The Impact of Vitamin D Deficiency on Population Health: Assessment, Monitoring, and Intervention Strategies

Alanoud Abduallh Alhulayyil (1), Hessa trad alonzay , Mohammed Habbas Mater Alshammari (2), Sarah Saab Alanzi (3), Fahad Muzil O Al Harbi (4), Wed Suliaman Qunfuthi (5), Mohammed Ahmed Ghbri (6), Raed Jameel Mohammed Zaylaee (7), Falah Awad Shaker Yahya (8), Ali Murdi Alqarni (9), Mohammadih Ahmed Khder Magfoory (5), Aeshah Mudhaya Ahmed Madkhali (10)
(1) King Khalid Hospital in Al-kharj, Ministry of Health, Saudi Arabia,
(2) AJA Hospital, Ministry of Health, Saudi Arabia,
(3) Maternity and Children Hospital, Ministry of Health, Saudi Arabia,
(4) King Salman bin Abdulaziz Medical City, Ministry of Health, Saudi Arabia,
(5) Central Blood Bank – Jazan, Ministry of Health, Saudi Arabia,
(6) Sabya General Hospital, Ministry of Health, Saudi Arabia,
(7) Vector Control Center – Al-Eidabi, Ministry of Health, Saudi Arabia,
(8) Security Force Primary Health Care – Tabuk, Ministry of Health, Saudi Arabia,
(9) King Khalid University Hospital – King Saud University, Ministry of Health, Saudi Arabia,
(10) Jazan Health Cluster, Ministry of Health, Saudi Arabia

Abstract

Background: Vitamin D is an essential fat‑soluble hormone involved in calcium and phosphate homeostasis, bone mineralization, and multiple extra‑skeletal physiological processes. Despite advances in nutrition and food fortification, vitamin D deficiency remains a major global public health problem, affecting diverse populations and contributing to significant morbidity.


Aim: This review aims to assess the global burden of vitamin D deficiency, examine its etiology, pathophysiology, clinical manifestations, and evaluate current strategies for assessment, monitoring, prevention, and management.


Methods: A narrative synthesis of epidemiological data, clinical outcomes, diagnostic criteria, and therapeutic approaches to vitamin D deficiency was conducted, incorporating evidence from observational studies, clinical trials, and international guidelines discussed in the literature.


Results: Vitamin D deficiency affects approximately one billion individuals worldwide, particularly older adults, obese individuals, hospitalized patients, and those with limited sun exposure. Deficiency is linked to skeletal disorders such as rickets and osteomalacia, increased fracture risk, muscle weakness, and potential non‑skeletal complications. Vitamin D3 supplementation is superior to vitamin D2 in correcting deficiency and maintaining adequate serum levels.


Conclusion: Targeted screening, individualized supplementation, and interprofessional healthcare strategies are essential to reduce the burden of vitamin D deficiency and its complications.

Full text article

Generated from XML file

References

1. Chang SW, Lee HC. Vitamin D and health - The missing vitamin in humans. Pediatr Neonatol. 2019 Jun;60(3):237-244.

2. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics. 2003 Aug;112(2):e132-5.

3. Pludowski P, Holick MF, Grant WB, Konstantynowicz J, Mascarenhas MR, Haq A, Povoroznyuk V, Balatska N, Barbosa AP, Karonova T, Rudenka E, Misiorowski W, Zakharova I, Rudenka A, Łukaszkiewicz J, Marcinowska-Suchowierska E, Łaszcz N, Abramowicz P, Bhattoa HP, Wimalawansa SJ. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018 Jan;175:125-135.

4. Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother. 2012 Apr;3(2):118-26.

5. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7.

6. Bikle DD. Vitamin D metabolism, mechanism of action, and clinical applications. Chem Biol. 2014 Mar 20;21(3):319-29.

7. Sugimoto H, Shiro Y. Diversity and substrate specificity in the structures of steroidogenic cytochrome P450 enzymes. Biol Pharm Bull. 2012;35(6):818-23.

8. Czernichow S, Fan T, Nocea G, Sen SS. Calcium and vitamin D intake by postmenopausal women with osteoporosis in France. Curr Med Res Opin. 2010 Jul;26(7):1667-74

9. Naeem Z. Vitamin d deficiency- an ignored epidemic. Int J Health Sci (Qassim). 2010 Jan;4(1):V-VI.

10. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998 Mar 19;338(12):777-83.

