Vitamin D deficiency
Also called: low vitamin D, vitamin D insufficiency, hypovitaminosis D, vitamin D ki kami
Vitamin D deficiency means the body does not have enough vitamin D to keep bones and muscles healthy. It often causes no symptoms at first but can lead to bone pain, weak muscles, rickets in children and soft bones in adults. It is common in Pakistan and is easy to treat.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Vitamin D helps the body take in calcium and control calcium and phosphate levels. These minerals keep bones, teeth and muscles strong. Vitamin D also plays a part in how nerves, muscles and the immune system (the body's defence against infection) work. Most of our vitamin D is made in the skin when it is in sunlight. Only a few foods contain it, such as oily fish, egg yolks and red meat.
Deficiency happens when the skin gets too little sunlight, the diet is short of vitamin D, the gut cannot absorb it, or the liver and kidneys cannot change it into its active form. Some medicines also make the body break it down faster. People with darker skin, people who cover most of their skin outdoors, older people and those who rarely go outside are more likely to be low.
Many people with low vitamin D feel well. When it is low for a long time, it can cause aching bones, sore muscles, weakness and tiredness. In children, severe deficiency can cause rickets (soft, bent bones). In adults, it can cause osteomalacia (soft, painful bones). A simple blood test can show the level. Treatment with vitamin D supplements works well, and your doctor decides the dose and how long to take it.
In Pakistan
In a survey of 4,830 people across Pakistan, just over half had vitamin D deficiency and nearly a third more had insufficient levels, despite plenty of sunshine. The researchers called for vitamin D fortification of foods and more sun exposure.
Symptoms
- No symptoms at all in many people, especially early on
- Aching or painful bones, often in the back, hips or legs
- Joint aches and muscle aches
- Muscle weakness, such as trouble getting up from a chair or climbing stairs
- Tiredness and low energy
- Muscle twitching
- In children: irritability, low energy and slow development
- In children: bent or bowed legs and other bone changes (rickets)
- Bones that break more easily than expected
Causes and risk factors
Causes
- Too little sunlight on the skin, for example from staying indoors or covering most of the skin
- Too little vitamin D in the diet
- Poor absorption from the gut, as in coeliac disease, Crohn's disease, ulcerative colitis or after weight-loss (gastric bypass) surgery
- Long-term liver or kidney disease, which stops the body making the active form of vitamin D
- Medicines that speed up the breakdown of vitamin D, such as some epilepsy medicines, rifampicin and steroid medicines
- Rarely, an inherited condition where the body does not respond to vitamin D
What makes it more likely
- Darker skin, including people of South Asian background
- Covering most of the skin when outdoors, or rarely going outside (housebound, in care homes or long hospital stays)
- Older age
- Babies who are breastfed without a vitamin D supplement
- Pregnancy and breastfeeding
- Obesity
- Gut conditions that affect absorption, or past gastric bypass surgery
- Long-term kidney or liver disease, or taking medicines that lower vitamin D
Complications
Long-lasting deficiency lowers the amount of calcium reaching the bones. To make up for this, the parathyroid glands (small glands in the neck) make more hormone, which pulls calcium out of bone. This is called secondary hyperparathyroidism. Over time it can lead to rickets in children, with soft, bent bones, and osteomalacia in adults, with bone pain and muscle weakness. Low vitamin D also adds to thinning of the bones (osteoporosis), broken bones and falls in older people. Taking too much vitamin D is also harmful: it can raise blood calcium (hypercalcaemia), which can damage the kidneys, heart and bones.
When to see a doctor
- A child with bowed legs, bone pain, poor growth or slow development
- A bone that breaks after a minor fall or knock
- Muscle weakness that makes walking or climbing stairs hard, or bone pain that keeps getting worse
- While taking vitamin D: confusion, repeated vomiting, loss of appetite, great thirst or passing much more urine than usual. These can be signs of too much calcium, so get medical help the same day
Are you a PMDC-registered doctor who treats Vitamin D deficiency? List your profile free.
Diagnosis
Vitamin D deficiency is found with a blood test that measures 25-hydroxyvitamin D, the main form of vitamin D stored in the body. Doctors usually do this test in people who have symptoms such as bone pain or muscle weakness, people at high risk, or people with conditions where vitamin D matters, such as low blood calcium. The Endocrine Society advises against routine testing in healthy people with no symptoms. Labs and guidelines use slightly different cut-off levels, so your doctor will explain what your result means.
