Vitamin D deficiency causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Sadaf Sharfaei M.D.[2]

## Overview

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Common causes of vitamin D deficiency are inadequate vitamin D skin production, less dietary vitamin D intake and impaired absorption. Other causes of vitamin D deficiency include vitamin D loss, abnormal metabolism, resistance to vitamin D and medication.[1]

## Causes

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Vitamin D deficiency may be caused by:[1][2][3][4][5][6][7][8]

* Inadequate vitamin D skin production
* Inadequate vitamin D dietary intake
* Vitamin D loss
* Malabsorption
* Impaired metabolism
* Resistance to Vitamin D
* Medication

### Common causes

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* Antiepileptic medication
* Glucocorticoid
* Inadequate sun exposure including dark skin and clothing
* Inadequate vitamin D dietary intake
* Malabsorption

### Less common cause

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* Autosomal dominant hypophosphatemic rickets
* Celiac disease
* Chronic kidney disease: impaired renal 1α-hydroxylation
* Crohn disease
* Cystic fibrosis
* Highly active antiretroviral therapy (HAART)
* Hyperthyroidism
* Impaired enterohepatic circulation
* Nephrotic syndrome
* Post gastric bypass surgery
* Primary hyperparathyroidism
* Rifampin
* Sarcoidosis
* Severe liver failure: impaired hepatic 25-hydroxylation
* Short bowel syndrome
* St John's wort
* Tuberculosis
* Type I hereditary vitamin D–dependent rickets
* Type II hereditary vitamin D–dependent rickets
* Vitamin D-resistant rickets
* Whipple disease
* X-linked familial hypophosphatemia

### Causes by organ system

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Cardiovascular | No underlying causes

|

Chemical/Poisoning | St John's wort
Dental | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | Glucocorticoid, Highly Active Antiretroviral Therapy (HAART), Phenobarbital, Phenytoin, Primidone, Rifampin, Valproate
Ear Nose Throat | No underlying causes
Endocrine | Autosomal-dominant hypophosphatemic rickets, Hyperthyroidism, Primary hyperparathyroidism, Type I hereditary vitamin D–dependent rickets, Type II hereditary vitamin D–dependent rickets, Vitamin D-resistant rickets, X-linked familial hypophosphatemia
Environmental | No underlying causes
Gastroenterologic | Celiac disease, Crohn disease, Cystic fibrosis, Liver failure, Post gastric bypass surgery, Short bowel syndrome, Whipple disease
Genetic | Autosomal-dominant hypophosphatemic rickets, Type I hereditary vitamin D–dependent rickets, Type II hereditary vitamin D–dependent rickets, Vitamin D-resistant rickets, X-linked familial hypophosphatemia
Hematologic | No underlying causes
Iatrogenic | No underlying causes
Infectious Disease | Tuberculosis
Musculoskeletal/Orthopedic | Autosomal-dominant hypophosphatemic rickets, Type I hereditary vitamin D–dependent rickets, Type II hereditary vitamin D–dependent rickets, Vitamin D-resistant rickets, X-linked familial hypophosphatemia
Neurologic | No underlying causes
Nutritional/Metabolic | Inadequate vitamin D dietary intake
Obstetric/Gynecologic | No underlying causes
Oncologic | No underlying causes
Ophthalmologic | No underlying causes
Overdose/Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | No underlying causes
Renal/Electrolyte | Chronic kidney disease, Nephrotic syndrome
Rheumatology/Immunology/Allergy | Sarcoidosis
Sexual | No underlying causes
Trauma | No underlying causes
Urologic | No underlying causes
Miscellaneous | No underlying causes

### Causes in alphabetical order

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* Autosomal dominant hypophosphatemic rickets
* Carbamazepine
* Celiac disease
* Chronic kidney disease
* Crohn's disease
* Cystic fibrosis
* Glucocorticoid
* Highly active antiretroviral therapy (HAART)
* Hyperthyroidism
* Impaired enterohepatic circulation
* Inadequate sun exposure
* Inadequate vitamin D dietary intake
* Nephrotic syndrome
* Phenobarbital
* Phenytoin
* Post gastric bypass surgery
* Primary hyperparathyroidism
* Primidone
* Rifampin
* Sarcoidosis
* Severe liver failure
* Short bowel syndrome
* St John's wort
* Tuberculosis
* Type I hereditary vitamin D–dependent rickets
* Type II hereditary vitamin D–dependent rickets
* Valproate
* Vitamin D-resistant rickets
* Whipple's disease
* X-linked familial hypophosphatemia

## References

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1. ↑ 1.0 1.1 Hossein-nezhad A, Holick MF (2013). "Vitamin D for health: a global perspective". Mayo Clin Proc. 88 (7): 720–55. doi:10.1016/j.mayocp.2013.05.011. PMC 3761874. PMID 23790560.
2. ↑ Pack AM, Morrell MJ (2004). "Epilepsy and bone health in adults". Epilepsy Behav. 5 Suppl 2: S24–9. doi:10.1016/j.yebeh.2003.11.029. PMID 15123008.
3. ↑ Zhou C, Assem M, Tay JC, Watkins PB, Blumberg B, Schuetz EG; et al. (2006). "Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia". J Clin Invest. 116 (6): 1703–12. doi:10.1172/JCI27793. PMC 1459072. PMID 16691293.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ Kyriakidou-Himonas M, Aloia JF, Yeh JK (1999). "Vitamin D supplementation in postmenopausal black women". J Clin Endocrinol Metab. 84 (11): 3988–90. doi:10.1210/jcem.84.11.6132. PMID 10566638.CS1 maint: Multiple names: authors list (link)
5. ↑ Holick MF (2012). "Vitamin D: extraskeletal health". Rheum Dis Clin North Am. 38 (1): 141–60. doi:10.1016/j.rdc.2012.03.013. PMID 22525849.
6. ↑ Lo CW, Paris PW, Clemens TL, Nolan J, Holick MF (1985). "Vitamin D absorption in healthy subjects and in patients with intestinal malabsorption syndromes". Am J Clin Nutr. 42 (4): 644–9. PMID 4050723.CS1 maint: Multiple names: authors list (link)
7. ↑ Ali FN, Arguelles LM, Langman CB, Price HE (2009). "Vitamin D deficiency in children with chronic kidney disease: uncovering an epidemic". Pediatrics. 123 (3): 791–6. doi:10.1542/peds.2008-0634. PMID 19255004.CS1 maint: Multiple names: authors list (link)
8. ↑ Pappa HM, Gordon CM, Saslowsky TM, Zholudev A, Horr B, Shih MC; et al. (2006). "Vitamin D status in children and young adults with inflammatory bowel disease". Pediatrics. 118 (5): 1950–61. doi:10.1542/peds.2006-0841. PMC 3205440. PMID 17079566.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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