Vitamin D & Calcium Disorders
Diagnosis and management of abnormal vitamin D, calcium and related mineral levels
What is vitamin d & calcium disorders?
Vitamin D is made in the skin under ultraviolet light and is what allows the gut to absorb calcium. Calcium itself is held in a narrow range in the blood by the parathyroid glands, four small glands in the neck that release a hormone to pull calcium out of bone and hold it back in the kidney whenever the level dips.
Deficiency of vitamin D is very common in India despite the sunlight. Indoor work and travel, covered clothing, urban air pollution, more pigmented skin and a diet low in dairy all cut what is made and absorbed, and older adults make less from the same exposure.
When vitamin D runs low the parathyroid glands work harder to keep blood calcium normal, and they do it at the expense of bone. Blood calcium can therefore look reassuring while bone is being drawn down. A high calcium level is a different problem and most often comes from one of the parathyroid glands working independently.
What you might notice
- Aching bones and muscles with no injury to explain it
- Muscle cramps and weakness that keep coming back
- A bone broken by a minor fall
How it is diagnosed
Your doctor takes a history aimed at the things deficiency actually produces: aching bones, particularly the lower back, hips and ribs, difficulty rising from the floor or climbing stairs, a waddling gait, falls, and fractures from minor injury. In children they will ask about bowing of the legs, delayed walking and delayed teeth.
They examine muscle strength around the hips and shoulders, press over the shin and the breastbone for tenderness, and watch you stand from a chair without using your arms.
They will ask about sunlight, diet, stomach or bowel surgery, coeliac disease, kidney and liver problems, anticonvulsants and steroids, and about every supplement and injection you have already taken, including those given at a pharmacy. Blood tests measure calcium, vitamin D, parathyroid hormone, phosphate, alkaline phosphatase and kidney function together, since one value alone cannot be interpreted. Bone density and a scan of the neck are added where they are needed.
Recovery
Correcting a deficiency takes months. Muscle aches and weakness usually ease over six to eight weeks, bone pain takes longer, and levels are rechecked at around eight to twelve weeks before a maintenance dose is set.
The maintenance part continues. Levels fall again within months of stopping if the reasons for the deficiency have not changed, so your doctor will agree a long-term plan with you instead of a single course. Calcium is corrected through diet where possible and by supplement where it is not.
Where the problem is a parathyroid gland working on its own, removing it is a short operation with one or two nights in hospital and one to two weeks off work. Calcium is monitored closely for the first days afterwards while the remaining glands resume their work, and bone density improves over the following one to two years.
If it is left untreated
A mildly low vitamin D level with no symptoms, normal calcium and normal bone density can reasonably be corrected with sunlight and diet and rechecked.
Sustained deficiency softens bone. In adults that produces bone pain, muscle weakness around the hips, an unsteady gait and fractures from small falls, and the muscle weakness itself causes the falls. In children it deforms growing bone, and the changes in leg shape become permanent once growth is complete.
Untreated high calcium is the more urgent one. Over time it causes kidney stones, lasting kidney damage, thinning bone and fractures, stomach ulcers, low mood and poor concentration. Very high calcium causes vomiting, dehydration, confusion and drowsiness, and that needs same-day hospital assessment.
High-dose vitamin D taken without supervision, as repeated injections or sachets bought over the counter, causes harm of its own by raising calcium, and it is a preventable reason people arrive in hospital.
Questions about vitamin d & calcium disorders
Why am I deficient when there is so much sun in India?
Because very little of it reaches your skin. Most urban work is indoors through the hours when the sun is high enough to make vitamin D, clothing covers most of the skin, and city air scatters the wavelength that matters. More pigmented skin needs substantially longer exposure than pale skin for the same result, and older adults make less from the same time outdoors. Indian diets are also low in the few foods that supply it, and calcium intake is often low alongside. Deficiency is found in a large share of people tested, including those working outdoors.
Can I take vitamin D supplements on my own?
Modest daily doses are widely used and generally safe, and the high-dose weekly sachets and injections sold over the counter are where harm comes from. Taken repeatedly without monitoring they push calcium up, and that causes kidney stones, kidney damage, vomiting and confusion. People arrive in hospital this way every year. Have your level measured, take the dose your doctor sets for the period they set it, and have it rechecked at eight to twelve weeks before moving to maintenance. Tell your doctor about every injection or sachet you have already had.
How long do I need to keep taking it?
Usually indefinitely at a maintenance dose, because the reasons you became deficient rarely change. A correction course over eight to twelve weeks brings the level up, and levels fall again within a few months of stopping if your sunlight exposure and diet are the same as before. Your doctor will set a maintenance dose and a recheck interval, often yearly. Calcium in the diet matters alongside it, since vitamin D only lets you absorb the calcium you actually eat. Dairy, ragi, sesame and green leafy vegetables are the usual sources.
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