Vitamin D Deficiency including Osteomalacia and Rickets

[Night_Hawk]

Vitamin D is important for good health, growth and strong bones.
A lack of vitamin D is very common. Vitamin D is mostly made in the skin by exposure to sunlight.
Most foods contain very little vitamin D naturally, though some are fortified (enriched) with added vitamin D.
A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains.
A more severe lack can cause serious problems such as rickets (in children) and osteomalacia (in adults), described below.

Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely.
These include all pregnant and breastfeeding women, all infants (babies) and young children aged 6 months to 5 years, people aged 65 and over, and people who are not exposed to much sun.
A doctor may also recommend routine supplements for certain people with darker skin, and for people with certain gut, liver or kidney diseases.


[h=2]What is vitamin D?[/h]
Vitamin D is a vitamin that is needed for good health.
Unlike other vitamins, we do not need to get vitamin D from food.
A main source of vitamin D is made by our own bodies. It is made in the skin by the action of sunlight. This is a good thing because most foods contain no or very little vitamin D naturally. Foods that contain vitamin D include:

• Oily fish (such as sardines, pilchards, herring, trout, tuna, salmon and mackerel).
• Fortified foods (this means they have vitamin D added to them) such as margarine, some cereals, infant formula milk.

The best dietary source of vitamin D is oily fish and cod liver oil. There is little or no vitamin D in UK milk and dairy products. Only infant formula milk and margarine have statutory vitamin D supplementation in the UK. Egg yolk, liver, and wild mushrooms contain only small quantities of vitamin D.
Vitamin D and sunlight
Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D. For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK.
However, for people with darker skin and the elderly, the amount of time needed exposed to sunlight to make enough vitamin D can be much more than this. Note: it is not the same as sunbathing; the skin simply needs to be exposed to sunlight. But, the sunlight has to fall directly on to bare skin (through a window is not enough).

For six months of the year (October to April), much of western Europe (including 90% of the UK) lies too far north to have enough UVB rays in sunlight necessary to make vitamin D in the skin. So, many people in the UK are at risk of not getting enough vitamin D unless they get it in their diet.

Note: too much exposure to the sun's rays can be damaging. Sunburn should be avoided at all costs (mainly because it can increase your risk of skin cancer).



[h=2]Why do we need vitamin D?[/h] A main action of vitamin D is to help calcium and phosphorus in our diet to be absorbed from the gut. Calcium and phosphorus are needed to keep bones healthy and strong. So, vitamin D is really important for strong and healthy bones. In addition, vitamin D seems to be important for muscles and general health. There is also some evidence that vitamin D may also help to prevent other diseases such as cancer, diabetes and heart disease.
[h=2]Who gets vitamin D deficiency?[/h] Vitamin D deficiency means that there is not enough vitamin D in your body. Broadly speaking, this can occur in three situations:

• The body has an increased need for vitamin D.
• The body is unable to make enough vitamin D.
• Not enough vitamin D is being taken in the diet.

http://www.patient.co.uk/health/vitamin-d-deficiency-including-osteomalacia-and-rickets-leaflet

 

[Night_Hawk]

[h=2]How is vitamin D deficiency diagnosed?
[/h] It may be suspected from your medical history, symptoms, or lifestyle. A simple blood test for vitamin D level can make the diagnosis. Blood tests for calcium and phosphate levels and liver function may also show changes linked to a low level of vitamin D. Sometimes, a wrist X-ray is done for a child. This can assess how severe the problem is by looking for changes in the wrist bones.

 

[Night_Hawk]

[h=2]What is the treatment for vitamin D deficiency?
[/h] The treatment is to take vitamin D supplements. This is a form of vitamin D called ergocalciferol or calciferol. Vitamin D can be given as an injection or as a medicine (liquid or tablets). Your doctor will discuss the dose, and best treatment schedule, depending on your situation, age, severity of the deficiency, etc. Briefly, one of the following may be advised
[h=3]Injection[/h] A single small injection of vitamin D will last for about six months. This is a very effective and convenient treatment. It is useful for people who do not like taking medicines by mouth, or who are likely to forget to take their tablets.
[h=3]High-dose tablets or liquids[/h] There are different strengths available and a dose may be taken either daily, weekly or monthly. This will depend on your situation and on which particular treatment guideline your doctor is using. Always check with your doctor that you understand the instructions - with high doses of vitamin D it is important to take the medicine correctly. The advantage of the higher-dose treatment is that the deficiency improves quickly - important in growing children.
[h=3]Standard-dose tablets, powders or liquids[/h] These are taken every day for about 12 months so that the body can catch up on the missing vitamin D. This is a rather slow method of replacing vitamin D, but is suitable if the deficiency is mild, or for prevention.
[h=3]Maintenance therapy after deficiency has been treated[/h] After vitamin D deficiency has been treated, the body's stores of vitamin D have been replenished. After this, maintenance treatment is often needed long-term, to prevent further deficiency in the future. This is because it is unlikely that any risk factor for vitamin D deficiency in the first place will have completely resolved. The dose needed for maintenance may be lower than that needed to treat the deficiency.
http://www.patient.co.uk/health/vitamin-d-deficiency-including-osteomalacia-and-rickets-leaflet

