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Vitamin D and Bone Health: Basic and Clinical Aspects

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Osteoporosis

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Vitamin D is a calciotropic hormone with essential roles in postnatal skeletal development as well as mineral homeostasis in the elderly. Severe vitamin D deficiency or genetic defects in vitamin D actions may result in rickets (before epiphyseal growth plate closure) or osteomalacia. Vitamin D is mainly synthesized in the epidermis from cholesterol precursors by ultraviolet B light exposure, followed by conversion to 25-hydroxyvitamin D in liver by CYP2R1 and other cytochrome P450 enzymes. The definition of vitamin D deficiency as well as the role of free vitamin D not bound to vitamin D-binding protein (GC globulin) remains controversial. In the kidney, CYP27B1 converts the 25-hydrovitamin D prohormone to the active metabolite 1,25-dihydroxyvitamin D which acts upon the vitamin D receptor to regulate transcription in target cells. The beneficial skeletal effects of vitamin D are mainly determined by its stimulation of intestinal calcium absorption, prevention of secondary hyperparathyroidism and subsequent increases in bone turnover, as well as reducing the risk of falls in vitamin D-deficient elderly. Remarkably low doses are however needed for these beneficial effects, while very high dose vitamin D supplements may stimulate bone resorption, suppress mineralization, and increase the risk of falls. This chapter will critically discuss basic and clinical aspects of vitamin D related to bone health across the lifespan.

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Conflicts of Interest

Bouillon: Lecture fees from l’Oréal and Abiogen; co-owner of university patent on vitamin D analogs licensed to Hybrigenix

Laurent: Lecture fees and travel support from Amgen; consultancy fees from Alexion, Kyowa Kirin, Sandoz, Takeda and UCB.

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Authors and Affiliations

  1. Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium

    Roger Bouillon

  2. Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Centre for Metabolic Bone Diseases and Gerontology and Geriatrics Section, University Hospitals Leuven – KU Leuven, Leuven, Belgium

    Michaël R. Laurent

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  1. Roger Bouillon
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Correspondence to Roger Bouillon .

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  1. Massachusetts General Hospital, Boston, MA, USA

    Benjamin Z. Leder

  2. Massachusetts General Hospital, Boston, MA, USA

    Marc N. Wein

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Bouillon, R., Laurent, M.R. (2020). Vitamin D and Bone Health: Basic and Clinical Aspects. In: Leder, B., Wein, M. (eds) Osteoporosis. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-319-69287-6_4

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