Vitamin D (Calciferol) deficiency in Africans: Diagnosis, Treatment and Prevention


By: Victoria Iyeduala (Freelance Health and Wellness Writer). Medically reviewed by the DLHA Team.

Aafrican couple sitted and hoding a container of vitamin D supplements

African couple sitted and holding a container of vitamin D supplements.





Vitamin D deficiency causes a number of serious health problems, and you should do all you can to avoid it. Because calcium and phosphorus are particularly essential minerals for making and maintaining healthy bones, vitamin D deficiency causes bone problems that create difficulties in your daily life.


Read on to discover what happens when your body doesn't have enough vitamin D and how to treat and prevent vitamin D deficiency.



What happens if your vitamin D levels are too low?


Vitamin D deficiency causes a series of health problems, including:

  • Calcium deficiency
  • Secondary hyperparathyroidism
  • Osteomalacia and rickets
  • Osteoporosis
  • Phosphorus deficiency


Calcium deficiency (hypocalcemia)


You need vitamin D to absorb a sufficient amount of calcium – about 30 to 40% – from your diet. Without vitamin D, your body absorbs less calcium, about 10 to 15%.


Vitamin D also enables calcium reabsorption in the kidneys so that too much calcium doesn't pass out of your body through urine. Vitamin D deficiency hinders this process.


Inadequate absorption of calcium can cause calcium deficiency or hypocalcemia – lower than normal calcium levels in your blood. Unnoticed and untreated calcium deficiency causes secondary hyperparathyroidism.


Symptoms usually show up when calcium deficiency becomes severe. They include:

  • Osteomalacia
  • Rickets in children
  • Osteoporosis
  • Mouth numbness
  • Tingling feeling in hands and feet
  • Muscle cramps
  • Depression


Secondary hyperparathyroidism


Hyperparathyroidism is when your parathyroid gland is overactive. Secondary hyperparathyroidism is when this over activity is caused by severe calcium deficiency.


When the parathyroid glands are overactive, they produce excess parathyroid hormone (PTH). PTH regulates calcium and phosphorus levels in the blood.


In severe calcium deficiency, more PTH is produced to increase blood calcium levels by taking calcium from your bones (bone demineralisation). This leads to having soft bones that break easily (osteomalacia in adults and rickets in children) and also increases your risk of osteoporosis.


Hyperparathyroidism can also lead to phosphorus deficiency. 


Osteomalacia, rickets and osteoporosis


When your body starts to take too much calcium from your bones, they begin to soften. This condition is called osteomalacia. Soft bones are weak and break easily. You may fall often because your bones can't hold up your body weight.


In children, the bones soften because there's not enough calcium to make strong bones. This is called rickets. Children with rickets have poor growth and development. They grow weak teeth and misshapen bones like bowed legs.


Symptoms of osteomalacia include:

  • Muscle and joint pain
  • Muscle spasms
  • Waddling or duck-like walk
  • Falling often
  • Bone pain, especially when you exert yourself, e.g. carrying a heavy object
  • Deformed spine, hands, legs or pelvis
  • Seizures




This is a condition in which your body makes fewer new bones to replace old bones. Because enough new bones are not created as you lose old bones, your bones become fragile and can easily break when you fall.


Osteoporosis usually occurs as you age. However, how you maintain healthy levels of calcium and phosphorus as a young person determines how early it starts and how serious it'll get.


Osteoporosis usually goes unnoticed until you break a bone

  • due to a fall from a height that normally wouldn't cause a break
  • from bending down, lifting objects or coughing


So, vitamin D, calcium and phosphorus deficiencies can increase your chance of early onset of osteoporosis and its severity.


Phosphorus deficiency (hypophosphatemia)


60% of the phosphorus you get from your food is absorbed into your body. However, vitamin D helps increase this amount to 80%.


Severe vitamin D deficiency ends up causing calcium deficiency, which leads to secondary hyperparathyroidism. Hyperparathyroidism causes your kidneys to excrete too much phosphorus.


