Vitamin D Deficiency: Symptoms, Causes and Treatment

Vitamin D deficiency means your body does not have enough vitamin D to keep calcium and phosphate in balance and to build strong bones. Doctors confirm it with a 25-hydroxyvitamin D blood test: most US experts call a level below 20 ng/mL (50 nmol/L) too low, and a level below 12 ng/mL (30 nmol/L) clearly deficient. Many people have no symptoms at all; when symptoms appear, they are usually tiredness, bone pain, muscle weakness, aches or cramps.

Low vitamin D is easy to treat and to prevent, usually with a vitamin D3 supplement and enough calcium. This guide covers symptoms, risk groups, treatment doses and safe limits. For a line-by-line reading of your lab report, see our dedicated guide to the 25-OH vitamin D blood test and how to read your results.

Key takeaways

• Vitamin D deficiency is common: worldwide, about 1 in 6 people have a level below 12 ng/mL (30 nmol/L) and nearly half are below 20 ng/mL (50 nmol/L).
• Symptoms are often absent or vague: fatigue, bone pain, muscle weakness, aches, cramps and low mood. Severe, long-lasting deficiency causes rickets in children and osteomalacia (soft bones) in adults.
• The main risk factors are little sun, dark skin, older age, obesity, gut diseases that block fat absorption, weight-loss surgery, kidney or liver disease and some medicines.
• Treatment is simple: vitamin D3 by mouth, with doses set by your clinician, then a lower maintenance dose. The safe upper limit for unsupervised use is 4,000 IU a day for adults.
• Since 2024, the Endocrine Society advises against routine vitamin D testing in healthy adults, but suggests supplements without testing for children, adults 75 and older, pregnant people and adults with high-risk prediabetes.

What is vitamin D deficiency?

Vitamin D is a fat-soluble vitamin that works more like a hormone. Your skin makes it when ultraviolet B (UVB) light reaches it, and a smaller amount comes from food and supplements. The liver turns it into 25-hydroxyvitamin D, the storage form measured on lab reports, and the kidneys turn part of that into calcitriol, the active hormone. Calcitriol acts by switching on the vitamin D receptor in the gut, bones, kidneys and many other tissues.

Its main job is to help your intestines absorb calcium. MedlinePlus explains that when you do not absorb enough calcium because vitamin D is low, bone production and bone tissue suffer.

How common is low vitamin D?

A 2023 pooled analysis of 308 studies covering 7.9 million people in 81 countries found that 15.7% had a level below 30 nmol/L (12 ng/mL), 47.9% were below 50 nmol/L (20 ng/mL) and 76.6% were below 75 nmol/L (30 ng/mL). Figures for the United States vary a lot with the cutoff used: a 2025 review cites 2.6% of Americans below 25 nmol/L (10 ng/mL), while Cleveland Clinic estimates that about 35% of US adults are deficient using a higher threshold.

Vitamin D deficiency causes and risk factors

Cleveland Clinic sums up the two main causes of vitamin D deficiency: not getting enough vitamin D from sunlight and food, and a body that cannot absorb or use it properly.

Too little sun

People who live far from the equator, stay indoors, work indoors during daylight hours, are homebound or live in nursing homes, wear clothing that covers most of their skin or use very strong sunscreen make less vitamin D. Levels are lower in winter and spring. The USPSTF notes that little or no UVB exposure, for example because of winter, high latitude or sun avoidance, is linked to lower levels.

Darker skin

Melanin acts as a natural sunscreen: it absorbs UVB light and reduces how much vitamin D the skin can make. People with darker skin therefore need more sun to make the same amount, and low vitamin D is more common in this group, especially in winter. MedlinePlus notes that low levels are more common in African American children in winter and in infants who are fed only breast milk.

Older age

Skin becomes less efficient at making vitamin D with age, appetite often falls and people get outside less. A 2025 review estimates that about 60% of older adults worldwide have levels below 50 nmol/L (20 ng/mL).

