vitamin D

ビタミンD

WordNet

1. the 4th letter of the Roman alphabet (同)d
2. any of a group of organic substances essential in small quantities to normal metabolism

PrepTutorEJDIC

1. deuteriumの化学記号
2. 『ビタミン』,栄養素(身体の喜常な機能を維持するために少量ながら必要な有機化合物)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/29 20:45:40」(JST)

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For other uses, see Vitamin D (disambiguation).

Vitamin D
Drug class
Cholecalciferol (D3)
Use	Rickets, osteoporosis, vitamin D deficiency
Biological target	vitamin D receptor
ATC code	A11CC
External links
MeSH	D014807
AHFS/Drugs.com	MedFacts Natural Products

Vitamin D refers to a group of fat-soluble secosteroids responsible for enhancing intestinal absorption of calcium, iron, magnesium, phosphate and zinc. In humans, the most important compounds in this group are vitamin D₃ (also known as cholecalciferol) and vitamin D₂ (ergocalciferol). Cholecalciferol and ergocalciferol can be ingested from the diet and from supplements. Very few foods contain vitamin D; synthesis of vitamin D (specifically cholecalciferol) in the skin is the major natural source of the vitamin. Dermal synthesis of vitamin D from cholesterol is dependent on sun exposure (specifically UVB radiation).

Vitamin D from the diet or dermal synthesis from sunlight is biologically inactive; activation requires enzymatic conversion (hydroxylation) in the liver and kidney. Evidence indicates the synthesis of vitamin D from sun exposure is regulated by a negative feedback loop that prevents toxicity, but because of uncertainty about the cancer risk from sunlight, no recommendations are issued by the Institute of Medicine (US), for the amount of sun exposure required to meet vitamin D requirements. Accordingly, the Dietary Reference Intake for vitamin D assumes no synthesis occurs and all of a person's vitamin D is from food intake, although that will rarely occur in practice. As vitamin D is synthesized in adequate amounts by most mammals exposed to sunlight, it is not strictly a vitamin, and may be considered a hormone as its synthesis and activity occur in different locations. Vitamin D has a significant role in calcium homeostasis and metabolism. Its discovery was due to effort to find the dietary substance lacking in rickets (the childhood form of osteomalacia).

Beyond its use to prevent osteomalacia or rickets, the evidence for other health effects of vitamin D supplementation in the general population is inconsistent. The best evidence of benefit is for bone health. The effect of vitamin D supplementation on mortality is not clear, with one meta-analysis finding a decrease in mortality in elderly people, and another concluding no clear justification exists for recommending vitamin D. Because it found mounting evidence for a benefit to bone health, though it had not found good evidence of other benefits, the Food and Drug Administration of the United States intends to begin requiring manufacturers to declare the amount of Vitamin D on nutrition facts labels, as "nutrients of public health significance".

In the liver, cholecalciferol (vitamin D₃) is converted to calcidiol, which is also known as calcifediol (INN), 25-hydroxycholecalciferol (aka 25-hydroxyvitamin D₃ — abbreviated 25(OH)D₃). Ergocalciferol (vitamin D₂) is converted in the liver to 25-hydroxyergocalciferol (aka 25-hydroxyvitamin D₂ — abbreviated 25(OH)D₂). These two specific vitamin D metabolites are measured in serum to determine a person's vitamin D status. Part of the calcidiol is converted by the kidneys to calcitriol, the biologically active form of vitamin D. Calcitriol circulates as a hormone in the blood, regulating the concentration of calcium and phosphate in the bloodstream and promoting the healthy growth and remodeling of bone. Calcitriol also affects neuromuscular and immune function.

