Vitamin D and bone health.

Vitamin D plays an essential role in maintaining a healthy mineralized skeleton for most land vertebrates including humans. Sunlight causes the photoproduction of vitamin D3 in the skin. Once formed, vitamin D3 is metabolized sequentially in the liver and kidney to 1,25-dihydroxyvitamin D. The major biological function of 1,25-dihydroxyvitamin D is to keep the serum calcium and phosphorus concentrations within the normal range to maintain essential cellular functions and to promote mineralization of the skeleton. Most foods do not contain any vitamin D. Foods fortified with vitamin D have a variable amount present and cannot be depended on as a sole source of vitamin D nutrition. Exposure to sunlight provides most humans with their vitamin D requirement. Aging, sunscreen use and the change in the zenith angle of the sun can dramatically affect the cutaneous production of vitamin D3. Vitamin D insufficiency and vitamin D deficiency is now being recognized as a major cause of metabolic bone disease in the elderly. Vitamin D deficiency not only causes osteomalacia but can exacerbate osteoporosis. It is generally accepted that an increase in calcium intake to 1000-1500 mg/d along with an adequate source of vitamin D of at least 400 IU/d is important for maintaining good bone health.