The serum 25(OH)D concentration is the best indicator for determining adequacy of vitamin D intake of an individual since it represents a summation of the total cutaneous production of vitamin D and the oral ingestion of either vitamin D2 or vitamin D3 (Haddad and Hahn, 1973; Holick, 1995). Thus, serum 25(OH)D will be used as the primary indicator of vitamin D adequacy.
The normal range of serum 25(OH)D concentration is the mean serum 25(OH)D ± 2 standard deviations (SD) from a group of healthy individuals. The lower limit of the normal range can be as low as 20 nmol/liter (8 ng/ml) and as high as 37.5 nmol/liter (15 ng/ml) depending on the geographic location where the blood samples were obtained. For example, the lower and upper limits of the normal range of 25(OH)D in California will be higher than those limits in Boston (Clemens and Adams, 1996). Two pathologic indicators, radiologic evidence of rickets (Demay, 1995) and biochemical abnormalities associated with metabolic bone disease, including elevations in alkaline phosphatase and PTH concentrations in the circulation (Demay, 1995), have been correlated with serum 25(OH)D. A 25(OH)D concentration below 27.5 nmol/liter (11 ng/ml) is considered to be consistent with vitamin D deficiency in infants, neonates, and young children (Specker et al., 1992) and is therefore used as the key indicator for determining the vitamin D reference value.
Little information is available about the level of 25(OH)D that is essential for maintaining normal calcium metabolism and peak bone mass in older children and in young and middle-aged adults. For the elderly, there is mounting scientific evidence to support their increased requirement for dietary vitamin D in order to maintain normal calcium metabolism and maximize bone health (Dawson-Hughes et al., 1991; Krall et al., 1989; Lips et al., 1988). Therefore, the serum 25(OH)D concentration was utilized to evaluate vitamin D deficiency in this age group, but it was not the only indicator used to determine the vitamin D reference value for the elderly.
Serum PTH concentrations are inversely related to 25(OH)D serum levels (Krall et al., 1989; Kruse et al., 1984; Lips et al., 1988; Webb et al., 1990; Zeghoud et al., 1997). Therefore, the serum PTH