Types

Name	Chemical composition	Structure
Vitamin D1	molecular compound of ergocalciferol with lumisterol, 1:1
Vitamin D2	ergocalciferol (made from ergosterol)
Vitamin D3	cholecalciferol (made from 7-dehydrocholesterol in the skin).
Vitamin D4	22-dihydroergocalciferol
Vitamin D5	sitocalciferol (made from 7-dehydrositosterol)

Several forms (vitamers) of vitamin D exist. The two major forms are vitamin D₂ or ergocalciferol, and vitamin D₃ or cholecalciferol; vitamin D without a subscript refers to either D₂ or D₃ or both. These are known collectively as calciferol. Vitamin D₂ was chemically characterized in 1931. In 1935, the chemical structure of vitamin D₃ was established and proven to result from the ultraviolet irradiation of 7-dehydrocholesterol.

Chemically, the various forms of vitamin D are secosteroids, i.e., steroids in which one of the bonds in the steroid rings is broken. The structural difference between vitamin D₂ and vitamin D₃ is the side chain of D₂ contains a double bond between carbons 22 and 23, and a methyl group on carbon 24.

Deficiency

Main article: Hypovitaminosis D

A diet deficient in vitamin D in conjunction with inadequate sun exposure causes osteomalacia (or rickets when it occurs in children), which is a softening of the bones. In the developed world, this is a rare disease. However, vitamin D deficiency has become a worldwide issue in the elderly and remains common in children and adults. Low blood calcidiol (25-hydroxy-vitamin D) can result from avoiding the sun. Deficiency results in impaired bone mineralization and bone damage which leads to bone-softening diseases, including:

Rickets

Rickets, a childhood disease, is characterized by impeded growth and soft, weak, deformed long bones that bend and bow under their weight as children start to walk. This condition is characterized by bow legs, which can be caused by calcium or phosphorus deficiency, as well as a lack of vitamin D; today, it is largely found in low-income countries in Africa, Asia, or the Middle East and in those with genetic disorders such as pseudovitamin D deficiency rickets. Rickets was first described in 1650 by Francis Glisson, who said it had first appeared about 30 years previously in the counties of Dorset and Somerset. In 1857, John Snow suggested rickets, then widespread in Britain, was being caused by the adulteration of bakers' bread with alum. The role of diet in the development of rickets was determined by Edward Mellanby between 1918–1920. Nutritional rickets exists in countries with intense year-round sunlight such as Nigeria and can occur without vitamin D deficiency. Although rickets and osteomalacia are now rare in Britain, outbreaks have happened in some immigrant communities in which osteomalacia sufferers included women with seemingly adequate daylight outdoor exposure wearing Western clothing. Having darker skin and reduced exposure to sunshine did not produce rickets unless the diet deviated from a Western omnivore pattern characterized by high intakes of meat, fish, and eggs, and low intakes of high-extraction cereals. The dietary risk factors for rickets include abstaining from animal foods. Vitamin D deficiency remains the main cause of rickets among young infants in most countries, because breast milk is low in vitamin D and social customs and climatic conditions can prevent adequate sun exposure. In sunny countries such as Nigeria, South Africa, and Bangladesh, where the disease occurs among older toddlers and children, it has been attributed to low dietary calcium intakes, which are characteristic of cereal-based diets with limited access to dairy products. Rickets was formerly a major public health problem among the US population; in Denver, where ultraviolet rays are about 20% stronger than at sea level on the same latitude, almost two-thirds of 500 children had mild rickets in the late 1920s. An increase in the proportion of animal protein in the 20th century American diet coupled with increased consumption of milk fortified with relatively small quantities of vitamin D coincided with a dramatic decline in the number of rickets cases. Also, in the United States and Canada, vitamin D-fortified milk, infant vitamin supplements, and vitamin supplements have helped to eradicate the majority of cases of rickets for children with fat malabsorption conditions.

Osteomalacia

Osteomalacia is a disease in adults that results from vitamin D deficiency. Characteristics of this disease are softening of the bones, leading to bending of the spine, bowing of the legs, proximal muscle weakness, bone fragility, and increased risk for fractures. Osteomalacia reduces calcium absorption and increases calcium loss from bone, which increases the risk for bone fractures. Osteomalacia is usually present when 25-hydroxyvitamin D levels are less than about 10 ng/mL. The effects of osteomalacia are thought to contribute to chronic musculoskeletal pain, There is no persuasive evidence of lower vitamin D levels in chronic pain sufferers.