This wastage of phosphorus is called phosphaturia. It leads to phosphorus deficiency or hypophosphatemia – an unhealthy low amount of phosphorus in your blood. Phosphorus deficiency can also cause rickets in children and osteomalacia in adults.


Signs of phosphorus deficiency include:

  • Bone disorders like osteomalacia and rickets
  • Bone pain
  • Muscle weakness
  • Higher risk of getting infections
  • Burning or tingling feeling in your hands, arms, legs and feet
  • Difficulty controlling your hands, arms, legs, feet and eyes (ataxia)
  • Confusion


Other complications


More complications of vitamin D deficiency can include:

  • Dental health issues
  • Heart failure



How do you prevent vitamin D deficiency?


The best ways to prevent vitamin D deficiency are through:

  • Exposure to sunlight
  • Eating foods containing vitamin D
  • Taking Vitamin D supplements


Exposure to sunlight


The fear of skin cancer discourages skin exposure to sunlight. However, the World Health Organisation (WHO) says that exposing your face, arms and hands to sunlight for 5 to 15 minutes during summer two to three times weekly is safe and enough to maintain adequate vitamin D levels. Africans, especially light-skinned people, in countries closer to the equator need less exposure because there's almost always adequate sunshine.


Eating foods rich in Vitamin D


You should also add foods that contain vitamin D to your diet, such as

  • fatty or oily fish like sardines, mackerel, salmon, trout and herring
  • fish liver oils, e.g. cod liver oil
  • liver meats
  • egg yolk
  • cheese
  • mushrooms
  • vitamin D-enriched food products like milk, fruit juices, cereal and flour


Taking Vitamin D supplements


You should take vitamin D supplements if you have a high risk of deficiency. Vitamin D oral supplements, vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol) are available over the counter. D3 is more effective than D2.


Check the table below for the recommended daily intake, measured in International Units (IU) and micrograms (mcg or μg), of vitamin D3 supplements.

Recommended daily intake of vitamin D by age

Table showing recommended daily intake of vitamin D by age. Adapted from:

Click on image to enarge


You should do routine checkups if you're at a high risk of developing vitamin D deficiency to ensure you maintain sufficient vitamin D levels.



How is vitamin D deficiency diagnosed?


Since most people with vitamin D deficiency do not exhibit symptoms early, high-risk individuals should be routinely screened.


Healthcare professionals use a blood test to check your vitamin D levels to determine if you're deficient or need to up your vitamin D intake to prevent deficiency.


The blood test measures the level of a form of the vitamin in blood (known as 25-hydroxyvitamin D or calcidiol).


The recommended normal blood level of 25-hydroxyvitamin D varies. However, if your blood serum level of 25-hydroxyvitamin D is:

  • Below 75 nmol/L (30 ng/mL), you may be at risk of vitamin D deficiency.
  • Below 50 nmol/L (20 ng/mL), you're considered to be vitamin D deficient. This level is considered to be inadequate for proper bone and overall health.
  • Below 30 nmol/L (12 ng/mL), you're considered to be severely vitamin D deficient. This level is associated with rickets in infants and children and osteomalacia in adults.
  • Above 125 nmol/L (50 ng/mL), you may have too much vitamin D. This is considered not good for your health.



How is vitamin D deficiency treated?


You need to put more vitamin D into your body to treat its deficiency and recover well. The amount of vitamin D you need depends on the severity of the deficiency and what is causing it.


Your doctor may recommend the following as well as treat any underlying condition causing the deficiency. :

  • Enough sun exposure possible without harm
  • Eating a healthy vitamin-rich diet
  • Taking vitamin D supplements





Vitamin D deficiency is a serious health condition that causes bone disorders like osteomalacia, rickets and osteoporosis. You can up your vitamin D levels by spending time in the sun, eating vitamin D-rich foods and taking vitamin D3 supplements. If you're at risk of having vitamin D deficiency, frequently check with your doctor to ensure you're maintaining adequate levels of the vitamin.




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Published: November 11, 2023

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