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The When, What & How of Measuring Vitamin D Metabolism in Clinical Medicine

1
Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
2
Laboratory of Endocrinology, Department of Clinical Chemistry, Academic Medical Center, 1100 DDAmsterdam Zuidoost, The Netherlands
3
Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, 1007 MB Amsterdam, The Netherlands
4
Department of Nephrology, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(4), 482; https://doi.org/10.3390/nu10040482
Received: 7 March 2018 / Revised: 3 April 2018 / Accepted: 11 April 2018 / Published: 13 April 2018
(This article belongs to the Special Issue Changing Times for Vitamin D and Health)
We now have the ability to measure a number of different vitamin D metabolites with very accurate methods. The most abundant vitamin D metabolite, 25-hydroxyvitamin D, is currently the best marker for overall vitamin D status and is therefore most commonly measured in clinical medicine. The added value of measuring metabolites beyond 25-hydroxyvitamin D, like 1,25-, and 24,25-dihydroxyvitamin D is not broadly appreciated. Yet, in some more complicated cases, these metabolites may provide just the information needed for a legitimate diagnosis. The problem at present, is knowing when to measure, what to measure and how to measure. For 25-hydroxyvitamin D, the most frequently used automated immunoassays do not meet the requirements of today’s standards for certain patient groups and liquid chromatography-tandem mass spectrometry is the desired method of choice in these individuals. The less frequently measured 1,25-dihydroxyvitamin D metabolite enables us to identify a number of conditions, including 1α-hydroxylase deficiency, hereditary vitamin D-resistant rickets and a number of granulomatous diseases or lymphoproliferative diseases accompanied by hypercalcaemia. Furthermore, it discriminates between the FGF23-mediated and non-FGF23-mediated hypophosphatemic syndromes. The 24,25-dihydroxyvitamin D metabolite has proven its value in the diagnosis of idiopathic infantile hypercalcaemia and has the potential of having value in identifying other diseases. For both metabolites, the understanding of the origin of differences between assays is limited and requires further attention. Nonetheless, in every way, appropriate measurement of vitamin D metabolism in the clinical laboratory hinges eminently on the comprehension of the value of the different metabolites, and the importance of the choice of method. View Full-Text
Keywords: vitamin D; metabolism; 25-hydroxyvitamin D; 1,25-dihydroxyvitamin D; 24,25-dihydroxyvitamin D; LC-MS/MS; immunoassay vitamin D; metabolism; 25-hydroxyvitamin D; 1,25-dihydroxyvitamin D; 24,25-dihydroxyvitamin D; LC-MS/MS; immunoassay
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Dirks, N.F.; Ackermans, M.T.; Lips, P.; De Jongh, R.T.; Vervloet, M.G.; De Jonge, R.; Heijboer, A.C. The When, What & How of Measuring Vitamin D Metabolism in Clinical Medicine. Nutrients 2018, 10, 482.

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