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Vitamin D deficiency results from inadequate dietary intake of preformed vitamin D, malabsorption of vitamin D, or too little exposure to sunlight.
Once a common childhood disease, rickets is now rare in the United States but occasionally appears in breast-fed infants who don’t receive a vitamin D supplement or in infants receiving a formula with a nonfortified milk base. This deficiency may also occur in overcrowded urban areas in which smog limits sunlight penetration. Incidence is highest in black children who, because of their skin color, absorb less sunlight. (Solar ultraviolet rays irradiate 7-dehydrocholesterol, a precursor of vitamin D, to form calciferol.)
Osteomalacia, also uncommon in the United States, is most prevalent in Asia, among young multiparas who eat a cereal diet and have minimal exposure to sunlight. Other causes include:
❑ vitamin D–resistant rickets (refractory rickets, familial hypophosphatemia) from an inherited impairment of renal tubular reabsorption of phosphate (from vitamin D insensitivity)
❑ conditions that lower absorption of fat-soluble vitamin D, such as chronic pancreatitis, celiac disease, Crohn’s disease, cystic fibrosis, gastric or small bowel resections, fistulas, colitis, and biliary obstruction
❑ hepatic or renal disease, which interferes with the formation of hydroxylated calciferol, necessary to initiate the formation of a calcium-binding protein in intestinal absorption sites
❑ malfunctioning parathyroid gland (decreased secretion of parathyroid hormone), which contributes to calcium deficiency (normally, vitamin D controls calcium and phosphorus absorption through the intestine) and interferes with activation of vitamin D in the kidneys.
Source: Professional Guide to Diseases (Eighth Edition), 2005
The term 'prevalence' of Vitamin D deficiency usually refers to the estimated population of people who are managing Vitamin D deficiency at any given time. The term 'incidence' of Vitamin D deficiency refers to the annual diagnosis rate, or the number of new cases of Vitamin D deficiency diagnosed each year. Hence, these two statistics types can differ: a short-lived disease like flu can have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but high prevalence. For more information see about prevalence and incidence statistics.
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