Vitamin D is the generic term used to designate Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol). Humans naturally produce Vitamin D3 when the skin is exposed to ultraviolet sun rays.
Vitamin D3 is metabolised, mainly in the liver, into 25-Hydroxyvitamin D3 (25OH D3) which is the main form of Vitamin D circulating in the body. 25OH D3 is a precursor for other Vitamin D metabolites and has also a limited activity by itself. The most active derivative is 1,25-hydroxyvitamin D3, produced in the kidney (or placenta) by 1-hydroxylation of 25OH D3.
25OH Vitamin D stimulates the intestinal absorption of both calcium and phosphorus and also bone resorption and mineralisation.25OH Vitamin D might also be active in other tissues responsible for calcium transport (placenta, kidney, mammary gland …) and endocrine gland (parathyroid glands, beta cells…).
Vitamin D3 and Vitamin D2 are also available by ingestion through food or dietary supplementation. Vitamin D2 is metabolised in a similar way to Vitamin D3 and both contribute to the overall Vitamin D status of an individual. It is very important to measure both forms of 25OH Vitamin D equally for a correct diagnosis of Vitamin D deficiency, insufficiency or intoxication.
Vitamin D deficiency is an important risk factor for rickets, osteomalacia, senile osteoporisis, cancer and pregnancy outcomes. The measurement of both 25OH Vitamin D forms is also required to determine the cause of abnormal serum calcium concentrations in patients. Vitamin D intoxication has been shown to cause kidney and tissue damages.
All current 25OH Vitamin D assays measure the sum of the bound and free forms.
Free 25OH Vitamin D seems to be a better marker of Vitamin D status than total 25OH Vitamin D for:
- Conditions affecting the binding proteins concentrations
- Liver disease
- Renal disease
- Osteoporosis/Bone mineral density
- Respiratory disease
- Intensive care
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