The use and interpretation of assays for vitamin D and its metabolites

Vitamin D is essential for the maintenance of calcium and bone metabolism in humans. The recommended daily allowance (RDA) for vitamin D in the United States of 200 IU (5.0 micrograms) is reasonable for adults who receive some exposure to sunlight; however, in the absence of any exposure to sunlight, this recommendation may be 2 to 3 times lower than that actually required to satisfy the body's needs. Vitamin D was first measured by bioassays. However, bioassays became obsolete in light of the revelation that vitamin D must be activated first in the liver to 25-hydroxyvitamin D (25-OH-D) and then in the kidney to 1,25-dihydroxyvitamin D [1,25(OH)2D] before becoming biologically functional. Current assays measure circulating concentrations of vitamin D, 25-OH-D or 1,25(OH)2D. The serum vitamin D concentration is of value for determining the role of sunlight in producing vitamin D in skin and as a provocative test to determine the absorption of vitamin D in patients with malabsorption syndromes. The serum concentration of 25-OH-D is most valuable for determining the overall vitamin D status of an individual, since it is an average of dietary and sunlight-induced vitamin D. The measurement of the serum 1,25(OH)2D concentrations has been most useful in evaluating disorders in calcium and bone metabolism related to acquired and inborn errors in the conversion of 25-OH-D to 1,25(OH)2D.