Vitamin D (Vit D) has multiple roles in human health. Vit D deficiency is a common, but often under-diagnosed condition with serious complications. Deficiency is predominantly common in the geriatric population, and has been associated with increased risk of musculoskeletal, neuropsychiatric, cardiovascular, endocrine and oncologic disease. Although the morbidity of Vit D deficiency is well known in the elderly and among children, physicians are unlikely to consider it as a diagnosis in young adults, even when it is symptomatic [1] . Generally, Vit D is obtained through exposure to UVB radiation in the form of sunlight and cutaneous Vit D production. The season, sun avoidance, sunscreen protection and types of cultural dress can all limit vitamin D production [2] .

The endocrine society clinical practice guideline recommends that clinicians screen for Vit D deficiency in people at risk for deficiency, such as obese individuals, blacks, pregnant and lactating women, patients treated with certain medications (anticonvulsant, glucocorticoids, antifungals such as ketoconazole) and patients with malabsorption syndromes. There are no guidelines for screening individuals who are not at risk [3] . According to some research studies, Vit D is particularly important for women and children [4] - [6] .

A comprehensive MEDLINE search was conducted. No data were found concerning the Vit D status among urban Bedouin women of childbearing age.

The objectives of the research:

1) Determining the prevalence of the Vitamin D deficiency among the Bedouin women of childbearing age in an urban population of one family doctor practice in Southern Israel.

2) Identifying the causes for the physicians’ reasons for testing Vit D levels in the blood, such as the complaints or symptoms causing the doctor to suspect Vit D deficiency.

3) Identifying diseases associated to Vit D deficiency in our sample, comparing them to the known data given in the literature.

The research study is retrospective and descriptive.

Median age was 37 years old. Most of them were multipara (Table 1). Musculoskeletal pain was the major complaint (49.8%). The group of neuro-psychiatric diseases associated to Vit D deficiency was slightly more (12.9%) than other conditions (Table 2). In 80.7% of study population levels of Vit D were less than 10 ng/ml, and in the rest of the population (19.3%) the levels were between 10 to 20 ng/ml (Figure 1).

In our research we found very low levels of Vit D in study population, along with different features or symp-

toms of vitamin D deficiency in the majority of women. Any of the surveyed patients had no normal or close to normal Vit D level. When we started to elucidate the phenomenon, we understood that we have more questions than answers: How can this phenomenon be explained? How does it influence the wellbeing of the women? What is the kind of problems we should anticipate in the future?

The list of organs and body systems in which Vit D plays a functional role is constantly increased. The precise role of low Vit D in the pathogenesis of some diseases is unclear. There are many controversies in current literature whether the associations are causal or due to confounding [7] - [10] .

We did not find an association between low Vit D and specific diseases or malignancy. Possibly this lack of association can be explained by the relatively young age of women or by the small sample size. A majority of women suffered from different kinds of pain (pain of limbs, general pain, headache, etc.). Possibly this presentation among patients with these complains might be an additional guideline for primary physicians to check levels of Vit D in high risk population such as ours. Some research’s investigated connection between fibromyalgia and Vit D, and didn’t find association between low level of vitamin D and a fibromyalgia [11] . This investigation did not show any direct connection between low levels of Vit D to obesity, skin color, or wearing a face cover. In addition, correlation between frequency of visits to the clinic and the number of complains was not significant (Table 3). We suppose that very low level of Vit D in Bedouin population is combined with a number of sociodemographic factors and lifestyle. Radical changes in lifestyle resulted from urbanization of the Be- douin population, as well as exposure to modern lifestyle. The population of Bedouins in the Negev is about 260,000, half of whom live in the city of Rahat, the other little towns and villages. The rest live in non-recog- nized rural communities. The Bedouins are desert people, but the ancient traditional lifestyle led by the Bedouin people is disappearing, pushed aside by the modern lifestyle of the western world, bringing to an end the no- madic life of the Negev Bedouins. Bedouin women in Israel typically marry young and raise large families. Having an average of five children gives them a strong identity as a mother and homemaker, along with great self esteem and social standing. The urbanization process has lead to a significant drop in the level of physical activity, outdoor activity, changes in food consumption patterns, uptake of large amounts of phytates by eating unleavened bread that can lead to violation of level of calcium and Vit D [12] , and limited exposure to sunlight as a result of their traditional, extensive clothing. These factors play an important role in our results of prominent Vit D deficiency in this population.

In lieu of our findings and in order to prevent serious health problems, Vit D screening plan should be seriously considered and discussed among those servicing this population with high risk of deficiency. No doubt, that even very low-level Vit D deficiency can be indicative of disturbances which can be prevented or reversed by

early diagnosis and prompt medical treatment. More extensive research investigations should substantiate our findings.