Intended for healthcare professionals

Clinical Review

Diagnosis and management of vitamin D deficiency

BMJ 2010; 340 doi: (Published 11 January 2010) Cite this as: BMJ 2010;340:b5664
  1. Simon HS Pearce, professor of endocrinology, honorary consultant physician12,
  2. Tim D Cheetham, senior lecturer in paediatric endocrinology, honorary consultant paediatrician 13
  1. 1Institute of Human Genetics, Newcastle University, International Centre for Life, Newcastle upon Tyne NE1 3BZ
  2. 2Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  3. 3Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  1. Correspondence to: SHS Pearce s.h.s.pearce{at}

    Summary Points

    • Vitamin D insufficiency is common in the UK population

    • Vitamin D deficiency typically presents with bony deformity (rickets) or hypocalcaemia in infancy and childhood, and with musculoskeletal pain and weakness in adults

    • Many other health problems—including cardiovascular disease, type 2 diabetes, several cancers, and autoimmune conditions—have recently been associated with vitamin D insufficiency

    • Risk factors include skin pigmentation, use of sunscreen or concealing clothing, being elderly or institutionalised, obesity, malabsorption, renal and liver disease, and anticonvulsant use

    • Vitamin D status is most reliably determined by assay of serum 25-hydroxyvitamin D (25-OHD)

    • Rickets and osteomalacia should be treated with high strength calciferol (ergocalciferol or colecalciferol) for 8-12 weeks, followed by regular vitamin D supplements

    Rickets in children and osteomalacia in adults are the classic manifestations of profound vitamin D deficiency. In recent years, however, non-musculoskeletal conditions—including cancer, metabolic syndrome, infectious and autoimmune disorders—have also been found to be associated with low vitamin D levels.1 The spectrum of these common disorders is of particular concern because observational studies have demonstrated that vitamin D insufficiency is widespread in many northern regions of the world, including industrialised countries.2 3 The increasing prevalence of disorders linked to vitamin D deficiency is reflected in the several hundred children with rickets treated each year in the UK.4 However, these children represent a small proportion of the individuals with a suboptimal vitamin D status in the UK population.1 3 5

    A recent nationwide survey in the United Kingdom showed that more than 50% of the adult population have insufficient levels of vitamin D and that 16% have severe deficiency during winter and spring.5 The survey also demonstrated a gradient of prevalence across the UK, with highest rates in Scotland, northern England, and Northern Ireland.5 People with pigmented skin are at high risk, …

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