Influence of skin pigmentation

Some research shows dark-skinned people living in temperate climates have lower vitamin D levels. Dark-skinned people may be less efficient at making vitamin D because melanin in the skin hinders vitamin D synthesis; however, a recent study has found novel evidence that low vitamin D levels among Africans may be due to other reasons. Recent evidence implicates parathyroid hormone in adverse cardiovascular outcomes. Black women have an increase in serum parathyroid hormone at a lower 25(OH)D level than white women. A large-scale association study of the genetic determinants of vitamin D insufficiency in Caucasians found no links to pigmentation.

However, the uniform occurrence of low serum 25(OH)D in Indians living in India and Chinese in China, does not support the hypothesis that the low levels seen in the more pigmented are due to lack of synthesis from the sun at higher latitudes.

Excess

For more details on this topic, see hypervitaminosis D.

Vitamin D toxicity is rare. It is caused by supplementing with high doses of vitamin D rather than sunlight. The threshold for vitamin D toxicity has not been established; however, the tolerable upper intake level (UL), according to some research, is 4,000 IU/day for ages 9–71. Whereas another research concludes that in healthy adults, sustained intake of more than 1250 μg/day (50,000 IU) can produce overt toxicity after several months and can increase serum 25-hydroxyvitamin D levels to 150 ng/ml and greater; those with certain medical conditions, such as primary hyperparathyroidism, are far more sensitive to vitamin D and develop hypercalcemia in response to any increase in vitamin D nutrition, while maternal hypercalcemia during pregnancy may increase fetal sensitivity to effects of vitamin D and lead to a syndrome of mental retardation and facial deformities.

Hypercalcemia is a strong indication of vitamin D toxicity, noted with an increase in urination and thirst. If hypercalcemia is not treated, it results in excess deposits of calcium in soft tissues and organs such as the kidneys, liver, and heart, resulting in pain and organ damage. Pregnant or breastfeeding women should consult a doctor before taking a vitamin D supplement. The FDA advised manufacturers of liquid vitamin D supplements that droppers accompanying these products should be clearly and accurately marked for 400 international units (IU). In addition, for products intended for infants, the FDA recommends the dropper hold no more than 400 IU. For infants (birth to 12 months), the tolerable upper limit (maximum amount that can be tolerated without harm) is set at 25 μg/day (1,000 IU). One thousand micrograms per day in infants has produced toxicity within one month. After being commissioned by the Canadian and American governments, the Institute of Medicine (IOM) as of 30 November 2010, has increased the tolerable upper limit (UL) to 2,500 IU per day for ages 1–3 years, 3,000 IU per day for ages 4–8 years and 4,000 IU per day for ages 9–71+ years (including pregnant or lactating women).

Vitamin D overdose causes hypercalcemia, and the main symptoms of vitamin D overdose are those of hypercalcemia: anorexia, nausea, and vomiting can occur, frequently followed by polyuria, polydipsia, weakness, insomnia, nervousness, pruritus, and, ultimately, renal failure. Proteinuria, urinary casts, azotemia, and metastatic calcification (especially in the kidneys) may develop. Other symptoms of vitamin D toxicity include mental retardation in young children, abnormal bone growth and formation, diarrhea, irritability, weight loss, and severe depression. Vitamin D toxicity is treated by discontinuing vitamin D supplementation and restricting calcium intake. Kidney damage may be irreversible. Exposure to sunlight for extended periods of time does not normally cause vitamin D toxicity. The concentrations of vitamin D precursors produced in the skin reach an equilibrium, and any further vitamin D produced is degraded.

Published cases of toxicity involving hypercalcemia in which the vitamin D dose and the 25-hydroxy-vitamin D levels are known all involve an intake of ≥40,000 IU (1,000 μg) per day. Recommending supplementation, when those supposedly in need of it are labeled healthy, has proved contentious, and doubt exists concerning long-term effects of attaining and maintaining high serum 25(OH)D by supplementation.

