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For a long time, we have been aware of the impact of severe Vitamin D deficiency which manifests as rickets. Rickets is a childhood disease characterised by growth retardation, deformities of the legs, bending of the spine, knobby projections of the ribcage, and weak and toneless muscles (Holick MF, 2006). A disease of the 19th Century, rickets was virtually eradicated half a century ago as diets improved in postwar Britain, however, there has been a re-emergence of the disease in recent years. In January 2011 Dame Sally Davies, the government's chief medical officer, recommended all children aged six months to five should be given vitamin D supplements, especially during winter months when the opportunity for sun exposure is reduced. Advice for children to wear a high factor sunscreen and remain covered up while outdoors is partly felt to be behind the reason for the re-emergence of rickets (Lowdon J, 2011)
Aside from rickets, epidemiologic evidence links vitamin D deficiency to autoimmune disease, cancer, cardiovascular disease, depression, dementia, infectious diseases, musculoskeletal decline, and more (Haines ST, 2012). Common manifestations of vitamin D deficiency are symmetric lower back pain, muscle weakness, muscle aches, and throbbing bone pain elicited by pressure over the sternum or tibia (Bordelon P, 2009).
More subtle signs of vitamin D deficiency may include fatigue and increased susceptibility to infection however an individual may be completely asymptomatic and still be deficient.
In addition to reduced sun exposure, being pregnant or breastfeeding can increase the risk of Vitamin D deficiency, as can wearing very covering clothing and/or spending a lot of time indoors. Babies and young children under the age of five and older people aged 65 years and over are also at increased risk.

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