25-hydroxyvitamin D2/D3 (calcidiol/calcifediol) in serum
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Indications
- evaluation of vitamin D deficiency
- evaluation of hypervitaminosis D
- inflammatory bowel disease (IBD)
- low serum 25-OH vitamin D is common & associated with higher morbidity & disease severity in patients with IBD[21]
Reference interval
- 14-60 ng/mL (35-150 nmol/L); 75-185 nmol/L[18]
- considerable variability across different assays (as much as 10 ng/mL)[9]
- levels >= 20 ng/mL appear to be adequate[10][22]*
- levels >= 24.4 ng/mL associated with lowest rates of hip fracture & nonvertebral fractures[17]
- levels 30-40 ng/mL deemed adequate for bone health[1]
- serum levels lower in blacks than in whites[14]
* Institute of Medicine recommendations[22]
Clinical significance
- circulating levels of 25-hydroxyvitamin D3 provide the best overall assessment of vitamin D status
- higher levels are associated with lower risk of skin cancer (non-melanoma) in elderly men
- higher levels are associated with diminished risk of colon cancer[5][27]
- higher levels associated with diminished risk for any cancer (RR=0.8 for highest vs lowest quartile)[26]
- low levels associated with cognitive impairment in the elderly[6]
- low serum 25-OH vitamin D is associated with an increase in all cause mortality[10][13][28]
- low free serum 25-OH vitamin D is the best predictor of mortality[28]
- compared with the highest quintile of serum 25-OH vitamin D, the lowest quintile was associated with increased risk for
- all-cause mortality (RR=1.57)
- cardiovascular mortality (RR=1.41-1.65)[19]
- low serum 25-OH vitamin D may be a marker of poor health rather than a cause of premature mortality[19]
- women with serum 25-hydroxyvitamin D levels < 12 ng/mL with 43% higher risk of multiple sclerosis within 9 years than those with levels > 20 ng/mL[25]
Increases
- sunlight, tanning booths[18]
- pharmaceutical agents:
- in vivo effects
- etidronate (oral)
- estrogen-containing contraceptive (20%)[24]
- in vivo effects
- clinical disorders
- vitamin D intoxication
- excessive exposure to light
- frailty[7]
- hypercalcemia associated with lymphoma
Decreases
- pharmaceutical agents
- clinical disorders
- vitamin D deficiency
- malabsorption
- osteomalacia
- biliary cirrhosis & portal cirrhosis
- renal osteodystrophy (some cases)
- osteitis fibrosa cystica
- thyrotoxicosis
- rickets
- hypoparathyroidism (< 3 ng/mL, < 7.5 nmol/L)
- pseudohypoparathyroidsm
- primary hyperparathyroidism (2-11 mg/mL, 6-28 nmol/L)
- chronic renal failure (0.5-1.5 ng/mL, 1-4 nmol/L)
- frailty[7]
- hypercalcemia of malignancy (except lymphoma)
- diabetes mellitus type 2[20]
- suboptimal 25-OH vitamin D levels associated with increased mortality[3]
- low 25-OH vitamin D levels may be a marker of poor health[15]
* Plasma levels decrease with age & pregnancy & vary with the extent sunlight exposure.
Methods
- HPLC*, RIA
- RIA measures both 25-OH vit-D2 & 25-OH vit-D3
- substantial variation in results by RIA methods[2]
* 'gold standard'[2]
Specimen
- serum or plasma (heparin)
- stable at room temp for 72 hours
- store frozen; stable indefinitely at -20 degrees C
Notes
- easier to measure than calcitriol
- cost is about $200 in 2008
More general terms
More specific terms
Additional terms
- 25-hydroxyvitamin D2; 25-hydroxyergocalciferol; ercalcidiol; 25-hydroxycalciferol
- calcifediol; 25-OH cholcalciferol; 25-OH vitamin D3 (Calderol)
References
- ↑ Jump up to: 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
- ↑ Jump up to: 2.0 2.1 2.2 Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab. 2004 Jul;89(7):3152-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15240586
Hollis BW. Editorial: The determination of circulating 25-hydroxyvitamin D: no easy task. J Clin Endocrinol Metab. 2004 Jul;89(7):3149-51. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15240585 - ↑ Jump up to: 3.0 3.1 Dobnig H et al, Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008 Jun 23; 168:1340. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18574092
- ↑ Tang JY et al Inverse association between serum 25(OH) vitamin D levels and non-melanoma skin cancer in elderly men. Cancer Causes Control 2009 Nov 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19921445 <Internet> http://dx.doi.org/10.1007/s10552-009-9470-4
- ↑ Jump up to: 5.0 5.1 Jenab M et al Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: A nested case-control study. BMJ 2010 Jan 21; 340:b5500 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20093284 <Internet> http://dx.doi.org/10.1136/bmj.b5500
- ↑ Jump up to: 6.0 6.1 Buell JS et al. 25-hydroxyvitamin D, dementia, and cerebrovascular pathology in elders receiving home services. Neurology 2010 Jan 5; 74:18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19940273
Slinin Y et al. 25-hydroxyvitamin D levels and cognitive performance and decline in elderly men. Neurology 2010 Jan 5; 74:33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19940271
Balion C et al. Vitamin D, cognition, and dementia: A systematic review and meta-analysis. Neurology 2012 Sep 25; 79:1397 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23008220 - ↑ Jump up to: 7.0 7.1 7.2 Ensrud KE et al. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab 2010 Dec; 95:5266. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21131545