Health effects of supplementation

The effects of vitamin D supplementation on health are uncertain. A 2013 review did not find any effect from supplementation on the rates of disease, other than a tentative decrease in mortality in the elderly. Low vitamin D levels may result from disease rather than cause disease.

A United States Institute of Medicine (IOM) report states: "Outcomes related to cancer, cardiovascular disease and hypertension, and diabetes and metabolic syndrome, falls and physical performance, immune functioning and autoimmune disorders, infections, neuropsychological functioning, and preeclampsia could not be linked reliably with calcium or vitamin D intake and were often conflicting." Some researchers claim the IOM was too definitive in its recommendations and made a mathematical mistake when calculating the blood level of vitamin D associated with bone health. Members of the IOM panel maintain that they used a "standard procedure for dietary recommendations" and that the report is solidly based on the data. Research on vitamin D supplements, including large-scale clinical trials, is continuing.

Mortality

Vitamin D₃ supplementation has been tentatively found to lead to a reduced risk of death in the elderly, but the effect has not been deemed pronounced or certain enough to make taking supplements recommendable.

Other forms (Vitamin D₂, alfacalcidol, and calcitriol) do not appear to have any beneficial effects with regard to the risk of death. High blood levels appear to be associated with a lower risk of death, but it is unclear if supplementation can result in this benefit. Both an excess and a deficiency in vitamin D appear to cause abnormal functioning and premature aging. The relationship between serum calcidiol level and all-cause mortality is parabolic. Harm from vitamin D appears to occur at a lower vitamin D level in the black population than in the white population.

Bone health

In general, no good evidence supports the commonly held belief that vitamin D supplements can help prevent osteoporosis. Its general use for prevention of this disease in those without vitamin D deficiency is thus likely not needed.

For older people with osteoporosis, taking vitamin D with calcium may help prevent hip fractures, but it also slightly increases the risk of stomach and kidney problems. Supplementation with higher doses of vitamin D, in those older than 65 years, may decrease fracture risk. This appears to apply more to people in institutions than those living independently.

Vitamin D deficiency causes osteomalacia (called rickets when it occurs in children). Use of vitamin D in children with normal vitamin D levels does not appear to improve bone density. Beyond that, low serum vitamin D levels have been associated with falls, and low bone mineral density. Taking extra vitamin D; however, does not appear to change the risk.

Athletes who are vitamin D deficient are at an increased risk of stress fractures and/or major breaks, particularly those engaging in contact sports. The greatest benefit with supplementation is seen in athletes who are deficient (25(OH)D serum levels <30 ng/ml), or severely deficient (25(OH)D serum levels <25 ng/ml). Incremental decreases in risks are observed with rising serum 25(OH)D concentrations plateauing at 50 ng/ml with no additional benefits seen in levels beyond this point.

Cancer

Vitamin D supplements have been widely marketed on the internet and elsewhere for their claimed anticancer properties, but taking vitamin D supplements has been found to have no significant effect on cancer risk. Some research has suggested that vitamin D3 decreases the risk of death from cancer, but concerns with the quality of the data were noted.

Insufficient evidence exists to recommend vitamin D to be prescribed for people with cancer, although some evidence suggests hypovitaminosis D may be associated with a worse outcome for some cancers, and that higher 25-hydroxy vitamin D levels at the time of diagnosis are associated with better outcomes.

Cardiovascular disease

Taking vitamin D supplements does not meaningfully reduce the risk of stroke, cerebrovascular disease, cardial infarction, or ischaemic heart disease. Supplementation has no effect on blood pressure.

Depression

Clinical trials of vitamin D supplementation for depressive symptoms have generally been of low quality and show no overall effect, although subgroup analysis showed supplementation for participants with clinically significant depressive symptoms or depressive disorder had a moderate effect.

Cognition and dementia

A systematic review of clinical studies shows an association between low vitamin D levels, cognitive impairment, and a higher risk of developing Alzheimer's disease. However, lower vitamin D concentrations is also associated with poor nutrition and spending less time outdoors. Therefore alternative explanations for the increase in cognitive impairment exist and hence a direct causal relationship between vitamin D levels and cognition could not be established.

