Vitamin D deficiency

Last reviewed: 7 Sep 2022
Last updated: 21 Aug 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • bowing of the legs
  • widening of the ends of the long bones
  • delayed tooth eruption and early dental caries
  • chest deformity
  • throbbing, aching bone discomfort and/or irritability
  • head sweating
  • localised or generalised bone tenderness
  • proximal muscle weakness
  • rachitic rosary
  • frontal bossing
  • waddling gait
More key diagnostic factors

Other diagnostic factors

  • failure to thrive
  • delayed achievement of motor milestones
  • fatigue and malaise
  • symptoms of hypocalcaemia
Other diagnostic factors

Risk factors

  • inadequate sunlight exposure
  • increased skin pigmentation
  • age >50 years
  • inadequate dietary and supplemental vitamin D intake
  • malabsorption
  • obesity
  • medication use
  • genetic mutations
  • tumour
  • chronic kidney disease
  • granulomatous disorders
  • primary hyperparathyroidism
  • hyperthyroidism
More risk factors

Diagnostic investigations

1st investigations to order

  • serum 25-hydroxyvitamin D
  • serum alkaline phosphatase
  • serum calcium
  • fasting serum phosphate
  • plain-film radiographs of knees and wrists
More 1st investigations to order

Investigations to consider

  • intact PTH
  • serum 1,25-dihydroxyvitamin D
  • bone density (DEXA) scan
More investigations to consider

Treatment algorithm

ACUTE

insufficiency

deficiency

Contributors

Authors

Michael F. Holick, PhD, MD

Director Bone Healthcare Clinic

Director Ehlers-Danlos Clinical Research Programme

Professor of Medicine, Physiology, and Biophysics

Departments of Medicine, Physiology, and Biophysics

Section of Endocrinology, Diabetes, and Nutrition

Vitamin D, Skin, and Bone Research Laboratory

Boston University School of Medicine

Boston

MA

Disclosures

MFH is a consultant for Quest Diagnostics and a speaker for Abbott. He also chaired the Endocrine Society’s practice guidelines on vitamin D. MFH is an author of references cited in this topic.

Peer reviewers

Vin Tangpricha, PhD, MD

Professor of Medicine

Division of Endocrinology

Metabolism and Lipids

Emory University School of Medicine

Atlanta

GA

Disclosures

VT is an author of references cited in this topic.

Stefan Pilz, MD

General Practitioner

Resident at the Department of Internal Medicine

Division of Endocrinology and Nuclear Medicine

Medical University of Graz

Graz

Austria

Disclosures

SP is an author of references cited in this topic.

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