[Calcium and vitamin D in osteology]

Calcium homeostasis is of paramount physiological and pathophysiological importance in health and disease. This article focuses on the skeletal relevance of calcium and vitamin D in daily clinical practice. Against the background of an endemic vitamin D deficiency in Germany and the increasing number of patients with drug-induced (proton pump inhibitor) enteral calcium uptake problems, it is of critical importance to understand that a vitamin D level of > 30 µg/l (> 75 nmol/l) is required for intact skeletal mineralization and that furthermore, a physiological gastric acid production is essential for a normal enteral uptake of calcium from foodstuffs. Therefore, a guideline-conform handling of vitamin D and calcium substitution is required not only for patients with rheumatoid diseases but also for any osteological therapy.