VITAMIN D DEFICIENCY

General Information

DEFINITION--Insufficient intake or absorption of vitamin D, coupled with too little exposure to sunlight. This deficiency causes rickets in children and osteomalacia (softening of the bone) in adults.

BODY PARTS INVOLVED--Total body, but bones are more affected than other tissues.

SEX OR AGE MOST AFFECTED--All ages, but most common in infants and young children up to age 10.

SIGNS & SYMPTOMS

In infants:

• Restlessness.
• Poor sleep habits.
• Profuse sweating.
• Delayed sitting, crawling or walking.
• Delayed closing of the fontanels.
• Poor muscular development, causing a pot belly.
• Bowed legs, "knock knees" and "pigeon breast" after weight-bearing activities begin (standing and walking).

In adults:

• No symptoms until late stages (sometimes).
• Bone pain.
• Muscle weakness.
• Shortening of the vertebral column and flattening of pelvic bones.

CAUSES

Insufficient dietary intake of vitamin D. > Poor absorption of vitamin D, causing poor absorption of calcium and phosphorous necessary for healthy bone. Vitamin D absorption is affected by chronic diseases, such as: pancreatitis; celiac disease; cystic fibrosis; colitis; bile-duct disorders;

liver disorders; kidney disease; or surgery on the stomach or small bowel.

• Inadequate exposure to sunlight. This is especially likely in persons confined to bed or home, or those who work at night and sleep during the day.
• Poor function of the parathyroid glands (sometimes).

RISK INCREASES WITH

• Genetic factors, such as black skin, which decreases the absorption of sunlight.
• Use of anticonvulsant drugs.
• Exposure to polluted air. Smog reduces sunlight penetration.
• Improper diet as a result of poverty, food faddism, bulimia or anorexia nervosa.
• Pregnancy, in which the body needs additional vitamin D.

> Provide vitamin D supplements for yourself and your family--including breast-fed babies--

unless you are sure your diet supplies a satisfactory amount.

• Exercise outdoors in sunlight (in moderation).
• Don't follow fad diets, which may be deficient in many nutrients, including vitamin D.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies of calcium, phosphorous and bone enzyme levels.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.

POSSIBLE COMPLICATIONS

• Spontaneous fractures in softened bones.
• Difficult or impossible vaginal childbirth in women with flattened pelvic bones. Delivery by Cesarean section is usually necessary.

PROBABLE OUTCOME--Usually curable with an adequate diet, vitamin D supplements, and treatment for any underlying disease. Bone malformation cannot be reversed.

How To Treat

GENERAL MEASURES----Sleep on a firm mattress.

MEDICATION--Your doctor may prescribe vitamin D tablets or injections.

ACTIVITY--

• Exercise whenever possible, especially in sunlight. Weight-bearing exercise, such as walking or running, is especially beneficial.
• Avoid excessive bed rest.
• Stoop--don't bend--to lift heavy objects.

DIET--Increase your intake of foods rich in vitamin D--even if you take vitamin D supplements. Dietary sources include: fortified milk; liver; eggs; margarine; green vegetables; cauliflower; tomatoes; cheese.

Call Your Doctor If

• You or your child have symptoms of vitamin D deficiency.
• Your child's symptoms don't improve in 1 month, despite treatment
• Pain or suspected fracture occurs following an injury--even minor injury.