Vitamin D levels very low

Question
Hi Melissa

I don't know if you can answer this or not, so I'll give it a shot.
First of all thank you for offering your help on this site.  I am an expert on another site (orthopedics)but I answer questions from a patient's point of view.  I have had eight hip replacement surgeries due to prednisone use to maintain a successful living donor transplant done in 1972 when I was 14.   

In general I have been healthy except for AVN due to prednisone usage.  I currently take many medications and my nephrologist is wonderful at monitoring the meds.  

Just recently I had blood tests which showed my Vitamin D level to be 40.  I was told the normal level is about 130.  So my nephrologist immediately put me on ergocalciferol.  I am to take one tablet once a week and he also suggested that I take a multivitamin.  I am to have blood tests again to check phospherous levels in two weeks from now.  My phospherous was a bit high.  I also had kidney stones in the graft about 16 years ago and am not allowed to eat much dairy.  I take fosamax weekly.

I have five questions for you:
1. Normally how long would it take for the level of Vitamin D to drop so low?  The reason I ask this is because for over two years, I have been getting severe cramping in my toes.  The cramps are so bad that that you can see the toes actually moving.  When I asked my doctors about this, they suggested potassium and drinking more water, neither of which helped.

2. In taking the Ergocalciferol (1.25 mgs) per week, and a multivitamin containing 400IUS of Vitamin D,  how long should it take for the levels to rise to a normal level of vitamin D.

3. I am 49 years old and in perimenopause.  For the last three months I have not been menstruating, could this be a symptom of low vitamin D levels?

4.  I have also been having clicking sounds and pain in both shoulders and sometimes it hurts when I move the shoulders.  This is has been more recent (within the past 6 months), it almost feels as if the shoulders are going to dislocate and then the pain goes away.  X-rays were taken and the shoulders look fine on the X-ray. When I complained about this to my primary physician (before the vitamin D levels were found to be low), he suggested to lift five pound weights to build muscle.  Could this pain be related to the low vitamin D levels?

5. What are the most common problems that you have seen related to vitamin D levels as low as mine are?  I seem to have many small bothersome problems and I don't know if they are related to the levels of Vitamin D.  My primary doctor wanted me to take an antidepressant saying that many of these symptoms are related to general anxiety disorder or depression.  I am neither anxious or depressed and I don't think my symptoms are related to depression and I feel that he is pushing a therapy that is not necessary with prescribing antidepressants.  

The most bothersome of my symptoms are:
1. Shoulder pain and pain in the area between the breasts that feels like an ache or pulling sensation
2. Absence of menstruation (although I am in perimenopause)
3. Fatigue
4. lack of appetite and inability to gain weight (I am 5 foot 5 and weigh 117).

All other blood values are normal.

Thank you for taking the time to read this, and answer my questions.  I do appreciate it.

Sharon Davis

Answer
You're right, I can't answer all of your questions. But I can take a stab at a few.
1. I don't know how long it would take to manifest vitamin D deficiency. If you were to throw a person in a dark room and feed them a diet completely lacking in vitamin D, their blood levels would start dropping in weeks, but symptoms would probably take longer. Because your case is due to prednisone, I would guess that years is a reasonable estimate.

2. Not long at all. Remember vitamin D is fat soluble, so everything you swallow will stay with you.

3. Have your doctor draw FSH and LH levels to sort that one out. These are hormones that normally signal the ovaries during your cycle. As the ovaries fail, LH and FSH have to start signalling a lot louder to get the ovaries' attention. If your LH and FSH levels are starting to go up, then you have plain old menopause. If they're not, then it could be a prednisone/endocrine problem-your best bet would be to visit a gynecologist at a big, academic hospital.

4. Yes. Chronic vitamin D deficiency in the adult can definitely present as odd musculoskeletal pain syndromes.

5. Chronic musculoskeletal pain syndromes are common, followed by fractures soon after menopause. There isn't a lot known about the minor symptoms, because most people are just so focused on the bone health.

Finally the fatigue/weight issues-You say you are not anxious or depressed, and I believe you. I also think your doctor is right to consider an antidepressant. You have several problems that can cause an imbalance of brain chemicals-chronic pain is the major one, but you have many more, including prednisone and a history of kidney disease. Having this imbalance is the most common cause of the syndrome of "clinical depression", which often includes low mood, crying, inability to enjoy yourself, increased pain sensation, inability to gain weight, and fatigue. But most people don't get all of those symptoms. It's possible to have a serious brain chemical imbalance and have a completely normal mood. If that's the case, then taking antidepressants for a few months will decrease your pain, give you energy, and help you get up to a healthy weight. If not, then you'll be able to taper off the pills in a matter of weeks.
However, you may want to give the vitamin D pills a few months, because your muscle and joint pains should calm down as your vitamin D levels come back up. You don't want to start antidepressants right away and not know if your pain is better because of the vitamin D or the antidepressants.

I hope I've been able to help you out at least a little, and if you have any other questions feel free to ask!
Melissa

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