Immune system

Infectious disease

In general, vitamin D functions to activate the innate and dampen the adaptive immune systems. Deficiency has been linked to increased risk of viral infections, including HIV and influenza. Low levels of vitamin D appear to be a risk factor for tuberculosis, and historically it was used as a treatment.

Autoimmune disease

Although tentative data link low levels of vitamin D to asthma, evidence to support a beneficial effect from supplementation is inconclusive. Accordingly, supplementation is not currently recommended for treatment or prevention of asthma.

Vitamin D hypovitaminosis may be a risk factor for multiple sclerosis, but no evidence indicates vitamin D has any clinically significant benefit as a treatment. Further research is needed to determine if the association represents a cause and effect relationship.

Pregnancy

Low levels of vitamin D in pregnancy are associated with gestational diabetes, pre-eclampsia, and small infants. The benefit of supplements, however, is unclear. Pregnant women who take an adequate amount of vitamin D during gestation may experience positive immune effects. Pregnant women often do not take the recommended amount of vitamin D.

Mechanism of action

Metabolic activation

Calcium regulation in the human body. The role of vitamin D is shown in orange.

Liver hydroxylation of cholecalciferol to calcidiol

Kidney hydroxylation of calcidiol to calcitriol

Vitamin D is carried in the bloodstream to the liver, where it is converted into the prohormone calcidiol. Circulating calcidiol may then be converted into calcitriol, the biologically active form of vitamin D, in the kidneys. Following the final converting step in the kidney, calcitriol is released into the circulation. By binding to vitamin D-binding protein, a carrier protein in the plasma, calcitriol is transported to various target organs. In addition to the kidneys, calcitriol is also synthesized by monocyte-macrophages in the immune system. When synthesized by monocyte-macrophages, calcitriol acts locally as a cytokine, defending the body against microbial invaders by stimulating the innate immune system.

Whether it is made in the skin or ingested, cholecalciferol is hydroxylated in the liver at position 25 (upper right of the molecule) to form 25-hydroxycholecalciferol (calcidiol or 25(OH)D). This reaction is catalyzed by the microsomal enzyme vitamin D 25-hydroxylase, which is produced by hepatocytes. Once made, the product is released into the plasma, where it is bound to an α-globulin, vitamin D-binding protein.

Calcidiol is transported to the proximal tubules of the kidneys, where it is hydroxylated at the 1-α position (lower right of the molecule) to form calcitriol (1,25-dihydroxycholecalciferol and abbreviated to 1,25(OH)₂D). This product is a potent ligand of the vitamin D receptor, which mediates most of the physiological actions of the vitamin. The conversion of calcidiol to calcitriol is catalyzed by the enzyme 25-hydroxyvitamin D₃ 1-alpha-hydroxylase, the levels of which are increased by parathyroid hormone (and additionally by low calcium or phosphate).

Biosynthesis

In the presence of UV radiation, many animals synthesize vitamin D₃ from 7-dehydrocholesterol, and many fungi synthesize vitamin D₂ from ergosterol.

Photochemistry

The photochemistry of vitamin D biosynthesis in animal and fungi

Thermal isomerization of previtamin D₃ to vitamin D₃

The transformation that converts 7-dehydrocholesterol to vitamin D₃ occurs in two steps. First, 7-dehydrocholesterol is photolyzed by ultraviolet light in a 6-electron conrotatory ring-opening electrocyclic reaction; the product is previtamin D₃. Second, previtamin D₃ spontaneously isomerizes to vitamin D₃ (cholecalciferol) in an antarafacial sigmatropic [1,7] hydride shift. At room temperature, the transformation of previtamin D₃ to vitamin D₃ in an organic solvent takes about 12 days to complete. The conversion of previtamin D₃ to vitamin D₃ in the skin is about 10 times faster than in an organic solvent

Evolution

Photosynthesis of vitamin D in the ocean by phytoplankton (such as coccolithophore and Emiliania huxleyi) has existed for more than 500 million years and continues to the present. Although primitive vertebrates in the ocean could absorb calcium from the ocean into their skeletons and eat plankton rich in vitamin D, land animals required another way to satisfy their vitamin D requirement for a calcified skeleton without relying on plants. Land vertebrates have been making their own vitamin D for more than 350 million years.