 

[hrbhatti]

Here in New Zealand, Doctors are prescribing separate Vit D to patients. Around 50000iu tablet to be taken every month

 

[Night_Hawk]

[h=2]Preventing vitamin D deficiency
[/h] Various groups of people (detailed earlier) are prone to develop vitamin D deficiency. Therefore, certain people are advised to take vitamin D supplements routinely. In February 2012 the Chief Medical Officers for the United Kingdom issued the following recommendations:

• All pregnant and breast-feeding women should take a daily supplement containing 10 micrograms of vitamin D.
• All infants (babies) and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breast-fed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.
• People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D.

In addition a doctor may advise routine vitamin D supplements for people with certain gut, kidney or liver diseases, and people prescribed certain medicines, and to certain people with darker skin.
You can buy vitamin D supplements at pharmacies. They are also available on prescription to certain groups of people. Also, women and children from families who are eligible for the Government’s Healthy Start scheme can also get free vitamin supplements which include vitamin D.
If you are unsure as to whether you should be taking a regular supplement of vitamin D, or the appropriate dose, then your doctor, pharmacist, health visitor or midwife can advise.

 

[Night_Hawk]

[h=2]Cautions when taking vitamin D supplements
[/h] Care is needed with vitamin D supplements in certain situations:

• If you are taking certain other medicines: digoxin (for an irregular heartbeat - atrial fibrillation) or thiazide diuretics such as bendroflumethiazide (commonly used to treat high blood pressure). In this situation, avoid high doses of vitamin D, and digoxin will need monitoring more closely.
• If you have other medical conditions: kidney stones, some types of kidney disease, liver disease or hormonal disease. Specialist advice may be needed.
• Vitamin D should not be taken by people who have high calcium levels or certain types of cancer.
• You may need more than the usual dose if taking certain medicines which interfere with vitamin D. These include: carbamazepine, phenytoin, primidone, barbiturates and some medicines for the treatment of HIV infection.

Multivitamins are not suitable for long-term high-dose treatment because the vitamin A they also contain can be harmful in large amounts.
[h=2]Are there any side-effects from vitamin D supplements?[/h] It is very unusual to get side effects from vitamin D if taken in the prescribed dose. However, very high doses can raise calcium levels in the blood. This would cause symptoms such as thirst, passing a lot of urine, nausea or vomiting, dizziness and headaches. If you have these symptoms, you should see your GP promptly, so that your calcium level can be checked with a blood test. Some guidelines advise that people taking high vitamin D doses should have their calcium levels checked during the first few weeks. In practice, this is not usually done unless you develop symptoms of a high blood calcium level.
[h=2]What is the prognosis (outlook)?[/h] The outlook is usually excellent. Both the vitamin levels and the symptoms generally respond well to treatment. However, it can take time (months) for bones to recover and symptoms such as pain to get better or improve.

The complications of severe deficiency have been mentioned. Rickets can occur in children, and osteomalacia in adults. These diseases affect the strength and appearance of bones, and can lead to permanent bone deformities if untreated or if treatment is delayed.

Vitamin D has been linked to other diseases. In recent years there have been associations with conditions such as cancer, heart disease, infectious disorders, autoimmune disease and diabetes. This does not mean that all people with vitamin D deficiency will get these problems. Nor does it mean that if you have one of these illnesses, a vitamin D deficiency is the cause. In these cases, vitamin D is thought to be just one factor.
[h=2]Follow-up[/h] Most people who are treated for vitamin D deficiency will need to be reviewed a few weeks or months after starting treatment - depending on how severe their symptoms are. A further review after one year is advised.
http://www.patient.co.uk/health/vitamin-d-deficiency-including-osteomalacia-and-rickets-leaflet

 

[Farah Qureshi]

Noone mentions the role of sunshine...its also known as sunshine vitamin..natural source..

 

[Night_Hawk]

[h=2]Further reading & references
[/h]

• Vitamin D clinical guideline, NHS North of Tyne (2011)
• Update on Vitamin D, Scientific Advisory Committee on Nutrition, February 2007
• Tangpricha V et al, Vitamin D Deficiency and Related Disorders, Medscape, Jun 2012
• Schwarz SM et al, Rickets, Medscape, Aug 2011
• Pearce SH, Cheetham TD; Diagnosis and management of vitamin D deficiency. BMJ. 2010 Jan 11;340:b5664. doi: 10.1136/bmj.b5664.
• Holick MF; Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266-81.
• Vitamin D - advice on supplements for at risk groups; Chief Medical Officers of the UK (February 2012)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details

 

[Farah Qureshi]

Some of my patients ask...whether wearing hijab will lead to vitamin d deficiency....

