Vitamin D is essential for musculoskeletal health as it promotes calcium absorption from the bowel, enables mineralisation of newly formed osteoid tissue in bone and plays an important role in muscle function. The main manifestation of vitamin D deficiency is osteomalacia in adults and rickets in children. The main symptoms of osteomalacia include proximal muscle weakness, persistent muscle pain and waddling gait. Less severe vitamin D deficiency, termed vitamin D insufficiency, may lead to secondary hyperparathyroidism, bone loss, muscle weakness, falls and fragility fractures in older people.
Previously, the lack of national guidance on the indications for vitamin D measurements, on the interpretation of the results and on the correction of vitamin D deficiency has resulted in confusion among patients and health-care professionals and in the proliferation of conflicting guidelines and inconsistent practice across the UK. As a result, NHS Highland has developed this guideline on the management of vitamin D deficiency in adult patients, based on:
- National guidance from the National Osteoporosis Society (UK)
- Endocrine Society’s Clinical Guidelines
- Royal College of Paediatrics and Child Health – Guide for Vitamin D in Childhood, October 2013.
- Tangpricha V et al; Cystic Fibrosis Foundation Vitamin D Evidence-Based Review Committee. An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis: evidence-based recommendations from the Cystic Fibrosis Foundation. Journal of Clinical Endocrinology & Metabolism. 97(4):1082-93, 2012.
This guidance does not apply to the management of patients at risk of vitamin D deficiency or with osteoporosis. Population groups at higher risk of having a low vitamin D status include:
- All pregnant and breastfeeding women, particularly teenagers and young women
- Infants and children under 5 years
- People over 65 People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
- People who have darker skin, for example, people of African, African–Caribbean and South Asian origin.