If the level is low, the doctor may also check blood calcium and parathyroid hormone (PTH) to see whether the bones are being affected. They will also look for a cause, such as a gut problem, kidney or liver disease, or a medicine that lowers vitamin D.
Treatment
- Your doctor confirms the low level with a blood test and looks for a cause, such as poor absorption, kidney or liver disease, or a medicine.
- A vitamin D supplement is started. Vitamin D3 (colecalciferol) is usually preferred because it raises levels better. Your doctor decides the dose and how long to take it, based on how low the level is and your risk factors.
- Once the level has improved, people who remain at risk are usually advised to keep taking a supplement to stop it falling again.
- Your doctor may check blood calcium during treatment, because too much vitamin D can raise calcium.
- People with advanced kidney failure, underactive parathyroid glands or severe liver disease may need a different, active form of vitamin D under specialist care.
- Do not take extra or high-strength vitamin D on your own without medical advice.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Vitamin D supplements (colecalciferol, vitamin D3) | main treatment to restore vitamin D levels and to prevent deficiency in people at risk; your doctor decides the dose | Cholecalciferol (135 brands) |
| Active vitamin D forms (specialist use) | only for special situations, such as advanced kidney failure, underactive parathyroid glands, severe liver disease or deficiency that does not improve with ordinary vitamin D; blood calcium must be watched closely | Chosen by your specialist |
Also used (not yet in our price list): Calcitriol (active vitamin D, specialist use), Calcifediol (calcidiol, for severe liver disease, specialist use)
Self-care and prevention
Self-care
- Take your vitamin D exactly as your doctor or pharmacist advised and finish the course
- Do not take more than advised or add extra vitamin D products without asking
- Get some regular sunlight on your skin, but avoid burning, as too much sun damages the skin
- Eat foods that contain vitamin D, such as oily fish, egg yolks, red meat and fortified foods
- Avoid liver if you are pregnant, even though it contains vitamin D
- Tell your doctor about all your medicines, as some can lower vitamin D
- Keep follow-up appointments and blood tests
Prevention
- People at high risk, such as those who cover their skin, stay indoors or have darker skin, should talk to a doctor or pharmacist about a regular vitamin D supplement
- Breastfed babies usually need a daily vitamin D supplement; ask your doctor or pharmacist
- Children, pregnant women and older people should ask their doctor whether they need a supplement
- Include vitamin D-rich and fortified foods in the family diet
- Spend some time outdoors in daylight, while protecting the skin from burning
Common questions
Pakistan is sunny. Why is vitamin D deficiency so common?
A large Pakistani survey found that most people had low vitamin D even though the country gets plenty of sunshine. Covering most of the skin, staying indoors and having darker skin all reduce the vitamin D the skin can make. Few everyday foods contain much vitamin D.
Should everyone get a vitamin D blood test?
No. The Endocrine Society advises against routine testing in healthy people without symptoms. Testing is useful if you have symptoms such as bone pain or weakness, are at high risk, or have a condition such as low blood calcium. Your doctor will decide if you need it.
Can I take too much vitamin D?
Yes. Taking too much for a long time can build up calcium in the blood. This can weaken bones and harm the kidneys and heart. You cannot get too much vitamin D from sunlight, so the risk comes from supplements.
Which foods contain vitamin D?
Oily fish such as salmon and mackerel, egg yolks, red meat, liver, cheese and some mushrooms contain vitamin D. Some milk, cereals and spreads have vitamin D added (fortified). Food alone is often not enough for people at high risk.
Can low vitamin D make me feel tired?
Long-lasting or severe deficiency can cause tiredness, aches and weak muscles. But most people with low vitamin D have no symptoms. If you feel tired all the time, see a doctor so other causes can be checked too.
Sources
- Endocrine Society. Vitamin D for the Prevention of Disease (Clinical Practice Guideline) (2024).
- NICE. Overview | Vitamin D: supplement use in specific population groups (PH56) (n.d.).
- NHS. Vitamin D - NHS (2024).
- MedlinePlus (US National Library of Medicine). Vitamin D Deficiency: MedlinePlus (2024).
- StatPearls (NCBI Bookshelf). Vitamin D Deficiency - StatPearls - NCBI Bookshelf (2025).
- Expert Review of Clinical Pharmacology (Riaz et al., via Strathprints). Prevalence of vitamin D deficiency in Pakistan and implications for the future (2016).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.