al. Vitamin D deficiency in homebound elderly persons. JAMA 1995; 274:1683.
3. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. Mar 19 1998;338(12):777-83
4. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med 2002; 112:659
5. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. Dec 3 1992;327(23):1637-42.
6. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. Mar 2004;79(3):362-71.
7. Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr 2004; 80:1697S.
8. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-43.
9. Lagunova Z, Porojnicu AC, Aksnes L, et al. Effect of vitamin D supplementation and ultraviolet B exposure on serum 25-hydroxyvitamin D concentrations in healthy volunteers: a randomized, crossover clinical trial. Br J Dermatol 2013; 169:434.
10. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. Jun 6 2011