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
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