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roidism, all of which contribute to increased risk for poor bone health and osteoporotic fractures. As discussed below, there is inconsistent evidence as to whether intestinal absorption of vitamin D declines with age. In women, bone loss occurs as a result of the decreased estrogen levels that accompany menopause. As aging continues, both men and women experience age-related bone loss. As is the case for calcium intake, it is not well established whether and to what extent intakes of vitamin D may mitigate the bone loss.

Pregnancy and Lactation

The role of vitamin D in pregnancy and fetal development is the focus of current attention. However, at present the role of vitamin D is not clear, and there are very few data by which to examine the questions surrounding the effect of the nutrient on pregnancy and lactation. Animal studies and inferential human data do not readily elucidate a specific function in fetal development, especially with respect to formation and mineralization of the fetal skeleton. Calcitriol levels increase during pregnancy, but factors other than vitamin D appear to stimulate the increased calcium absorption. Although a number of avenues are still being explored, the bulk of the evidence suggests that calcium is moved from the mother to the fetus without requiring calcitriol.

Breast milk is not normally a significant source of vitamin D for the infant and remains unchanged with supplementation at least up to 2,000 IU/day. Existing evidence suggests that vitamin D nutriture does not appear to affect the maternal processes of bone resorption that occur during lactation, nor its restoration post-lactation.

MEASURES ASSOCIATED WITH VITAMIN D: SERUM 25OHD

Serum 25OHD level is widely considered as a marker of vitamin D nutriture, and consideration of serum 25OHD measures for the purposes of nutrient reference value development has generated notable interest. There is agreement that circulating serum 25OHD levels are currently the best available indicator of the net incoming contributions from cutaneous synthesis and total intake (foods and supplements) (Davis et al., 2007; Brannon et al., 2008; Davis, 2008). Thus, the serum 25OHD level may function as a biomarker of exposure; it is a reflection of the supply of vitamin D to the body and can be a useful adjunct to examining the intake level of vitamin D if the confounders and the measure’s variability depending upon a range of variables are kept in mind. However, what is not clearly established is the extent to which 25OHD levels serve as a biomarker of effect. That is, there is some question as to whether levels of 25OHD relate to



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