From the Guidelines
Clinical symptoms of low vitamin D (25-hydroxyvitamin D) levels often include bone pain, muscle weakness, and increased risk of fractures. Patients may experience fatigue, depression, impaired wound healing, and hair loss. In children, severe vitamin D deficiency can cause rickets, characterized by soft, weak bones, delayed growth, and skeletal deformities. In adults, prolonged deficiency can lead to osteomalacia, resulting in bone softening and pain. Some individuals may also notice increased susceptibility to infections due to vitamin D's role in immune function. Many people with vitamin D deficiency remain asymptomatic until levels become severely low. The symptoms develop gradually because vitamin D is essential for calcium absorption and bone metabolism, and when levels are insufficient, the body struggles to maintain proper calcium levels, affecting multiple body systems beyond just skeletal health. Muscle weakness occurs because vitamin D is necessary for proper muscle cell function and contractility, while mood changes reflect vitamin D receptors' presence in brain tissue involved in mood regulation 1.
Some key points to consider:
- Vitamin D deficiency can increase the risk for fractures, falls, functional limitations, some types of cancer, diabetes, cardiovascular disease, depression, and death 1.
- The exact threshold that defines vitamin D deficiency is not well-established, and the association between vitamin D status and health outcomes is unclear 1.
- Screening for vitamin D deficiency may misclassify persons with a vitamin D deficiency due to the uncertainty about the cut point for defining deficiency and the variability of available assays 1.
- Treatment with oral vitamin D does not seem to be associated with serious harms, but treatment with increased sun exposure may increase the risk for skin cancer 1.
Overall, while the evidence is not yet conclusive, it is essential to be aware of the potential symptoms and risks associated with vitamin D deficiency and to consult with a healthcare professional for personalized advice on screening and treatment 1.
From the Research
Clinical Symptoms of Low Vitamin D
The clinical symptoms of low vitamin D levels can be diverse and affect various aspects of health. Some common manifestations include:
- Symmetric low back pain
- Proximal muscle weakness
- Muscle aches
- Throbbing bone pain elicited with pressure over the sternum or tibia 2
- Osteopenia
- Osteoporosis
- Osteomalacia, a painful bone disease
- Increased muscle weakness, which worsens the risk of falls and fractures 3, 4
- Tiredness and general aches and pains in cases of mild deficiency 5
- Serious problems such as rickets in children and osteomalacia in adults in cases of severe deficiency 5
- Depression and impaired cognitive function 5
Diagnosis and Treatment
Diagnosis of vitamin D deficiency is typically done by measuring the serum 25-hydroxyvitamin D level. Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L) 2. Treatment may include oral ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) supplements, with the goal of normalizing vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes 2, 3, 4.
Prevention
Prevention of vitamin D deficiency can be achieved through sensible sun exposure and adequate supplementation. The American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements 2. Adults may require higher doses, such as 1000 IU per day of vitamin D3, especially in the absence of sun exposure 4. Certain populations, including pregnant and breastfeeding women, infants, young children, people aged 65 and over, and those with limited sun exposure or certain medical conditions, may be recommended to take vitamin D supplements routinely 5.