Obesity and weight-loss surgery

Vitamin D is stored in fat tissue, so less of it circulates in the blood. The USPSTF reports that people with obesity have a 1.3- to 2-fold higher risk of being vitamin D deficient. Higher doses are often needed to reach the same level, and the link between vitamin D and belly fat is an active research topic. Gastric bypass and other weight-loss operations reduce absorption, and Cleveland Clinic notes that most people need vitamin D supplements for life after them.

Gut, liver and kidney diseases

Because vitamin D is absorbed with fat, conditions that disturb fat absorption lower it: celiac disease, Crohn's disease, ulcerative colitis and cystic fibrosis. Liver disease slows the first conversion step, and chronic kidney disease slows the second, so the active hormone runs short even when intake is normal.

Medicines that lower vitamin D

Some drugs speed up the breakdown of vitamin D or block its absorption. Cleveland Clinic and MedlinePlus list:

• glucocorticoids (steroids such as prednisone);
• anticonvulsants (seizure medicines such as phenytoin and phenobarbital);
• rifampin, an antibiotic used for tuberculosis;
• cholesterol-binding drugs (cholestyramine, colestipol);
• orlistat, a weight-loss drug, and laxatives.

Vitamin D deficiency symptoms: signs of low vitamin D

Low vitamin D is often silent. Cleveland Clinic stresses that you may have no signs or symptoms at all, especially when the deficiency is mild. When symptoms do appear, adults may notice:

• tiredness (fatigue);
• bone pain, often in the hips, lower back, pelvis or legs;
• muscle weakness, aches or cramps, trouble climbing stairs or rising from a chair;
• mood changes such as depression.

These signs are not specific, so only a blood test can confirm low vitamin D. Low mood deserves its own assessment; read more about depression symptoms and diagnosis.

Low calcium: tingling, cramps and twitching

When deficiency is severe and long-lasting, the gut absorbs too little calcium and blood calcium can fall (hypocalcemia). MedlinePlus describes the signs of low calcium as muscle cramps, spasms or stiffness, tingling in the lips, tongue, fingers and feet, and an irregular heartbeat; seizures can occur when calcium is extremely low. Severe muscle spasms are called tetany. Your calcium blood test is the key check when these symptoms appear.

Signs in children

In children, severe deficiency causes rickets: bone pain, muscle weakness, delayed growth and teeth, and bone deformities such as bowed legs or bumps along the ribs. Mild deficiency may only cause weak, sore or painful muscles.

What happens if vitamin D is low? Health effects

The parathyroid response and bone loss

When calcium absorption drops, the parathyroid glands release more parathyroid hormone (PTH). This keeps blood calcium normal by taking calcium out of the bones, a state called secondary hyperparathyroidism. Over time, bone becomes thinner and weaker. A high result on a PTH blood test next to a low vitamin D level is a classic sign that the deficiency is affecting your body.

Osteomalacia in adults

Osteomalacia means soft bones: the bone framework is there, but it is not properly mineralized. MedlinePlus lists fractures without a significant injury, muscle weakness and widespread bone pain, especially in the hips. Blood tests often show a high alkaline phosphatase (ALP), a high PTH and sometimes low calcium or low phosphorus. On a bone density scan, osteomalacia can look like osteoporosis. With treatment, healing should happen within 6 months.

Rickets in children

Rickets is the childhood form, which occurs before bone growth is complete. MedlinePlus notes that it is rare in the United States and most likely between 6 and 24 months of age or during growth spurts. Exclusively breastfed babies who get no supplement are at risk, because breast milk contains little vitamin D. The global consensus on nutritional rickets calls rickets and osteomalacia preventable public health problems.

Falls and fractures

Low vitamin D weakens muscles as well as bones. Reviews note that supplements can reduce falls in older adults who are deficient. In people who are not deficient, the picture is different: in the VITAL trial, 2,000 IU a day did not reduce fractures among more than 25,000 generally healthy US adults aged 50 and over.

How vitamin D deficiency is diagnosed

Diagnosis rests on the 25-hydroxyvitamin D test, which MedlinePlus calls the most accurate way to measure how much vitamin D is in your body. Fasting is usually not needed. Testing is mainly useful when you have symptoms, bone disease or a clear risk factor, such as malabsorption, weight-loss surgery, kidney or liver disease, osteoporosis or a medicine like phenytoin.

In 2021, the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against screening adults without symptoms (an "I" statement). The 2024 Endocrine Society guideline went further and suggests against routine testing in healthy adults, including people with obesity or dark skin, because no trial has shown that testing improves outcomes. Our vitamin panel blood test guide explains how vitamin D is often checked together with B12 and folate.

Vitamin D levels: deficiency and insufficiency thresholds

The Institute of Medicine (now the National Academies, IOM/NAM) set its intake targets so that 97.5% of people reach at least 20 ng/mL (50 nmol/L). The 2011 Endocrine Society guideline used higher categories that many labs still print, but the 2024 update no longer endorses any target level. To convert, 1 ng/mL equals 2.5 nmol/L. This short table helps you place a result; for full interpretation, use the vitamin D test guide linked at the top of this page.

Labs may use slightly different ranges, so always compare your result with the range printed on your own report.

Vitamin D deficiency treatment

Treatment aims to raise your level, then keep it there. The 2011 Endocrine Society guideline recommended either vitamin D2 or D3 for deficient patients, and today most clinicians start with vitamin D3.

Vitamin D2 or D3?

Vitamin D2 (ergocalciferol) comes from plants and fungi; vitamin D3 (cholecalciferol) is the form your skin makes and is found in animal foods. A meta-analysis of randomized trials found that D3 raised blood levels more than D2, especially when given as large, spaced-out doses; the difference faded with daily dosing. Cleveland Clinic notes that in the US you need a prescription for D2, while D3 is sold over the counter.

Typical repletion doses

There is no single official schedule, and your clinician will choose the dose from your level, weight, gut health and kidney function. Recent reviews describe these common approaches for adults:

• daily repletion: about 4,000 IU of vitamin D3 a day, or the same total given weekly or monthly;
• a loading course when quick correction is needed: 25,000 to 50,000 IU once a week for 4 to 6 weeks;
• maintenance afterwards: up to 2,000 IU a day (often 800 to 2,000 IU) to stop the deficiency from coming back.

As a rough guide, each extra 100 IU a day raises the blood level by about 1 ng/mL (2.5 nmol/L), so 2,000 IU a day adds about 20 ng/mL over a few months. In one study of deficient adults starting around 13.5 ng/mL, high-dose schedules brought 93% of them above 30 ng/mL by week 4.

The 2024 Endocrine Society guideline prefers daily, lower doses over large, infrequent doses for adults aged 50 and over who need vitamin D. People with obesity, malabsorption or weight-loss surgery often need higher doses, and people with severe kidney or liver disease may need active forms such as calcitriol, prescribed and monitored by a specialist.

Calcium, magnesium and follow-up

Vitamin D works with calcium, so your clinician will check that you get enough from food (700 to 1,300 mg a day depending on age, per the IOM). Magnesium is often checked at the same time, because low magnesium also causes cramps; read more about magnesium levels in blood. When deficiency caused symptoms, a repeat 25(OH)D test with calcium and phosphorus confirms that treatment is working, and calcium is worth checking with high doses.

Wondering about a popular high-dose habit? Our news analysis of taking vitamin D 5,000 IU a day explains why that dose sits above the safe upper limit.

How much vitamin D do you need? Prevention

The IOM/NAM Recommended Dietary Allowances, listed by MedlinePlus, assume minimal sun exposure:

• infants 0 to 12 months: 400 IU (10 mcg) a day;
• children and adults 1 to 70 years, including pregnancy and breastfeeding: 600 IU (15 mcg) a day;
• adults over 70: 800 IU (20 mcg) a day.

The Bone Health and Osteoporosis Foundation suggests 800 to 1,000 IU a day from age 50. One microgram equals 40 IU.

Vitamin D deficiency food: what to eat

Very few foods naturally contain vitamin D, so food alone rarely fixes a deficiency, but it helps prevent one. Good sources include:

• fatty fish such as salmon, trout, tuna, mackerel and sardines, and cod liver oil;
• egg yolks, beef liver and cheese (small amounts);
• mushrooms, especially those exposed to ultraviolet light;
• fortified foods: most US milk (about 400 IU per quart), many breakfast cereals, and some orange juice, yogurt, soy, almond and oat drinks and margarine. Check the label.

Sun exposure

A few minutes of sun on bare skin may cover daily needs for some people, but this varies with skin color, season, latitude and age. Because sun exposure raises skin cancer risk, MedlinePlus does not recommend more than a few minutes without sunscreen. You cannot get vitamin D toxicity from the sun.

Special populations

Babies and breastfed infants

The American Academy of Pediatrics recommends that all infants, including those who are exclusively breastfed, get at least 400 IU of vitamin D a day starting soon after birth. Infant formula is fortified, but breastfed and partly breastfed babies usually need drops.

Children and teens

The 2024 Endocrine Society guideline suggests vitamin D supplements without testing for everyone aged 1 to 18 years, to prevent rickets and possibly reduce respiratory infections.

Pregnancy

The same guideline suggests supplements in pregnancy because they may lower the risk of preeclampsia, stillbirth, preterm birth, small babies and newborn death. In the trials it reviewed, doses averaged about 2,500 IU a day. See also our page on blood tests during pregnancy.

Adults 75 and older

For adults 75 and over, the Endocrine Society suggests daily supplements because they may lower mortality; trial doses averaged about 900 IU a day.

Chronic kidney disease

Damaged kidneys make less of the active hormone, so deficiency and secondary hyperparathyroidism are common. Treatment is guided by a nephrologist, with calcium, phosphate and PTH checks. Your eGFR result shows how well your kidneys filter.

Vitamin D toxicity: how much is too much?

The tolerable upper intake level, the most that is safe for almost everyone without supervision, is 4,000 IU (100 mcg) a day from age 9. It is lower for younger children: 1,000 IU for infants 0 to 6 months, 1,500 IU at 7 to 12 months, 2,500 IU at 1 to 3 years and 3,000 IU at 4 to 8 years. MedlinePlus notes that toxicity usually appears only with doses above 10,000 IU a day, almost always from supplements.

Too much vitamin D raises blood calcium (hypercalcemia). Watch for nausea, vomiting, constipation, poor appetite, thirst, frequent urination, weakness, confusion and kidney stones. Treatment is to stop vitamin D; recovery is expected, but kidney damage can be permanent.

When to see a doctor

See your doctor if you have persistent bone pain, muscle weakness, frequent falls or a fracture after a minor injury, or if you belong to a risk group (malabsorption, weight-loss surgery, kidney or liver disease, long-term steroids or seizure medicines). Ask before taking more than 4,000 IU a day.

Call 911 or go to the emergency room if you or your child has:

• a seizure, or severe muscle spasms that do not stop;
• tingling around the mouth with cramps and a racing or irregular heartbeat;
• confusion, repeated vomiting or extreme thirst while taking high-dose vitamin D;
• trouble breathing.

Latest scientific advances in vitamin D deficiency

2024: a new Endocrine Society guideline

The Endocrine Society replaced its 2011 guideline in 2024. Using randomized trials only, it suggests vitamin D without testing for ages 1 to 18, adults 75 and older, pregnancy and high-risk prediabetes, but advises against doses above the RDA for healthy adults under 75 and against routine testing. A 2026 critical appraisal in Nutrients praised the method but noted open questions on doses and on people already deficient, who are outside the guideline's scope. In short: no routine test if you are healthy, but a real deficiency still needs treatment.

2023: vitamin D slows the move from prediabetes to diabetes

An individual-data meta-analysis of 3 trials in adults with prediabetes (Annals of Internal Medicine, 2023) found that vitamin D cut the risk of developing type 2 diabetes by 15%, with a 3-year absolute risk reduction of 3.3%. It also raised the chance of returning to normal blood sugar by 30%. Lifestyle changes remain the first step; see our prediabetes A1c guide.

2023: monthly vitamin D and heart events in D-Health

The Australian D-Health trial gave 21,315 adults aged 60 to 84 either 60,000 IU of vitamin D3 a month or placebo for up to 5 years. Major cardiovascular events were slightly less frequent with vitamin D (6.0% vs 6.6%), a difference that was not clearly significant overall, with fewer heart attacks.

2025: VITAL and cellular aging

In 1,031 VITAL participants, 2,000 IU of vitamin D3 a day slowed the shortening of telomeres, the protective caps on chromosomes, by about 140 base pairs over 4 years (NCT04386577). Earlier VITAL results showed a 22% lower rate of autoimmune disease over about 5 years, but no reduction in cancer, heart disease or fractures.

Ongoing trials

A University of Miami phase 4 trial (NCT07006714) is testing whether one high dose of vitamin D3 before hip or knee replacement corrects deficiency in 200 patients, with results expected after July 2027.

Which tests can help?

When low vitamin D is suspected or being treated, these tests are usually read together:

• 25-hydroxyvitamin D: the storage form, the test that defines deficiency;
• calcium: 8.8 to 10.3 mg/dL (2.20 to 2.58 mmol/L); low in severe deficiency, high with toxicity;
• phosphorus: 2.8 to 4.5 mg/dL in adults (about 0.90 to 1.45 mmol/L); often low in osteomalacia;
• PTH: 10 to 65 pg/mL (about 1.1 to 6.9 pmol/L); high in secondary hyperparathyroidism;
• alkaline phosphatase: 40 to 129 IU/L (0.68 to 2.19 µkat/L); high when bones are remodeling;
• magnesium: 1.7 to 2.2 mg/dL (0.70 to 0.91 mmol/L);
• creatinine and eGFR, to check kidney function before high doses.

Ranges from MedlinePlus; they vary between labs.

Glossary

• 25-hydroxyvitamin D (25(OH)D, calcidiol): the storage form of vitamin D measured by the blood test.
• Calcitriol: the active vitamin D hormone, made mainly in the kidneys.
• Cholecalciferol (D3) and ergocalciferol (D2): the two supplement forms of vitamin D.
• IU (international unit): dose unit; 40 IU equal 1 microgram.
• Osteomalacia: soft, poorly mineralized bones in adults; rickets is the childhood form.
• Secondary hyperparathyroidism: high PTH in response to low calcium or vitamin D.
• Hypocalcemia: low blood calcium; tetany is the muscle spasm it can cause.
• Tolerable upper intake level (UL): the highest daily intake considered safe without supervision.

Frequently asked questions

What are the symptoms of vitamin D deficiency?

Often none. When present, the most common signs of low vitamin D are fatigue, bone pain, muscle weakness, aches or cramps, and low mood. Severe deficiency can cause tingling and muscle spasms from low calcium, fractures from minor falls, and rickets in children.

What happens if vitamin D is low?

The body takes calcium from the bones to keep blood calcium normal, which over time leads to bone loss, osteomalacia or rickets, muscle weakness and more falls and fractures.

Can low vitamin D cause twitching?

Indirectly, yes. Severe deficiency can lower blood calcium, and low calcium makes nerves and muscles overexcitable: cramps, spasms, twitching and tingling in the lips, fingers and feet. Twitching has many other causes, so a calcium and magnesium check is useful.

How does vitamin D deficiency affect blood sugar levels?

Low vitamin D is linked with a higher risk of type 2 diabetes. In adults with prediabetes, a 2023 meta-analysis of 3 trials found that vitamin D lowered the risk of diabetes by 15%. It is not a treatment for diabetes itself.

What is the normal range for vitamin D?

