Vitamin D Deficiency Symptoms
Vitamin D deficiency most commonly presents with fatigue, muscle weakness, bone pain, and general body aches—symptoms that are often nonspecific but should prompt laboratory testing when present together. 1
Common Musculoskeletal Manifestations
The most characteristic symptoms involve the musculoskeletal system:
- Muscle-related symptoms include proximal muscle weakness, muscle aches, and generalized fatigue that interferes with daily activities 1, 2
- Bone pain presents as symmetric low back pain, throbbing bone pain (particularly when pressure is applied over the sternum or tibia), and deep bone pain in more severe cases 2, 3
- Gait disturbances often accompany the muscle weakness and can increase fall risk, particularly in elderly patients 3
General Constitutional Symptoms
Beyond musculoskeletal complaints, vitamin D deficiency causes:
- Fatigue and tiredness are among the earliest and most common symptoms, though they are nonspecific 1, 4
- General aches and pains throughout the body that may be dismissed as normal aging or overexertion 4
Severe Deficiency Manifestations
When deficiency becomes severe (25-hydroxyvitamin D < 20 ng/mL), more serious skeletal changes occur:
- Rickets in children presents with visible skeletal deformities and growth abnormalities 1
- Osteomalacia in adults causes reduced bone mineralization, leading to low-energy fractures and persistent bone pain 4, 3
- Secondary hyperparathyroidism may develop, particularly in patients with inflammatory bowel disease 1
High-Risk Populations with Specific Presentations
Certain groups experience unique symptom patterns:
- Bariatric surgery patients may present with unexplained anemia, severe fatigue, and increased fracture risk 1
- Elderly patients often experience the combination of muscle weakness, falls, and fractures as their primary manifestation 3
- Patients with darker skin require more vigilant monitoring as they are at higher risk but may not present differently 4
Important Clinical Caveats
- Mild deficiency may be asymptomatic or cause only subtle tiredness that patients don't report spontaneously 4
- Symptoms are nonspecific, so a high index of suspicion is needed—don't rely on symptoms alone to rule out deficiency 2
- Individual variation exists in how deficiency manifests based on genetics, phenotype, and environmental factors 1
- Laboratory confirmation is mandatory: serum 25-hydroxyvitamin D < 20 ng/mL defines deficiency, and you cannot diagnose based on symptoms or indirect markers like alkaline phosphatase alone 1, 3