- ↑ Interpretation of Diagnostic tests, 8th edition, Wallach J, Lippincott, Williams & Wilkens, Philadelphia, 2007
- ↑ Jump up to: 9.0 9.1 Barake M et al. 25-hydroxyvitamin D assay variations and impact on clinical decision making. J Clin Endocrinol Metab 2012 Mar; 97:835 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22238386
- ↑ Jump up to: 10.0 10.1 10.2 de Boer IH et al. Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: A cohort study. Ann Intern Med 2012 May 1; 156:627. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22547472
- ↑ Vitamin D 25 OH Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0080379.jsp
- ↑ Panel of 3 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0000000.jsp
- ↑ Jump up to: 13.0 13.1 Dobnig H et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008 Jun 23; 168:1340. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18574092
- ↑ Jump up to: 14.0 14.1 Powe CE et al. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med 2013 Nov 21; 369:1991 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24256378 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1306357
- ↑ Jump up to: 15.0 15.1 Autier P et al Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology. December 6, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24622671 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70165-7/abstract
The Lancet Diabetes & Endocrinology Vitamin D: chasing a myth? The Lancet Diabetes & Endocrinology. December 6, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24622652 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70164-5/fulltext - ↑ Cauley JA et al Serum 25-Hydroxyvitamin D Concentrations and Risk for Hip Fractures. Ann Intern Med. 2008 Aug 19;149(4):242-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18711154
- ↑ Jump up to: 17.0 17.1 Bischoff-Ferrari HA, Willett WC, Orav EJ et al A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention N Engl J Med 2012; 367:40-49 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22762317 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1109617
Heaney RP Vitamin D - Baseline Status and Effective Dose N Engl J Med 2012; 367:77-78 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22762324 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1206858 - ↑ Jump up to: 18.0 18.1 18.2 Frei B et al Enough Is Enough. Ann Intern Med. 2014;160(11):807 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24887621 <Internet> http://annals.org/article.aspx?articleid=1877028
- ↑ Jump up to: 19.0 19.1 19.2 Schottker B et al Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States. BMJ 2014;348:g3656 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24938302 <Internet> http://www.bmj.com/content/348/bmj.g3656
- ↑ Jump up to: 20.0 20.1 Ye Z, Sharp SJ, Burgess S Association between circulating 25-hydroxyvitamin D and incident type 2 diabetes: a mendelian randomisation study. The Lancet Diabetes & Endocrinology, 1 October 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25281353 <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2814%2970184-6/abstract
- ↑ Jump up to: 21.0 21.1 Kabbani TA, Koutroubakis IE, Schoen RE et al Association of Vitamin D Level With Clinical Status in Inflammatory Bowel Disease: A 5-Year Longitudinal Study. Am J Gastroenterol. 2016 May;111(5):712-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26952579
- ↑ Jump up to: 22.0 22.1 22.2 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
- ↑ Sattar N, Welsh P, Panarelli M, Forouhi NG. Increasing requests for vitamin D measurement: costly, confusing, and without credibility. Lancet. 2012 Jan 14;379(9811):95-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22243814
- ↑ Jump up to: 24.0 24.1 Harmon QE, Umbach DH, Baird DD Use of Estrogen-Containing Contraception Is Associated With Increased Concentrations of 25-Hydroxy Vitamin D. J Clin Endocrinol Metab 101: Aug, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27490916 <Internet> http://press.endocrine.org/doi/pdf/10.1210/jc.2016-1658
- ↑ Jump up to: 25.0 25.1 Munger KL, Hongell K, Aivo J et al 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology. Sept 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28904091 <Internet> http://www.neurology.org/content/early/2017/09/13/WNL.0000000000004489
Marrie RA, Beck CA Preventing multiple sclerosis. To (take) vitamin D or not to (take) vitamin D? Neurology. Sept 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28904085 <Internet> http://www.neurology.org/content/early/2017/09/13/WNL.0000000000004506 - ↑ Jump up to: 26.0 26.1 Budhathoki S et al. Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: Large case-cohort study within Japan Public Health Center- based Prospective Study cohort. BMJ 2018 Mar 7; 360:k671 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29514781 Free PMC Article
- ↑ Jump up to: 27.0 27.1 McCullough ML, Zoltick ES, Weinstein SJ et al Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts. JNCI: Journal of the National Cancer Institute. June 14, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29912394 https://academic.oup.com/jnci/advance-article-abstract
- ↑ Jump up to: 28.0 28.1 28.2 McCall B Low Free 25(OH)D Vitamin D Is Best Predictor of Mortality Medscape - Sep 21, 2020 https://www.medscape.com/viewarticle/937756