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It has been suggested that for both children and adults, 25-OHD should be maintained at a level of greater than 30 ng/ml (Holick, 2009 Pazirandeh and Burns, 2018). Sub-clinical vitamin D deficiency may be associated with an increased risk of falls and fractures in the elderly, decreased immune function, bone pain, and possibly cancer and cardiovascular health. Recent studies suggested that vitamin D is important not only for promoting bone health in children and adults, but also for other health benefits, including reducing the risk of chronic diseases. The serum parathyroid hormone (PTH) level typically is inversely related to 25-OHD levels, and is a useful secondary laboratory indicator of vitamin D insufficiency. Most experts, however, agree that 25-OHD of less than 20 ng/ml is considered to be vitamin D deficiency, whereas a 25-OHD concentration of 21 to 29 ng/ml is considered to be insufficient. Moreover, there is no consensus on the optimal 25-OHD concentration for skeletal or extra-skeletal health. The lower limit of normal 25-OHD levels is dependent on the geographical location and sunlight exposure of the reference population (range of 8 to 15 ng/ml).
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Serum 25-OHD is the best index for vitamin D status while serum 1,25-OH(2)D provides no information about vitamin D status and is often normal or even increased as the result of secondary hyper-parathyroidism associated with vitamin D deficiency. Vitamin D and its metabolites have a significant clinical role because of their inter-relationship with calcium (Ca) homeostasis and bone metabolism. Second, in the kidney on carbon 1 to form 1,25-OH(2)D. First, in the liver on carbon 25 to form 25-hydroxyvitamin D (25-OHD).
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Vitamin D that is synthesized in the skin via photo-isomerization or ingested in the diet via intestinal absorption is biologically inert and requires 2 successive hydroxylations. Calcitriol (1,25-dihydroxycholecalciferol ) is the biologically active form of vitamin D found in the body.
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The term vitamin D also refers to metabolites and other analogs of these substances. Vitamin D (calciferol) refers to a group of lipid-soluble prohormones the 2 major forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Aetna considers measurements of serum 25-hydroxyvitamin D experimental and investigational for routine preventive screening.