Vitamin D deficiency

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 13 Nov 2025

最后更新： 29 May 2025

Vitamin D deficiency is the most common nutritional deficiency worldwide. Definitions regarding optimal serum concentrations vary according to the source used. However, there is broad clinical consensus that serum 25-hydroxyvitamin D concentrations <20 nanograms/mL are suboptimal for human health. Furthermore, many guidelines and experts recommend maintaining a serum 25-hydroxyvitamin D concentration >30 nanograms/mL, particularly in older adults.

Main causes include sun avoidance, increased skin pigmentation, inadequate dietary and supplemental vitamin D intake, malabsorption syndromes, obesity, and use of certain drugs. Acquired and inherited disorders that either reduce or prevent the metabolism of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D also present with biochemical and skeletal abnormalities seen with vitamin D deficiency, but in a more severe form.

Most patients are asymptomatic. Severe prolonged vitamin D deficiency causes decreased growth and rickets in children, and osteomalacia, osteopenia, and osteoporosis in adults.

In addition to the skeletal effects, it is now increasingly recognized that vitamin D deficiency is associated with an increased risk of many chronic diseases, including cancer, autoimmune diseases, type 2 diabetes, heart disease and hypertension, neurocognitive dysfunction, infectious diseases (including respiratory tract infections, tuberculosis, and COVID-19), and schizophrenia. Vitamin D deficiency/insufficiency has been associated with increased risk for morbidity and mortality associated with COVID-19.

Both vitamin D deficiency and vitamin D insufficiency are corrected by giving vitamin D2 or vitamin D3 in treatment doses followed by lifelong maintenance doses. Additional replacement with 1,25-dihydroxyvitamin D or one of its active analogs is necessary for those with disorders of vitamin D metabolism, including patients with chronic kidney disease.

定义

Definitions of optimal serum concentrations of 25-hydroxyvitamin D vary depending on the source, and there is no consensus on the ideal serum concentration for skeletal or extraskeletal health.[1][2]

Vitamin D deficiency may be defined as a serum 25-hydroxyvitamin D concentration <20 nanograms/mL, whereas vitamin D insufficiency may be regarded as a 25-hydroxyvitamin D level between 21 and 29 nanograms/mL.[3] The Endocrine Society in 2024 no longer endorses specific 25-hydroxyvitamin D concentrations to define vitamin D sufficiency, insufficiency, and deficiency.[4]

Vitamin D toxicity is usually seen when serum 25-hydroxyvitamin D concentrations >150 nanograms/mL.[5]

Definitions are further complicated by variability in serum 25-hydroxyvitamin D concentrations across different assay methods. Assay variability remains a significant concern and requires resolution through the widespread adoption of an international standard.[6]

病史和体格检查

关键诊断因素

inadequate sunlight exposure
increased skin pigmentation
age >50 years
history of inadequate dietary and supplemental vitamin D intake
malabsorption
obesity
use of certain drugs
history of chronic kidney disease
history of benign or malignant tumor
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
localized or generalized bone tenderness
proximal muscle weakness
rachitic rosary
frontal bossing
waddling gait

完整详情

其他诊断因素

delayed growth
delayed achievement of motor milestones
fatigue and malaise
symptoms of hypocalcemia

完整详情

危险因素

inadequate sunlight exposure
increased skin pigmentation
age >50 years
inadequate dietary and supplemental vitamin D intake
malabsorption
obesity
use of certain drugs
genetic mutations
history of benign or malignant tumor
chronic kidney disease
granulomatous disorders
primary hyperparathyroidism
hyperthyroidism

完整详情

诊断性检查

首要检查

serum 25-hydroxyvitamin D
serum calcium
fasting serum phosphate
serum alkaline phosphatase

完整详情

需考虑的检查

plain film radiographs of knees and wrists
intact PTH
serum 1,25-dihydroxyvitamin D
bone density (DEXA) scan

完整详情

治疗流程

急症处理

insufficiency

deficiency

撰稿人

作者

Michael F. Holick, PhD, MD

Director Vitamin D, Skin, and Bone Research Laboratory

Director Ehlers-Danlos Clinical Research Program

Professor of Medicine, Physiology, and Biophysics and Molecular Medicine

Departments of Medicine, Physiology, and Biophysics

Section of Endocrinology, Diabetes, Nutrition and Weight Management

Boston University School of Medicine

Boston

利益声明

MFH has a clinical research contract and consultant for Solius Inc., clinical and basic research contract and grant from Carbogen-Amcis, and is a consultant for Faes Farma, Adela, Ontometrics Inc., Eureka program, KBD Sperti Inc., and Biogena Inc. He is a speaker for Pulse Ltd, Abbott Inc., Sanofi Inc., Menarini Inc., PharmaEVO Pvt. Ltd., and a former board member of Bridge to Life. He also chaired the Endocrine Society’s 2011 practice guidelines on vitamin D. MFH is an author of The Vitamin D Solution and The UV Advantage. MFH is an author of references cited in this topic.

同行评议者

Linda Lester, MD, MS

Associate Professor of Medicine

Division of Endocrinology, Diabetes and Clinical Nutrition

School of Medicine

Oregon Health & Science University

Portland

利益声明

LL declares that she has no competing interests.

Stefan Pilz, MD

General Practitioner

Resident at the Department of Internal Medicine

Division of Endocrinology and Nuclear Medicine

Medical University of Graz

Graz

Austria

利益声明

SP is an author of references cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2024 Jul 12;109(8):1907-47.全文摘要

Chanchlani R, Nemer P, Sinha R, et al. An overview of rickets in children. Kidney Int Rep. 2020 Jul;5(7):980-90.全文摘要

US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement. JAMA. 2021 Apr 13;325(14):1436-42.全文摘要

Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Vitamin D deficiency

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

insufficiency

deficiency

撰稿人

作者

Michael F. Holick, PhD, MD

利益声明

同行评议者

Linda Lester, MD, MS

利益声明

Stefan Pilz, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

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