What are the symptoms and treatment of Vitamin D (Vit D) deficiency?

Symptoms and Treatment of Vitamin D Deficiency

Vitamin D deficiency commonly presents with muscle pain, proximal muscle weakness, bone pain, and fatigue, and should be treated with appropriate vitamin D supplementation based on deficiency severity. 1

Symptoms of Vitamin D Deficiency

Vitamin D deficiency can affect people of all ages and presents with various symptoms:

Common Clinical Manifestations:

• Symmetric low back pain
• Proximal muscle weakness
• Muscle aches and pain
• Throbbing bone pain (especially when pressure is applied over sternum or tibia)
• Fatigue and general tiredness
• Difficulty walking and waddling gait in severe cases 1, 2
• Unexplained anemia 3

Severe Deficiency Symptoms:

• Osteomalacia in adults (softening of bones)
• Deep bone pain
• Reduced bone mineralization
• Low-energy fractures 4
• Depression and impaired cognitive function 5

Diagnosis

Diagnosis of vitamin D deficiency requires laboratory testing:

• Serum 25-hydroxyvitamin D [25(OH)D] is the appropriate test to diagnose vitamin D status 1
• Deficiency is defined as serum 25(OH)D level <20 ng/mL (50 nmol/L)
• Insufficiency is defined as serum 25(OH)D level of 20-30 ng/mL (50-75 nmol/L) 1

Screening based solely on other markers like alkaline phosphatase and parathyroid hormone (PTH) will be incomplete 4.

Treatment Approach

For Vitamin D Deficiency:

1. Initial Treatment for Deficiency:

   • Oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks 1
   • For severe cases: Consider parenteral administration (repeated injections of 300,000 IU 2-3 times with monthly intervals) 4

2. Maintenance Therapy:

   • After normalization: Cholecalciferol (vitamin D3) at 800-1,000 IU per day from dietary and supplemental sources 1
   • Combined with calcium supplementation (1g daily) 4

3. Treatment Target:

   • Aim to achieve serum 25(OH)D values in the range of 50-100 nmol/L (20-40 ng/mL) 4

Special Populations:

• Bariatric Surgery Patients:

  • May require higher maintenance doses due to malabsorption 3
  • Check adherence with recommended supplements if deficiency persists
  • Consider referral to specialist if deficiency doesn't respond to standard treatment

• HIV-Infected Patients:

  • Evaluate for vitamin D deficiency in those with risk factors
  • Exclude osteomalacia before initiating bisphosphonates 3

Prevention

• Infants and children: At least 400 IU per day from diet and supplements 1
• Adults: 700-800 IU per day reduces fracture and fall rates 1
• Higher-risk groups requiring routine supplementation:
  • Pregnant and breastfeeding women
  • Infants and young children aged 6 months to 5 years
  • Adults over 65 years
  • People with limited sun exposure
  • Those with darker skin pigmentation 5
  • Those wearing concealing religious garments 2

Risk Factors for Vitamin D Deficiency

• Inadequate sun exposure (northern latitudes, winter season, sun avoidance) 3, 6
• Obesity (vitamin D sequestration in adipose tissue) 3
• Darker skin pigmentation 3
• Malabsorption syndromes
• Advanced age 5
• Institutionalization 2
• Wearing concealing clothing 2

Clinical Pitfalls to Avoid

1. Don't rely solely on symptoms for diagnosis - Laboratory confirmation with 25(OH)D levels is essential

2. Don't overlook vitamin D deficiency in patients with unexplained anemia or fatigue - These may be presenting symptoms 3

3. Don't miss secondary causes - Always check for underlying conditions like malabsorption, medications affecting vitamin D metabolism, or inadequate sun exposure

4. Don't forget calcium supplementation - Combined calcium and vitamin D supplementation is more effective than vitamin D alone for bone health 4

5. Don't overlook vitamin D deficiency in patients with darker skin - They have higher prevalence of deficiency despite potentially lower fracture risk 3