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vitamin D deficiency

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Vitamin D and its active metabolite 1,25-dihydroxyvitamin D (1,25(OH)2D) have classical actions on calcium balance and bone metabolism (1)

  • insufficient 1,25(OH)2D leads to inadequate absorption of calcium and phosphate which results in secondary hyperparathyroidism and lack of new bone mineralisation - rickets in children and osteomalacia in adults
  • a consensus statement representing the unified views of a number of organisations (the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society), states that the evidence suggesting that vitamin D might protect against cancer, heart disease, diabetes, multiple sclerosis and other chronic diseases is still inconclusive. Furthermore, there is no standard definition of what constitutes an optimal level of vitamin D (2)

Vitamin D deficiency is common in northern Europe.

  • in the UK, the prevalence of vitamin D deficiency in all adults is around 14.5%, and may be more than 30% in those over 65 years old, and as high as 94% in otherwise healthy south Asian adults
  • it is three times more common in the winter and spring compared to the summer and autumn in the UK (1)
  • prevalence of vitamin D deficiency in commonly encountered clinical patient population are as follows: (3)
    • nursing home or house bound residents (mean age 81 years) - 25-50%
    • elderly ambulatory women aged>80 years                                         - 44%
    • women with osteoporosis aged 70-79 years                                      - 30%
    • patients with hip fractures (mean age 77 years)                                  - 23%
    • African American women  aged 15-49 years                                     - 42%
    • adult hospitalised patients (mean age 62 years)                                  - 57%

Opinions on optimal vitamin D serum concentrations in adults vary.

  • according to the Endocrine Society Task Force guidelines  vitamin D deficiency is defined as a serum 25-hydroxycholecalciferol (25OHD)  <50 nmol/L but advocated that 25OHD concentration should exceed 75 nmol/L, to maximise the effect of vitamin D on calcium, bone and muscle metabolism
  • the UK National Osteoporosis Society recommends the following  vitamin D thresholds for UK practitioners in respect to bone health
    • serum 25OHD < 30 nmol/L is deficient
    • serum 25OHD of 30–50 nmol/L may be inadequate in some people
    • serum 25OHD > 50 nmol/L is sufficient for almost the whole population (4)


  1. Royal College of Obstetricians and Gynaecologists (RCOG) 2014. Vitamin D in Pregnancy. Scientific Impact Paper No. 43
  2. Consensus Vitamin D position statement, (represents the unified views of the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society) - December
  3. Kennel KA, Drake MT, Hurley DL. Vitamin D Deficiency in Adults: When to Test and How to Treat. Mayo Clinic Proceedings. 2010;85(8):752-758
  4. National Osteoporosis Sociaety (NOS) 2018. Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management


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