clinical features of vitamin D deficiency/insufficiency in adults

Last edited 09/2018

Features of vitamin D deficiency in adults

• associated features with primary vitamin D deficiency include:
• extensive covering with clothing, failure to spend time outdoors or the use of anti-UVB sunscreens (resulting in decreased skin synthesis of vitamin D)
• in adults aged over 65 years, an inadequate diet, reduced gut absorption and reduced mobility increase that risk, particularly those in residential care
• clinical features in adults include:
• vitamin D insufficiency can be asymptomatic or may present with the insidious onset of non-specific musculoskeletal aches
• the majority of patients with vitamin D deficiency who present clinically do so because of muscle weakness, or muscle aches and pains
• there may be marked muscle weakness - usually most noticeable in the quadriceps and glutei (this can result in difficulty in rising from a chair and in a waddling gait)
• more diffuse muscular aches and muscle weakness (including in the limbs and back) are also common and may be labelled as “fibromyalgia” or as a somatisation of depression
• may also be localised or generalised bone pain, local bone tenderness and, rarely, swelling and redness at pseudofracture sites (Looser's zones on X-ray); may also be fractures
• increased risk of falls and impaired physical function
• however, there may be no clinical features, even in those with proven defective mineralisation of bone, or osteomalacia, on bone biopsy
• if osteoporosis is present then vitamin D insufficiency further amplifies bone loss and this may increase fracture risk (1,2,3)
• secondary vitamin D insufficiency, requiring prophylactic supplementation, can occur with fat malabsorption (e.g. due to coeliac disease, pancreatic insufficiency); gastrointestinal bypass surgery; gastrectomy; parenteral nutrition; or medication (e.g. carbamazepine, phenytoin). Hepatic disorders can result in impaired vitamin D hydroxylation and renal failure impairs vitamin D activation

Reference:

1. Bordelon P, Ghetu MV, Langan RC. Recognition and management of vitamin D deficiency. Am Fam Physician. 2009;80(8):841-6.   
2. Drug and Therapeutics Bulletin 2006;44 (4);25-9.
3. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010;340:b5664.