11. Elangovan H, Chahal S, Gunton JE. Vitamin D in liver disease: Current evidence and potential directions. Biochim Biophys Acta Mol Basis Dis. 2017 Apr;1863(4):907-916.

12. Yeung WG, Toussaint ND, Badve SV. Vitamin D therapy in chronic kidney disease: a critical appraisal of clinical trial evidence. Clin Kidney J. 2024 Aug;17(8):sfae227.

13. Cipriani C, Cianferotti L. Vitamin D in hypoparathyroidism: insight into pathophysiology and perspectives in clinical practice. Endocrine. 2023 Aug;81(2):216-222.

14. Gröber U, Kisters K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 2012 Apr 01;4(2):158-66.

15. Levine MA. Diagnosis and Management of Vitamin D Dependent Rickets. Front Pediatr. 2020;8:315.

16. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015 Apr;16(4):341-9.

17. Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. 2003 Jun;23(6):702-10.

18. Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010 Aug;85(8):752-7; quiz 757-8.

19. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014 Oct;144 Pt A:138-45.

20. Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, Martucci G, Pilz S, Malle O. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020 Nov;74(11):1498-1513. [

21. Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open. 2019 May 22;9(5):e027666.

22. Veldurthy V, Wei R, Oz L, Dhawan P, Jeon YH, Christakos S. Vitamin D, calcium homeostasis and aging. Bone Res. 2016;4:16041.

23. Rejnmark L, Ejlsmark-Svensson H. Effects of PTH and PTH Hypersecretion on Bone: a Clinical Perspective. Curr Osteoporos Rep. 2020 Jun;18(3):103-114.

24. Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, Lips P, Munns CF, Lazaretti-Castro M, Giustina A, Bilezikian J. Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions. Endocr Rev. 2019 Aug 01;40(4):1109-1151.

25. Jones AN, Hansen KE. Recognizing the musculoskeletal manifestations of vitamin D deficiency. J Musculoskelet Med. 2009 Oct;26(10):389-396.

26. Zhang X, Liu Z, Xia L, Gao J, Xu F, Chen H, Du Y, Wang W. Clinical features of vitamin D deficiency in children: A retrospective analysis. J Steroid Biochem Mol Biol. 2020 Feb;196:105491.

27. Giustina A, Adler RA, Binkley N, Bouillon R, Ebeling PR, Lazaretti-Castro M, Marcocci C, Rizzoli R, Sempos CT, Bilezikian JP. Controversies in Vitamin D: Summary Statement From an International Conference. J Clin Endocrinol Metab. 2019 Feb 01;104(2):234-240.

28. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010 Jul;21(7):1151-4.

29. Marcinowska-Suchowierska E, Kupisz-Urbańska M, Łukaszkiewicz J, Płudowski P, Jones G. Vitamin D Toxicity-A Clinical Perspective. Front Endocrinol (Lausanne). 2018;9:550.

30. Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64.

31. Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, Lips P, Mitchell DM, Murad MH, Powers S, Rao SD, Scragg R, Tayek JA, Valent AM, Walsh JME, McCartney CR. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024 Jul 12;109(8):1907-1947.

32. Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans. J Clin Endocrinol Metab. 2011 Mar;96(3):E447-52.

33. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M., Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008 Aug;122(2):398-417.

34. Melamed ML, Thadhani RI. Vitamin D therapy in chronic kidney disease and end stage renal disease. Clin J Am Soc Nephrol. 2012 Feb;7(2):358-65.

35. Vieth R. Vitamin D supplementation: cholecalciferol, calcifediol, and calcitriol. Eur J Clin Nutr. 2020 Nov;74(11):1493-1497.

36. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007 Sep 10;167(16):1730-7.

37. Bolland MJ, Grey A, Gamble GD, Reid IR. Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women's Health Initiative (WHI) limited-access data set. Am J Clin Nutr. 2011 Oct;94(4):1144-9.

38. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.

39. Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Apr;74(4):337-345.

40. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016 Jan;27(1):367-76.

41. Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Dhillon H, Swaid B, Yelangi A, Sundus S, Bachuwa G, Alkotob ML, Manson JE. Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83 000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis. JAMA Cardiol. 2019 Aug 01;4(8):765-776.

