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- What are the stages of vitamin D deficiency?
Depending on the alterations in mineral homeostasis, vitamin D deficiency
may be classified into three stages, stage 1–3 as depicted in the table given
below.StagesSerum
calcium Phosphorus ALP 25(OH)D iPTH 1,25(OH) 2 D Radiography
Stage 1 ↓ Normal ↑ ↓ ↑ Normal Osteopenia
Stage 2 Normal ↓ ↑↑ ↓↓ ↑↑ ↑ Mild rachitic
changes
Stage 3 ↓↓ ↓↓ ↑↑↑ ↓↓↓ ↑↑↑ Normal/↑/↓ Marked rachitic
changes- Who should be screened for vitamin D deficiency?
Routine screening for vitamin D deficiency is not cost-effective, hence not rec-
ommended. However, individuals who are at risk for vitamin D deficiency
should be screened by estimation of serum 25(OH)D; these include patients
with chronic kidney disease, hepatic failure, malabsorption syndromes, patients
on anticonvulsant or glucocorticoid therapy, morbidly obese individuals, and
those undergoing bariatric surgery. In addition, estimation of 25(OH)D should
also be performed in patients with rickets–osteomalacia, osteoporosis, hyper-
parathyroidism, granulomatous disorders, and unexplained hypercalcemia for
the differential diagnosis and further management.- What are the foods rich in vitamin D?
The dietary sources of vitamin D are limited. Plant products are poor source of
vitamin D and there are only limited sources of vitamin D of animal origin.
Vitamin D obtained from plant sources contains ergocalciferol (vitamin D 2 ),
while that of animal origin is cholecalciferol (vitamin D 3 ); both vitamin D 2 and
D 3 are equipotent precursors for the synthesis of 25(OH)D. The vitamin D con-
tent of different foods is shown in the table given below.Sources Quantity (IU)
Cod liver oil (1 teaspoon) 400–1000
Salmon fish (100 g) 600–1000
Sardine fish (100 g) 300
Mackerel fish (100 g) 250
Egg yolk (per egg) 20
Human breast milk (1 l) 25
Cow milk (1 l) 4–40
Mushroom, sun-dried (100 g) 16005 Rickets–Osteomalacia