Vitamin D: Biochemistry and clinical applications

Major advances in the field of vitamin D metabolism have been achieved in the past decade that have considerably enhanced our understanding of a variety of metabolic bone diseases which include the rachitic and osteomalacic syndromes and parathyroid gland disorders. Delineation of the biochemical structure, metabolic pathways, mechanisms regulating synthesis, and physiologic functions has established that the compound should more appropriately be considered a hormone. Obligatory sequential, two-step hydroxylation of the prohormone, vitamin D, is necessary before physiologic action occurs. Initial hydroxylation occurs mainly in the liver while the second hydroxylation occurs exclusively in the kidney. The physiologically active form of the hormone, 1,25-(OH)₂-D, coordinates with parathyroid hormone (and probably calcitonin) in promoting homeostasis of both extra-cellular calcium and phosphorus and the skeletal system. This article reviews the basic metabolism of vitamin D, the modes of physiologic action, the endocrine features of vitamin D and its relationship to parathyroid hormone, and discusses the important medical applications of this information.