Vitamin D and bone health

Overview

Vitamin D is a nutrient that helps your body absorb calcium, which is needed to build and keep strong bones. Without enough vitamin D, your bones can become thin, brittle, or soft.

Yes, vitamin D deficiency is common, especially in people who live in cloudy regions, have darker skin, or spend most of their time indoors.

It can affect anyone, but it is more common in older adults, people with limited sun exposure, people who are overweight, and those with certain medical conditions that affect nutrient absorption.

Symptoms

Common symptoms

• Tiredness or fatigue
• Bone pain or aching
• Muscle weakness or cramps
• Mood changes, such as feeling sad or depressed

Symptoms in children

• Soft or bent bones (rickets)
• Delayed growth or short stature
• Bone pain, especially in the legs
• Muscle weakness or trouble walking

Symptoms in older adults

• Increased risk of falls due to weak muscles
• Bone fractures from minor bumps or falls
• Chronic bone or joint pain

Causes

Main causes

• Not enough sun exposure – your skin needs sunlight to make vitamin D
• Low intake of foods that contain vitamin D
• Certain medical conditions that reduce how your body absorbs vitamin D, such as Crohn's disease or celiac disease
• Having darker skin – more melanin reduces your skin's ability to make vitamin D from sunlight

Risk factors

• Living far from the equator (e.g., northern countries like the UK)
• Wearing sunscreen or covering skin most of the time
• Being older than 65
• Having a body mass index (BMI) over 30
• Taking medications that affect vitamin D levels, such as some seizure medicines or steroids

When to see a doctor

See a doctor urgently if:

• If you have a fracture from a minor fall or injury
• If you have sudden, severe bone pain that limits your daily activities

Book a routine appointment if:

• If you have ongoing tiredness, bone pain, or muscle weakness
• If you are at higher risk (older, limited sun exposure, dark skin) and want a check-up
• If you have a condition that affects how your body absorbs nutrients

Diagnosis

Your doctor will ask about your symptoms, lifestyle, and medical history. They may order a blood test to measure your vitamin D level.

Tests that may be done

• Blood test for 25-hydroxy vitamin D – this is the main test to check your vitamin D level

What to expect at your appointment

The blood test is simple and takes only a few minutes. You do not usually need to fast (avoid food) for it. The results will tell your doctor if your vitamin D level is normal, low, or very low.

Treatment

Treatment aims to raise your vitamin D level and keep your bones healthy. It usually involves increasing your sun exposure and vitamin D-rich foods, and sometimes taking a vitamin D supplement. Always follow your doctor's advice on what is best for you.

Self-care at home

• Spend 10–30 minutes outdoors in the sun a few times a week, with some skin uncovered (but not so long that you burn)
• Eat foods rich in vitamin D, such as oily fish (salmon, mackerel, sardines), egg yolks, and fortified foods (like some cereals and milk)
• Consider a vitamin D supplement if your doctor recommends one – do not take high doses without medical advice

Medical treatments

Your doctor may recommend a vitamin D supplement in a specific dose, usually taken daily or weekly for a few months. In severe cases, they may prescribe a high-dose treatment. Your doctor will monitor your blood levels to make sure they return to normal.

When is surgery considered?

Surgery is not used for vitamin D deficiency alone. If you have a fracture, you may need surgical repair, but that treatment is for the injury, not the deficiency.

Living with this condition

Once your vitamin D level is normal, you can maintain it by getting regular sunshine and eating vitamin D-rich foods. If you live in a place with long winters, you may need to take a daily supplement as advised by your doctor.

Lifestyle tips

• Aim for regular, safe sun exposure – check local advice on how much sun is right for your skin type and location
• Include vitamin D-rich foods in your meals
• Stay active – weight-bearing exercise like walking or dancing helps keep bones strong
• If you take supplements, take them as directed and never exceed the recommended dose

Diet and exercise

Eat a balanced diet with plenty of calcium (dairy, leafy greens, fortified foods) and vitamin D. Weight-bearing exercise – such as brisk walking, jogging, or strength training – helps your bones stay dense and strong.

Mental health and emotional wellbeing

Low vitamin D has been linked to low mood and depression in some people. Treating the deficiency may help improve your mood. If you feel down, talk to your doctor. There is also support available from mental health services.

Prevention

Yes, in many cases you can prevent vitamin D deficiency by getting safe sun exposure, eating vitamin D-rich foods, and considering a daily supplement if you are at risk (e.g., during winter or if you have limited sun).

Vaccines

There is no vaccine for vitamin D deficiency.

Screening programmes

Routine screening is not recommended for everyone. Your doctor may offer a blood test if you have symptoms or are in a high-risk group.

Complications

If left untreated

• Soft, weak, or brittle bones (osteomalacia in adults, rickets in children)
• Increased risk of bone fractures
• Muscle weakness and increased risk of falls, especially in older adults
• Possible link to longer-term health problems, such as heart disease or diabetes, though more research is needed

Long-term outlook

The good news is that vitamin D deficiency is usually easy to treat. With proper sun exposure, diet, and any supplements your doctor recommends, your vitamin D level can return to normal, and your bones can become stronger. Most people feel better and have a lower risk of fractures.

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