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Aetiology of vitamin D deficiency

Authoring team

Reduced intake of vitamin D:

  • lack of sunlight - deficiency of vitamin D3 - cholecalciferol
  • dietary lack of vitamin D3 - ergocalciferol
  • fat malabsorption - e.g. coeliac disease, pancreatic insufficiency, extrahepatic biliary obstruction

Reduced hepatic production of 25(OH)D3:

  • severe chronic liver disease - interference with synthesis of vitamin D binding protein
  • induction of hepatic P-450 enzymes accelerating rate of degradation e.g. phenytoin, carbamazepine
  • nephrotic syndrome - excess excretion of vitamin D binding protein

Reduced renal production of calcitriol - 1,25(OH)2 D3:

  • deficiency of 1 alpha hydroxylase:
    • hereditary - vitamin D dependent rickets type I
    • chronic renal failure
  • suppression of 1 alpha hydroxylase action:
    • deficiency of PTH - hypoparathyroidism
    • end organ resistance - pseudohyperparathyroidism

Resistance to calcitriol:

  • vitamin D dependent rickets type II

Reference:

  1. Kennel KA, Drake MT, Hurley DL. Vitamin D Deficiency in Adults: When to Test and How to Treat. Mayo Clinic Proceedings. 2010;85(8):752-758

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