The IOM/NAM considers 20 ng/mL (50 nmol/L) or above enough for most people, and above 50 ng/mL (125 nmol/L) probably too high. MedlinePlus adds that many experts recommend 30 to 80 ng/mL (75 to 200 nmol/L). Our vitamin D test guide details both scales.

How can I improve vitamin D deficiency quickly?

A supplement is the fastest and most reliable way. Your clinician may prescribe a short loading course, such as 25,000 to 50,000 IU once a week for 4 to 6 weeks, or about 4,000 IU a day, followed by a maintenance dose. Food and sensible sun help keep levels up afterward.

Which vitamin D deficiency tablets are best?

Vitamin D3 (cholecalciferol) raises blood levels more reliably than D2, especially when doses are spaced out. Ask your clinician for the dose; daily doses above 4,000 IU should only be taken under medical supervision.

Sources

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• Pilz S et al. — The 2024 Endocrine Society Guideline on Vitamin D: Comprehensive Summary and Critical Appraisal — Nutrients, 2026 — doi.org
• Ross AC et al. — The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know — J Clin Endocrinol Metab, 2011 — doi.org
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• Sosa-Henríquez M et al. — Rethinking Vitamin D Deficiency: Controversies and Practical Guidance for Clinical Management — Nutrients, 2025 — doi.org
• Dina MA et al. — Updated perspectives on vitamin D deficiency, screening, supplementation and clinical guidance — Cardiovasc Diabetol Endocrinol Rep, 2026 — doi.org
• Cui A et al. — Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022: a pooled analysis of 7.9 million participants — Front Nutr, 2023 — doi.org
• Tripkovic L et al. — 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 — doi.org
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• Pittas AG et al. — Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes: Individual Participant Data Meta-analysis — Ann Intern Med, 2023 — doi.org
• Manson JE et al. — Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease (VITAL) — N Engl J Med, 2019 — doi.org
• LeBoff MS et al. — Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults — N Engl J Med, 2022 — doi.org
• Hahn J et al. — Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial — BMJ, 2022 — doi.org
• Zhu H et al. — Vitamin D3 and marine omega-3 fatty acids supplementation and leukocyte telomere length: 4-year findings from VITAL — Am J Clin Nutr, 2025 — doi.org
• Neale RE et al. — The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality — Lancet Diabetes Endocrinol, 2022 — doi.org
• Thompson B et al. — Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial — BMJ, 2023 — doi.org
• University of Miami — Preoperative Single High-Dose Vitamin D for Correcting Deficiency in Hip and Knee Arthroplasty Patients (NCT07006714) — ClinicalTrials.gov — clinicaltrials.gov
• Endocrine Society — Vitamin D for the Prevention of Disease guideline resources — Endocrine Society, 2024 — endocrine.org
• US Preventive Services Task Force — Vitamin D Deficiency in Adults: Screening — USPSTF, 2021 — uspreventiveservicestaskforce.org
• MedlinePlus — Vitamin D — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — 25-hydroxy vitamin D test — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Osteomalacia — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Rickets — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Hypervitaminosis D — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Calcium Blood Test — Lab Tests — medlineplus.gov
• MedlinePlus — Vitamin D Test — Lab Tests — medlineplus.gov
• MedlinePlus — Calcium blood test — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Phosphorus blood test — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Parathyroid hormone (PTH) blood test — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — ALP blood test — Medical Encyclopedia — medlineplus.gov
• MedlinePlus — Magnesium blood test — Medical Encyclopedia — medlineplus.gov
• Cleveland Clinic — Vitamin D Deficiency: Causes, Symptoms and Treatment — Cleveland Clinic — clevelandclinic.org
• EMBL-EBI — ChEMBL: ergocalciferol and vitamin D receptor agonists — ChEMBL — ebi.ac.uk

Further reading

• Calcium blood test and the bone and mineral panel
• Magnesium deficiency: symptoms, causes and tests
• Vitamin B12 deficiency: signs, causes and treatment
• Folate deficiency symptoms and causes
• Kidney function panel: how to read it
• B12 deficiency and fracture risk after 50

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