 

[Farah Qureshi]

but its a myth that wearing hijab or niqab causes vit d deficiency in muslim women/...as sunlight do penetrate cloth...

 

[Night_Hawk]

[h=3]Causes of Vitamin D Deficiency
[/h]Vitamin D deficiency can occur for a number of reasons:
You don't consume the recommended levels of the vitamin over time. This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, cheese, fortified milk, and beef liver.
Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure.
You have dark skin. The pigment melanin reduces the skin's ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.
Your kidneys cannot convert vitamin D to its active form. As people age, their kidneys are less able to convert vitamin D to its active form, thus increasing their risk of vitamin D deficiency.
Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn's disease, cystic fibrosis, and celiac disease, can affect your intestine's ability to absorb vitamin D from the food you eat.
You are obese. Vitamin D is extracted from the blood by fat cells, altering its release into the circulation. People with a body mass index of 30 or greater often have low blood levels of vitamin D.

http://www.webmd.com/food-recipes/vitamin-d-deficiency

 

[Night_Hawk]

[h=2]Genes May Play a Role in Vitamin D Deficiency
[/h]Study Shows 4 Gene Variants May Indicate Risk of Having Low Levels of Vitamin D





By Katrina Woznicki
WebMD Health News
Reviewed by Laura J. Martin, MD
WebMD News Archive

June 9, 2010 -- Having too little vitamin D may not be due solely to diet or lack of sunlight, but may be due to your genes.


An international consortium of researchers and doctors has identified four gene variants that may play a role in vitamin D deficiency, a condition which may affect up to half of all healthy adults in the developed world.
It can contribute to poor musculoskeletal health as well as potentially increase the risk of diabetes, cardiovascular disease, and certain types of common cancers.


Knowing who carries the gene variants could help doctors identify who is at risk for vitamin D deficiency and could potentially help reduce the risk of low vitamin D before the problem advances.


Researchers in the SUNLIGHT Consortium (Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits) analyzed data from 15 epidemiologic groups that included nearly 34,000 whites of European ancestry. The team looked at vitamin D concentration levels in the blood as well as genetics. Vitamin D insufficiency was defined as concentrations lower than 75 nmol/L (nanomoles per liter) or 50 nmol/L.
Three common gene variants -- including those involved with cholesterol, vitamin D metabolism, and transporting vitamin D throughout the body -- were associated with vitamin D deficiencies.
The researchers found that the more of these variants an individual had, the greater the risk of having low vitamin D levels.

In fact, individuals who had inherited several of the gene variants and who fell in the highest quartile in the group had a two-and-a-half times increased risk of having a blood vitamin D concentration that was lower than 75 nmol/L when compared with those in the lowest quartile, who had fewer of these gene variants and were at a lower risk.
The findings will be published in The Lancet and were released online early.
Slideshow: Vitamin D, Nutrition's Newest Star

[h=3]Rethinking Treatment Strategy[/h]The researchers say the results may make doctors rethink treatment strategies for improving patients' vitamin D deficiencies. However, they note that they only studied white populations, so it is unclear if these gene variants would be identified in other racial/ethnic groups.



"It's possible that these results could explain why some people respond well to vitamin D supplements and others don't, but that needs to be studied further since we didn't specifically examine response to supplementation," said Thomas Wang, MD, a consortium member and cardiologist at Massachusetts General Hospital in Boston, who co-authored the report. "We also need to investigate how genetic background can modify response to sunlight, whether these associations are seen in other populations, and if these gene variants have an impact in the chronic diseases that appear to be associated with vitamin D deficiency."



In an accompanying editorial published in The Lancet, Roger Bouillon, MD, from the Katholieke Universiteit in Leuven, Belgium, writes: "Today's results only partly explain the wide variability of vitamin D status, and whether these genetically based variations modify the health outcomes in vitamin D deficiency is not known. Therefore the battle against vitamin D deficiency will probably not be modified by these new findings. We need additional studies to explain the mechanisms underlying the pandemic of vitamin D deficiency and, above all, we need a strategy to correct this serious worldwide deficiency."


[h=3]Rethinking Treatment Strategy continued...
[/h]Vitamin D is essential for calcium absorption and bone health; it helps regulate immune function, among other roles. Vitamin D is naturally produced in the skin when you are outside exposed to ultraviolet light from the sun.



Foods that naturally contain vitamin D include fish (particularly salmon and tuna) shrimp, and eggs. Many foods are now fortified with vitamin D, including milk and other dairy products, to boost overall vitamin D intake. Taking a dietary supplement containing vitamin D is also a common way to maintain sufficient vitamin D levels.
http://www.webmd.com/vitamins-and-s.../genes-may-play-arole-in-vitamin-d-deficiency