“My hands and feet are really stiff and achy. I thought it was vitamin D deficiency like last time,” says Nusrat, “but I’ve taken a supplement and it’s made no difference.”
“Did you get another prescription?” asks Parveen.
“Oh no, paying for my prescriptions works out quite expensive,” Nusrat says, “ so I got one of those multivitamins from your 99p range. It’s got vitamin D in it so it must basically be the same thing...” How should Parveen respond?
The most sensible first step is to check how much vitamin D is in the supplement Nusrat has been taking. Chances are it is around 400iU per tablet, which is fine as a preventative measure but will not correct a deficiency.
A trip to the GP is in order for Nusrat – perhaps for a blood test to check her vitamin D level, although the doctor may decide against it if convinced that her symptoms are the same as when she was found to have a deficiency on a previous occasion – in order for her to be prescribed a high dose supplement. This is usually around 280,000- 300,000iU over the course of six to 10 weeks.
Once her deficiency has been corrected, Nusrat should take a daily vitamin D supplement throughout the year. Her doctor will be able to advise her, but it may be the case that she needs a higher amount of 800iU per day as maintenance treatment compared to the more usual 400iU. There isn’t usually a need to monitor serum vitamin D levels, but it is a good idea for Nusrat to consider her calcium intake. If it is less than 700mg per day, dietary measures should be taken to address this or a supplement added if this is not appropriate.
The National Diet and Nutrition Survey, conducted by Public Health England and the Food Standards Agency, revealed that just under a quarter of people in the UK had low vitamin D levels, although this figure increased to 30 per cent of over-65s and 40 per cent of 19-64s in the months of January to March. This is thought to be because the amount of UVB radiation in the UK is not enough to synthesize vitamin D in the skin during the winter months.
Vitamin D is essential for the regulation of calcium and phosphate levels in the body, and therefore core to good musculoskeletal health. Symptoms of low vitamin D levels can include bone loss, muscle weakness, falls and fragility fractures, hypocalcaemia and secondary hyperparathyroidism, with the main complication osteomalacia, which in turn can lead to osteopenia and osteoporosis.
• Find out which groups of people are at higher risk of developing vitamin D deficiency. See NICE’s Clinical Knowledge Summary