Vitamin D Deficiency

Vitamin D deficiency is very common in refugee patients (Aucoin et al., 2013). Because of this, instead of screening for vitamin D deficiency, we simply offer vitamin D supplementation to all refugees and refugee claimants. This is especially important for women of child bearing age and children.

We usually prescribe supplements for 3 months and renew the prescription if the patients have been taking it.
 

Here are the usual initial vitamin D supplements we prescribe to our refugee patients (all covered by the Interim Federal Health Program):

  • Children

D-Vi-Sol or Jamp Vitamin D drops 800 UI (2 mL) once daily​

  • Adults

Vitamin D3 10,000 UI tablet once weekly

 

RICKETS

Refugee children with severe vitamin D deficiency may develop rickets (deficient mineralization at the growth plate). It is more commonly seen in breastfed dark-skinned children between the age of 3 months and 3 years who have not received vitamin D supplementation.

Signs of rickets include: frontal bossing, delayed closure of  fontanelles, enlarged costochondral junctions ("rachitic rosary"), widening of the wrist, bowing of the legs (if weight-bearing), elevated alkaline phosphatase.​


Vitamin D Deficiency

Rickets Photos. Thachers. Credit: Dr. Tom Thacher. With permission.

Vitamin D Deficiency

Rickets. Radiopaedia. Case courtesy of Dr Angela Byrne, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8116">rID: 8116</a>

Patients with rickets require higher doses of vitamin D and close follow-up. They should be rapidly referred to a Pediatrician. The management of rickets is outside the scope of these guidelines.