t D deficiency

Presented by :
Asmaa
 Vit D
• Vitamin D is a group of fat-soluble vitamins.
• Vitamin has several important functions
in the body:
• It helps to absorb dietary calcium and phosphorus
from the intestines.
• It suppresses the release of parathyroid hormone, a
hormone that causes bone resorption.
• Vitamin D may have other benefits, such as
improving muscle and immune function.
 Sources of vit D:
• 1. skin source
• 2. nutritional source:
 Vit D deficiency
Vitamin D deficiency is caused by:

• decreased exposure to the sun,

• an inability of the body to absorb vitamin D,
• or a lack of vitamin D in the diet.
• Risk Factors for vit d
deficiency:
• Dark Skin
• Intestinal malabsorption
• Inflammatory Bowel disease
• Gastric bypass
• No sun exposure
• Osteomalacia/Fragility Fractures
• Renal Disease
• Old age
 Symptoms of Vitamin D
deficiency:
• Many people have no symptoms of vitamin D
deficiency until complications are present.
Symptoms may also be mild.
• Symptoms of vitamin D deficiency include:
Bone pain ,
muscle cramps,
weakness and tingling,
loss of height.
difficulty standing up or climbing stairs
Complications of vitamin D
deficiency:
 Complications of vitamin D
deficiency:
• Rickets,
• Osteomalacia,
• and osteoporosis .
• tetany

• other possible complications include:

hypertension,
depression,
cardiovascular disease,
and an increased risk of cancer
 management of vit d
deficiency:
a. diagnosis :
often missed
signs and symptoms develop slowly or are
nonspecific.
normal values in adults :
1. A normal level :25OHD concentration >
30 ng/mL
2. Vitamin D insufficiency 25OHD
concentration =20 to 30 ng/mL
3. Vitamin D deficiency 25OHD level < 20
ng/mL
 Diagnosis may be suspected
based on any of the following:
1.A history
2.Symptoms and signs of rickets, osteomalacia, or
neonatal tetany
3.Blood test of 25(OH)D (D2+D3) levels
the best way to diagnose deficiency
4. Characteristic bone changes seen on x‑ray
5.serum levels of Ca,
alkaline phosphatase, PTH
 treatment of vit D
deficiency:
1. summer day sun

2. artificial UVB radiation

3. human Oral vit D

 Oral vitamin D treatment is more difficult
than treatment with UVB light

why
1. unexpectedly high doses of vitamin D may be
needed to achieve adequate serum 25(OH)D levels
2. the amount of vitamin D needed varies with body
weight, body fat, age, skin colour, season, and
sunning habits.
3. unlike sun exposure, toxicity is possible with oral
supplementation
available forms of vitamin D supplements are :
• ergocalciferol (vitamin D2)
• cholecalciferol (vitamin D3).
Vit D3 is better than vit D2:
1. vitamin D3 is the naturally occurring form
2. ergocalciferol is not human, and its
consumption results in metabolic by-products
not normally found in humans
3. vit D2 is also two- to four-times less effective
than vit D3
• dose of vit d therapy
depends on:
– age
– body weight
– skin colour
– patients with malabsorbtion
syndrome.
Vit d deficiency in the
elderly:
 Causes of vit d deficiency in
the elderly:
1. The production of vitamin D from the
skin decreases with age.
reduced levels of 7-dehydrocholesterol,
2. Housebound elderly people often do not
get adequate exposure to sunlight.
3. Decreased dietary intake, impaired
intestinal absorption, and impaired
hydroxylation in the liver and kidneys
 Consequences of vit d
deficiency in the elderly:
1. high bone turnover, bone loss,
mineralization defects, and hip and
other fractures. Less certain
consequences include myopathy and
falls.
2. osteomalacia:
3. osteoporosis:
4. Cancer
5. cardiovascular diseases:
1. high bone turnover, bone loss,
mineralization defects, and hip and
other fractures. Less certain
consequences include myopathy
and falls.
 2. osteomalacia:
Osteomalacia is the softening of the bones
due to defective bone mineralization.

• Signs and Symptoms:

• Bone weakness and pain
• Muscle weakness
• Easy fracturing
• Hypocalcaemia
• Biochemical findings
The serum calcium is low
Urinary calcium is low
Serum phosphate is low
Serum alkaline phosphatase is high
• Radiological appearances include:
Pseudo fractures, also called Looser’s
zones.
Protrusio acetabuli, a hip joint disorder
• Treatment
 3.osteoporosis:
• is a disease of bones that leads to
an increased risk of fracture. In
osteoporosis the bone mineral
density (BMD) is reduced, bone
microarchitecture is disrupted, and
the amount and variety of proteins in
bone is altered.
 4. cancer
The effect mechanisms :
• regulation of the cell cycle,
• stimulation of differentiation,
• impairment of growth stimuli,
• inhibition of angiogenesis
• and increased apoptosis of malignant
cells.
• The active vitamin D metabolite 1α,25-
dihydroxyvitamin D3 (1,25(OH)2D3,
Calcitriol) is a major regulator of gene
expression
 Common types of cancer
that vit D can suppress:
• 1.Colon Cancer

• 2.Prostate Cancer

• 3.breast cancer
5. Cardiovascular disease.
• Vitamin D receptors have a broad
tissue distribution that includes
vascular smooth muscle,
endothelium, and cardiomyocytes.
• Vitamin D deficiency also alters
hormone levels and immune function,
which can increase the risk of
diabetes, a major contributor to
cardiovascular disease,
 Cvs diseases that may be
caused by low vit D levels:
• Atherosclerosis

• Hypertension and Myocardial

Hypertrophy and infarction
• Congestive Heart Failure