Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency.

The seasonal variation of 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol was analyzed in 240 elderly subjects (mean age: 78 yr) in Belgium. Serum 25-hydroxycholecalciferol was lowest from February until May (mean levels less than 25 nmol/L). Summer peak levels were, however, not higher than nadir levels in younger control subjects. A seasonal variation in total and free 1,25-dihydroxycholecalciferol concentrations was also observed in the geriatric population with a nadir in February and March (50 +/- 24 pmol/L). The peak values in summer (110 +/- 33 pmol/L) were not different from those of the younger controls. Serum calcium and phosphate were decreased whereas alkaline phosphatase and parathyroid hormone were increased throughout the year in the geriatric patients. Oral 25-hydroxycholecalciferol treatment rapidly normalized serum 1,25-dihydroxycholecalciferol concentrations in vitamin D-deficient subjects. Deficiency of both the vitamin D substrate and hormone is frequent in the elderly population in Belgium.