| Vitamin D deficiency is a nutritional disorder characterized in adults by softening of the bones. In children it manifests as rickets and in adults as osteomalacia.
Vitamin D is an essential nutrient that increases serum calcium levels by facilitating calcium absorption and mobilizing calcium from bone. It also absorbs calcium and phosphorous from the diet. Without vitamin D, these minerals are not absorbed in sufficient quantities. Because calcium and phosphorous are important in forming and maintaining healthy bones and teeth, a deficiency in vitamin D has a profound effect on these structures.
Vitamin D deficiency is a relatively rare condition since it is found in many foods such as fortified milk, margarine, eggs, liver, fish, and fish oils. The body can also make vitamin D when the skin is exposed to sunlight. A lack of vitamin D in the diet is usually only seen in strict vegetarians (vegans) who avoid all animal products including dairy products and eggs. Individuals who avoid exposure to sunlight or wear protective sunscreen may limit the body's ability to make vitamin D, thereby increasing the need to rely on dietary sources. Another cause of vitamin D deficiency is an inability of the body to absorb the vitamin during digestion (malabsorption) or an inability to process the vitamin once it is absorbed. These individuals may experience a deficiency despite a healthy, balanced diet and normal sun exposure. Certain medications used to treat seizures can also cause vitamin D deficiency. The recommended daily allowance (RDA) for vitamin D is 400 IU.Risk: The risk of developing osteomalacia is higher in those who are housebound, institutionalized, elderly, poor, or required by custom to be completely covered when outdoors. Those with dark skin are also at increased risk. Certain diseases of the kidney, pancreas, liver, intestines, or stomach may also increase the risk of vitamin D deficiency. Alcoholics, individuals with eating disorders such as anorexia nervosa or bulimia nervosa, and those who follow diets that severely limit certain foods (fad diets) have a greater risk of developing vitamin D deficiency. Individuals who abuse laxatives are also at increased risk. Incidence and Prevalence: The overall incidence of osteomalacia is 1 in every 1,000 individuals. Pregnancy and breastfeeding increase a woman's need for vitamin D and therefore increase the risk of deficiency. Women are affected slightly more often than men. |
Source: Medical Disability Advisor
| History: Individuals may complain of bone pain particularly around the hips. Muscle weakness is also commonly reported. Some individuals may feel such discomfort and weakness that they choose to remain in bed. Fracturing bones after only minor trauma is also significant history. Individuals may report other symptoms such as tiredness (fatigue), muscle pain, loss of appetite (anorexia), unintentional weight loss, numbness around the mouth, tingling and/or numbness of the extremities (hands, arms, legs, feet), or muscle spasms (tetany) of the hands or feet. Lack of calcium can also cause confusion, memory loss, depression, and hallucinations. Physical exam: The exam may reveal that the individual has lost inches in height due to collapse of the vertebrae. Reported bone pain is usually dull and spread over a large area (diffuse). Muscle weakness may be evident in the muscles close to the affected bone(s). Questioning the individual on dietary habits may reveal a lack of food sources that are typically rich in vitamin D. Further questioning may also reveal that the individual avoids being outdoors or carefully applies sunscreen before leaving the house. Tests: Routine blood tests reveal abnormal levels of calcium and phosphate. An x-ray and/or CT of the bone(s) confirm the diagnosis. In most cases, these tests in combination with symptoms and history is sufficient for a definitive diagnosis, however, in unusual cases, a bone biopsy may be necessary to determine the extent of the mineral loss. |
Source: Medical Disability Advisor
| When vitamin D deficiency is caused by lack of sunlight or poor diet, individuals are given oral vitamin D supplements for up to 4 months. Calcium supplements may also be given.
If the deficiency is due to an underlying condition that prevents absorption or metabolism of vitamin D, successful treatment depends on treatment of the underlying condition. These individuals may require larger doses of vitamin D as well as megadoses of calcium. Depending on the nature of the underlying disease, these supplements may need to be given by injection. Controlled exposure to sunlight or a sunlamp may also be prescribed. Treatment for osteoporosis may also be needed.
All individuals require regular follow-up visits with their doctor to monitor progress. |
Source: Medical Disability Advisor
| Individuals whose deficiency is due to inadequate sunlight or poor diet are usually completely cured after 6 months of vitamin D supplements and/or sunlight exposure. If an underlying condition is causing or contributing to vitamin D deficiency, this disorder must be treated for a successful outcome. If a healthy, well-balanced diet is not maintained, vitamin D deficiency can recur. |
Source: Medical Disability Advisor
| Complications of vitamin D deficiency include bone fractures, infection of the bones (osteomyelitis), kidney (renal) failure, renal tubular acidosis, or seizures. In addition, individuals are often deficient in other vitamins and/or minerals as well as vitamin D, complicating the condition. |
Source: Medical Disability Advisor
| In most cases, work restrictions and accommodations are not necessary. For some individuals, heavy lifting and other strenuous work may need to be discontinued or adjusted. Work schedule flexibility may be required following the diagnosis to accommodate regular examinations at the physician's office. However, if symptoms are severe, individuals may require extended sick leave from work until symptoms begin to subside. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual complained of bone pain (particularly in the hips) or fatigue and paresthesias of fingers or hands?
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Does individual have risk factors for vitamin D deficiency such as inadequate consumption of dairy products (such as vegans, or those with lactose intolerance or those who do not have access to dairy products)?
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Has individual been housebound or lacked exposure to sunlight? Are they taking any medications that could cause the deficiency?
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Was the vitamin deficiency detected with serological testing? If not, was a bone biopsy indicated?
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If the diagnosis was uncertain, were other conditions with similar symptoms such as osteoporosis, Paget's disease of bone, and cancer, ruled out?
Regarding treatment:
- Were vitamin D and/or calcium supplements prescribed? Is individual taking the recommended dose at the recommended times?
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Is individual eating a healthy, balanced diet? Are foods rich in vitamin D being consumed? Would individual benefit from consultation with a nutritionist/dietitian?
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Does individual spend time outdoors or in a sunny window?
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Is individual also being treated for osteoporosis?
Regarding prognosis:
- Based on the underlying cause, what was the expected outcome?
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Is individual a strict vegetarian? Would individual benefit from consultation with a nutritionist/dietitian?
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Does individual have any underlying conditions (malnutrition, pregnancy or epilepsy) that could impact recovery?
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Did individual experience any associated conditions or complications (such as bone fractures, osteomyelitis, renal disorders, or seizures) that could impact recovery and prognosis?
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Source: Medical Disability Advisor
| Beers, Mark H., et al., eds. "Vitamin D Deficiency and Dependency." Merck Manual of Medical Information. 2nd Home Online ed. New York: Pocket Books, 1997. Merck. Merck & Co., Inc. 20 May 2005 <http://www.merck.com/mrkshared/mmanual/section1/chapter3/3d.jsp>. |
Source: Medical Disability Advisor
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