Vitamin D can be synthesized only by a photochemical process, so land vertebrates had to ingest foods that contained vitamin D or had to be exposed to sunlight to photosynthesize vitamin D in their skin to satisfy their vitamin D requirements.

Synthesis in the skin

In the epidermal strata of the skin, production is greatest in the stratum basale (colored red in the illustration) and stratum spinosum (colored light brown).

Vitamin D₃ is produced photochemically from 7-dehydrocholesterol in the skin of most vertebrate animals, including humans. The precursor of vitamin D₃, 7-dehydrocholesterol is produced in relatively large quantities. 7-Dehydrocholesterol reacts with UVB light at wavelengths between 270 and 300 nm, with peak synthesis occurring between 295 and 297 nm. These wavelengths are present in sunlight, as well as in the light emitted by the UV lamps in tanning beds (which produce ultraviolet primarily in the UVA spectrum, but typically produce 4% to 10% of the total UV emissions as UVB). Exposure to light through windows is insufficient because glass almost completely blocks UVB light.

Adequate amounts of vitamin D can be produced with moderate sun exposure to the face, arms and legs, averaging 5–30 minutes twice per week without sunscreen. (The darker the complexion, or the weaker the sunlight, the more minutes of exposure are needed, approximating 25% of the time for minimal sunburn. Vitamin D overdose is impossible from UV exposure; the skin reaches an equilibrium where the vitamin degrades as fast as it is created.)

The skin consists of two primary layers: the inner layer called the dermis, composed largely of connective tissue, and the outer, thinner epidermis. Thick epidermis in the soles and palms consists of five strata; from outer to inner, they are: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale. Vitamin D is produced in the two innermost strata, the stratum basale and stratum spinosum.

The naked mole-rat appears to be naturally cholecalciferol-deficient, as serum 25-OH vitamin D levels are undetectable. In some animals, the presence of fur or feathers blocks the UV rays from reaching the skin. In birds and fur-bearing mammals, vitamin D is generated from the oily secretions of the skin deposited onto the feathers or fur and is obtained orally during grooming.

Sunscreen

Sunscreen absorbs or reflects ultraviolet light and prevents much of it from reaching the skin. Sunscreen with a sun protection factor (SPF) of 8 based on the UVB spectrum has been reported to decrease vitamin D synthetic capacity by 95%, whereas sunscreen with an SPF of 15 can reduce synthetic capacity by 98%.

Biological activity

Synthesis of vitamin D

The active vitamin D metabolite calcitriol mediates its biological effects by binding to the vitamin D receptor (VDR), which is principally located in the nuclei of target cells. The binding of calcitriol to the VDR allows the VDR to act as a transcription factor that modulates the gene expression of transport proteins (such as TRPV6 and calbindin), which are involved in calcium absorption in the intestine. The vitamin D receptor belongs to the nuclear receptor superfamily of steroid/thyroid hormone receptors, and VDRs are expressed by cells in most organs, including the brain, heart, skin, gonads, prostate, and breast. VDR activation in the intestine, bone, kidney, and parathyroid gland cells leads to the maintenance of calcium and phosphorus levels in the blood (with the assistance of parathyroid hormone and calcitonin) and to the maintenance of bone content.

One of the most important roles of vitamin D is to maintain skeletal calcium balance by promoting calcium absorption in the intestines, promoting bone resorption by increasing osteoclast number, maintaining calcium and phosphate levels for bone formation, and allowing proper functioning of parathyroid hormone to maintain serum calcium levels. Vitamin D deficiency can result in lower bone mineral density and an increased risk of reduced bone density (osteoporosis) or bone fracture because a lack of vitamin D alters mineral metabolism in the body. Thus, although it may initially appear paradoxical, vitamin D is also critical for bone remodeling through its role as a potent stimulator of bone resorption.

