Indian Journal of Endocrinolody and Metabolism 2014, Vol 18, Issue 7, Page : 9-16 DOI: 10.4103/2230-8210.145043
Ashraf T Soliman1, Vincenzo De Sanctis2, Rania Elalaily3, Said Bedair4, Islam Kassem5
1 Department of Pediatrics, University of Alexandria, Alexandria, Egypt
2 Pediatric and Adolescent Outpatients Clinic, Quisisana Hospital, Ferrara, Italy
3 Department of Primary Health Care, AbuNakhla Hospital, Doha, Qatar
4 Department of Radiology, AlKhor Hospital, Hamad Medical Center, Doha, Qatar
5 Department of Faciomaxillay Surgery, University of Alexandria, Alexandria, Egypt
The prevalence of severe vitamin D deficiency (VDD) in adolescents is variable but considerably high in many countries, especially in Middle-east and Southeast Asia.
Different factors attribute to this deficiency including
- lack of sunlight exposure due to cultural dress codes and veiling or due to pigmented skin, and
- less time spent outdoors, because of hot weather, and
- lower vitamin D intake.
A potent adaptation process significantly modifies the clinical presentation and therefore clinical presentations may be subtle and go unnoticed, thus making true prevalence studies difficult. Adolescents with severe VDD may present with vague manifestations including
- pain in weight-bearing joints, back, thighs and/or calves,
- difficulty in walking and/or climbing stairs, or
- running and
- muscle cramps.
Adaptation includes increased parathormone (PTH) and deceased insulin-like growth factor-I (IGF-I) secretion. PTH enhances the tubular reabsorption of Ca and stimulates the kidneys to produce 1, 25-(OH) 2D3 that increases intestinal calcium absorption and dissolves the mineralized collagen matrix in bone, causing osteopenia and osteoporosis to provide enough Ca to prevent hypocalcaemia. Decreased insulin like growth factor-I (IGF-I) delays bone growth to economize calcium consumption. Radiological changes are not uncommon and include osteoporosis/osteopenia affecting long bones as well as vertebrae and ribs, bone cysts, decalcification of the metaphysis of the long bones and pseudo fractures. In severe cases pathological fractures and deformities may occur. Vitamin D treatment of adolescents with VDD differs considerably in different studies and proved to be effective in treating all clinical, biochemical, and radiological manifestations. Different treatment regiments for VDD have been discussed and presented in this mini-review for practical use. Adequate vitamin D replacement after treating VDD, improving calcium intake (milk and dairy products), encouraging adequate exposure to the sun and possible enrichment of the stable food with vitamin D in areas with high prevalence of VDD are important measures to prevent the harmful consequences of VDD.
Download the PDF from VitaminDWiki.
- Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014
- Symptoms of vitamin D deficiency vary with the age of the child – Feb 2013
- Half of children with chronic illness had low levels of vitamin D – April 2013
- Overview of Rickets and Vitamin D
- Infant-Child category listing with associated searches
- 3X more kids were vitamin D deficient when entering UK hospitals than 4 years before – Oct 2014
- Overview Vitamin D3 not D2 should NOT use D2, even as a loading dose
- Overview Loading of vitamin D contains the following
If a person is or is suspected to be, very vitamin D deficient a loading dose is typically given
- Loading = repletion = quick replacement = Stoss = megadose
- Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
- = 2.5 to 25 milligrams
- The size of the loading dose is a function of body weight - see below
- Unfortunately, some doctors persist in using Vitamin D2 instead of D3
- Loading may be done as quickly as a single day, to as slowly as 3 months.
- It appears that spreading the loading dose over 4+ days is a good compromise if speed is not essential
- Loading is typically oral, but sometimes by injection (I.M,)
- Loading dose is ~3X faster if done topically or swished inside of the mouth
- Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
- The loading dose persists in the body up to 3 months
- The loading dose should be followed up with continuing maintenance
- Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
- it appears prudent to test with a small amount of vitamin D before giving a loading dose
- The causes of a mild allergic reaction appear to be: (in order of occurrence)
- 1) lack of magnesium - which can be easily added
- 2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
- 3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )