GPAtlas🧭 When to suspect (and who to test)
Vitamin D is a fat-soluble vitamin that regulates calcium and phosphate homeostasis; deficiency causes osteomalacia in adults and rickets in children. It is common in the UK, but the clinical skill is knowing who to test rather than testing everyone.
Test when there are musculoskeletal symptoms that could be attributed to deficiency – persistent bone pain (ribs, hips, pelvis, feet), proximal muscle weakness, suspected osteomalacia, or chronic widespread pain with osteomalacic features – or where there is a specific clinical reason, such as before starting a potent antiresorptive, or when investigating malabsorption.
Do not routinely test asymptomatic people. Those at higher risk who have no symptoms – darker skin (African, African-Caribbean, South Asian), low sun exposure (housebound, institutionalised, skin routinely covered), malabsorption, or on enzyme-inducing drugs – should simply be advised to supplement without a blood test. Severe deficiency is what threatens bone, so the test earns its place only where the result changes what you do.
| Serum 25(OH)D | Status | Action |
|---|---|---|
| < 25 nmol/L | Deficient | Treat – loading course then maintenance |
| 25–50 nmol/L | May be inadequate (insufficiency) | Treat if symptomatic or high-risk; otherwise lifestyle advice + maintenance supplement |
| > 50 nmol/L | Sufficient | Reassure; general-population prevention advice |
Source: Royal Osteoporosis Society · SACN
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