What are the key clinical signs and symptoms to consider when assessing a patient for vitamin D deficiency?

When assessing a patient for vitamin D deficiency, key clinical signs and symptoms to consider include musculoskeletal complaints such as bone pain and muscle weakness, which are often the earliest and most common manifestations. Patients may report diffuse bone discomfort, particularly in the lower back, hips, pelvis, and legs, alongside proximal muscle weakness that can impair mobility and increase fall risk. In more severe or prolonged deficiency, signs of osteomalacia such as bone tenderness and fractures may be evident. Additionally, nonspecific symptoms like fatigue and general malaise can be present but are less specific. In children, vitamin D deficiency may present with rickets, characterized by skeletal deformities and delayed growth. It is also important to consider risk factors such as limited sun exposure, darker skin, older age, and certain medical conditions that impair vitamin D metabolism or absorption. While hypertension has been associated with vitamin D deficiency in some studies, it is not a primary clinical sign but may be a related comorbidity. Overall, clinical assessment should focus on musculoskeletal symptoms and risk factors to guide further biochemical testing and management NICE NG239 Demay et al. 2024.