The VDR may be involved in cell proliferation and differentiation. Vitamin D also affects the immune system, and VDRs are expressed in several white blood cells, including monocytes and activated T and B cells. In vitro, vitamin D increases expression of the tyrosine hydroxylase gene in adrenal medullary cells, and affects the synthesis of neurotrophic factors, nitric oxide synthase, and glutathione.

Apart from VDR activation, various alternative mechanisms of action are under study, such as inhibition of signal transduction by hedgehog, a hormone involved in morphogenesis.

History

American researchers Elmer McCollum and Marguerite Davis in 1914 discovered a substance in cod liver oil which later was called "vitamin A". British doctor Edward Mellanby noticed dogs that were fed cod liver oil did not develop rickets and concluded vitamin A, or a closely associated factor, could prevent the disease. In 1922, Elmer McCollum tested modified cod liver oil in which the vitamin A had been destroyed. The modified oil cured the sick dogs, so McCollum concluded the factor in cod liver oil which cured rickets was distinct from vitamin A. He called it vitamin D because it was the fourth vitamin to be named. It was not initially realized that, unlike other vitamins, vitamin D can be synthesised by humans through exposure to UV light.

In 1925, it was established that when 7-dehydrocholesterol is irradiated with light, a form of a fat-soluble vitamin is produced (now known as D₃). Alfred Fabian Hess stated, "light equals vitamin D." Adolf Windaus, at the University of Göttingen in Germany, received the Nobel Prize in Chemistry in 1928 for his work on the constitution of sterols and their connection with vitamins. In 1929, a group at NIMR in Hampstead, London, were working on the structure of vitamin D, which was still unknown, as well as the structure of steroids. A meeting took place with J.B.S. Haldane, J.D. Bernal and Dorothy Crowfoot to discuss possible structures, which contributed to bringing a team together. X-ray crystallography demonstrated the sterol molecules were flat, not as proposed by the German team led by Windaus. In 1932, Otto Rosenheim and Harold King published a paper putting forward structures for sterols and bile acids which found immediate acceptance. The informal academic collaboration between the team members Robert Benedict Bourdillon, Otto Rosenheim, Harold King, and Kenneth Callow was very productive and led to the isolation and characterization of vitamin D. At this time, the policy of the Medical Research Council was not to patent discoveries, believing the results of medical research should be open to everybody. In the 1930s, Windaus clarified further the chemical structure of vitamin D.

In 1923, American biochemist Harry Steenbock at the University of Wisconsin demonstrated that irradiation by ultraviolet light increased the vitamin D content of foods and other organic materials. After irradiating rodent food, Steenbock discovered the rodents were cured of rickets. A vitamin D deficiency is a known cause of rickets. Using $300 of his own money, Steenbock patented his invention. His irradiation technique was used for foodstuffs, most memorably for milk. By the expiration of his patent in 1945, rickets had been all but eliminated in the US.

In 1971–72, the further metabolism of vitamin D to active forms was discovered. In the liver, vitamin D was found to be converted to calcidiol and calcidiol is then converted by the kidneys to calcitriol, the biologically active form of vitamin D. Calcitriol circulates as a hormone in the blood, regulating the concentration of calcium and phosphate in the bloodstream and promoting the healthy growth and remodeling of bone. The vitamin D metabolites calcidiol and calcitriol were identified by competing teams led by Michael F. Holick in the laboratory of Hector DeLuca, and by Tony Norman and colleagues.

Guidelines

Dietary reference intakes

Different institutions propose different recommendations concerning daily amounts of the vitamin. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited.