42. Ruiz-García A, Pallarés-Carratalá V, Turégano-Yedro M, Torres F, Sapena V, Martin-Gorgojo A, Martin-Moreno JM. Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials. Nutrients. 2023 Apr 07;15(8)

43. Scragg R, Khaw KT, Toop L, Sluyter J, Lawes CMM, Waayer D, Giovannucci E, Camargo CA. Monthly High-Dose Vitamin D Supplementation and Cancer Risk: A Post Hoc Analysis of the Vitamin D Assessment Randomized Clinical Trial. JAMA Oncol. 2018 Nov 01;4(11):e182178.

44. Krul-Poel YH, Westra S, Simsek S. Response to Comment on Krul-Poel et al. Effect of Vitamin D Supplementation on Glycemic Control in Patients With Type 2 Diabetes (SUNNY Trial): A Randomized Placebo-Controlled Trial. Diabetes Care 2015;38:1420-1426. Diabetes Care. 2015 Nov;38(11):e191-2.

45. Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, Brodsky I, Ceglia L, Chadha C, Chatterjee R, Desouza C, Dolor R, Foreyt J, Fuss P, Ghazi A, Hsia DS, Johnson KC, Kashyap SR, Kim S, LeBlanc ES, Lewis MR, Liao E, Neff LM, Nelson J, O'Neil P, Park J, Peters A, Phillips LS, Pratley R, Raskin P, Rasouli N, Robbins D, Rosen C, Vickery EM, Staten M., D2d Research Group. Vitamin D Supplementation and Prevention of Type 2 Diabetes. N Engl J Med. 2019 Aug 08;381(6):520-530.

46. Khaw KT, Stewart AW, Waayer D, Lawes CMM, Toop L, Camargo CA, Scragg R. Effect of monthly high-dose vitamin D supplementation on falls and non-vertebral fractures: secondary and post-hoc outcomes from the randomised, double-blind, placebo-controlled ViDA trial. Lancet Diabetes Endocrinol. 2017 Jun;5(6):438-447.

47. Appel LJ, Michos ED, Mitchell CM, Blackford AL, Sternberg AL, Miller ER, Juraschek SP, Schrack JA, Szanton SL, Charleston J, Minotti M, Baksh SN, Christenson RH, Coresh J, Drye LT, Guralnik JM, Kalyani RR, Plante TB, Shade DM, Roth DL, Tonascia J., STURDY Collaborative Research Group. The Effects of Four Doses of Vitamin D Supplements on Falls in Older Adults : A Response-Adaptive, Randomized Clinical Trial. Ann Intern Med. 2021 Feb;174(2):145-156.

48. Waterhouse M, Sanguineti E, Baxter C, Duarte Romero B, McLeod DSA, English DR, Armstrong BK, Ebeling PR, Hartel G, Kimlin MG, O'Connell RL, Pham H, van der Pols JC, Venn AJ, Webb PM, Whiteman DC, Neale RE. Vitamin D supplementation and risk of falling: outcomes from the randomized, placebo-controlled D-Health Trial. J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):1428-1439.

49. Bouillon R, Manousaki D, Rosen C, Trajanoska K, Rivadeneira F, Richards JB. The health effects of vitamin D supplementation: evidence from human studies. Nat Rev Endocrinol. 2022 Feb;18(2):96-110.

Authors

Alanoud Abduallh Alhulayyil
nood011@outlook.sa (Primary Contact)
Hessa trad alonzay
Mohammed Habbas Mater Alshammari
Sarah Saab Alanzi
Fahad Muzil O Al Harbi
Wed Suliaman Qunfuthi
Mohammed Ahmed Ghbri
Raed Jameel Mohammed Zaylaee
Falah Awad Shaker Yahya
Ali Murdi Alqarni
Mohammadih Ahmed Khder Magfoory
Aeshah Mudhaya Ahmed Madkhali
Alhulayyil, A. A., alonzay, H. trad, Alshammari, M. H. M., Alanzi, S. S., Al Harbi, F. M. O., Qunfuthi, W. S., … Madkhali, A. M. A. (2025). The Impact of Vitamin D Deficiency on Population Health: Assessment, Monitoring, and Intervention Strategies. Saudi Journal of Medicine and Public Health, 2(2), pp 3282–3291. https://doi.org/10.64483/202522578

Article Details