Overview

Vitamin D deficiency means the body does not have enough vitamin D to keep bones and muscles healthy. The skin makes vitamin D in sunlight, and small amounts come from food. Low vitamin D is common in Kuwait and the Gulf despite strong sunshine, because many people spend most of the day indoors, avoid the heat, wear covering clothing, or have darker skin, which makes less vitamin D from the same amount of sun.

The blood level is measured as 25-hydroxyvitamin D. Many labs and doctors use these cutoffs: below 20 ng/mL (50 nmol/L) is deficiency, and below 12 ng/mL (30 nmol/L) is severe deficiency. The 2024 Endocrine Society guideline does not set one ideal target level, so a doctor reads the result alongside symptoms and health history.

Symptoms

• Often no symptoms, especially when the deficiency is mild
• Tiredness and low energy
• Bone pain, often in the lower back, hips, or legs
• Muscle aches, weakness, or cramps
• Difficulty climbing stairs or rising from a chair
• In children: slow growth, late walking, or bowed legs
• Seek prompt care for a broken bone after a minor fall, muscle spasms, or tingling around the mouth or fingers

Causes & Risk Factors

• Little direct sunlight due to indoor work, heat, and air-conditioned living
• Clothing that covers most of the skin
• Darker skin
• Obesity and older age
• Conditions that reduce absorption, such as celiac disease, inflammatory bowel disease, or weight-loss surgery
• Kidney or liver disease
• Some medicines, such as certain anti-seizure drugs

Complications

• Soft, weak bones in adults (osteomalacia)
• Rickets in children
• Thinning bones (osteoporosis) and a higher risk of fractures
• Falls in older adults due to muscle weakness
• Low blood calcium in severe cases

Diagnosis

A simple blood test for 25-hydroxyvitamin D shows the vitamin D level. The 2024 Endocrine Society guideline advises against routine testing in healthy adults under 75, because the result rarely changes advice for them. Testing is reasonable for people with symptoms, osteoporosis, conditions that affect absorption, kidney or liver disease, or medicines that lower vitamin D. A doctor may also check calcium, phosphate, and kidney function.

Treatment

• Vitamin D supplements, usually vitamin D3, at a dose set by a doctor
• A higher dose for a short time when deficiency is confirmed, then a lower daily dose
• Enough calcium from food, or supplements when intake is low
• Treating any underlying cause, such as a digestive condition
• Repeat testing only when a doctor needs it to guide treatment
• No very high doses without medical advice, since too much vitamin D can raise calcium to harmful levels

Prevention

• Safe sun exposure on the face and arms when the weather allows, without sunburn
• Foods with vitamin D, such as salmon, sardines, egg yolks, and fortified milk
• A daily supplement for groups named in the 2024 guideline: children and teens, pregnant women, adults 75 and older, and adults with prediabetes, after asking a doctor
• Regular physical activity, outdoors when the weather is mild
• A healthy body weight

The Internal Medicine and Laboratory departments at AlHayat Medical Center assess, test for, and treat vitamin D deficiency.

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