(Conversion : 1 µg = 40 IU and 0.025 µg = 1 IU)

Australia and New Zealand

About a third of Australians have vitamin D deficiency. Australia and New Zealand have established guidelines for dietary vitamin D intake as follows:

Age group	Adequate Intake (μg)	Upper Level of Intake (μg)
Infants 0–12 months	5.0	25.0
Children 1–18 years	5.0	80.0
Adults 19–50 years	5.0	80.0
Adults 51–70 years	10.0	80.0
Adults > 70 years	15.0	80.0

Canada

According to Health Canada the recommended dietary allowances (RDA) for vitamin D are:

Age group	RDA (IU)	Tolerable upper intake (IU)
Infants 0–6 months	400*	1,000
Infants 7–12 months	400*	1,500
Children 1–3 years	600	2,500
Children 4–8 years	600	3,000
Children and Adults 9–70 years	600	4,000
Adults > 70 years	800	4,000
Pregnancy & Lactation	600	4,000

Note*: Adequate intake rather than recommended dietary allowance

European Union

The recommended daily amount for vitamin D in the European Union is 5 µg. In 2012, the German Society for Nutrition, a private organisation, increased the recommended daily amount to 20 µg.

The European Menopause and Andropause Society recommended 15 µg (600 IU) until age 70, and 20 µg (800 IU) in older than 71 years, in postmenopausal women. This dose should be increased to 4,000 IU/day in some patients with very low vitamin D status or in case of comorbid conditions.

The UK National Health Service recommends babies and young children aged six months to five years, pregnant or breastfeeding women, and sun-deprived elderly people should take daily vitamin supplements to ensure sufficient vitamin D intake; the general population gets enough vitamin D from good diets and from sunlight.

United States

According to the United States Institute of Medicine, the recommended dietary allowances (RDA) of vitamin D are:

Age group	RDA (IU/day)
Infants 0–6 months	400*
Infants 6–12 months	400*
1–70 years	600 (15 μg/day)
71+ years	800 (20 μg/day)
Pregnant/Lactating	600 (15 μg/day)

• Asterisk for infants indicates adequate intake (AI) for infants, as an RDA has yet to be established for infants.

Upper intake levels

The tolerable upper intake level is defined as "the highest average daily intake of a nutrient that is likely to pose no risk of adverse health effects for nearly all persons in the general population. " Although tolerable upper intake levels are believed to be safe, information on the long-term effects is incomplete and these levels of intake are not recommended:

Age group	Tolerable upper intake level
Infants 0–6 months	1,000 IU/day (25 µg/day)
Infants 6–12 months	1,500 IU/day (37.5 µg/day)
1–3 years	2,500 IU/day (62.5 µg/day)
4–8 years	3,000 IU/day (75 µg/day)
9+ years	4,000 IU/day (100 µg/day)
Pregnant/lactating	4,000 IU/day(100 µg/day)

The dietary reference intake for vitamin D issued by the Institute of Medicine (IOM) in 2010 superseded a previous recommendation which had adequate intake status. The recommendations were formed assuming the individual has no skin synthesis of vitamin D because of inadequate sun exposure. The reference intake for vitamin D refers to total intake from food, beverages and supplements, is intended for the North American population, and assumes that calcium requirements are being met.

One school of thought contends the human physiology is fine-tuned to an intake of 4,000–12,000 IU/day from sun exposure with concomitant serum 25-hydroxyvitamin D levels of 40 to 80 ng/ml and this is required for optimal health. Proponents of this view, who include some members of the panel that drafted a now-superseded 1997 report on vitamin D from the IOM, contend the IOM's warning about serum concentrations above 50 ng/ml lacks biological plausibility. They suggest, for some people, reducing the risk of preventable disease requires a higher level of vitamin D than that recommended by the IOM.

According to the European Food Safety Authority, the tolerable upper intake levels are:

• 0–12 months: 25 µg/day (1,000 IU)
• 1–10 years: 50 µg/day (2,000 IU)
• 11–17 years: 100 µg/day (4,000 IU)
• 17+: 100 µg/day (4,000 IU)
• Pregnant/lactating women: 100 µg/day (4,000 IU)

Serum 25-hydroxyvitamin D

US labs generally report 25(OH)D levels as ng/ml. Other countries often use nmol/l.

An IOM committee concluded a serum 25-hydroxyvitamin D level of 20 ng/ml (50 nmol/l) is desirable for bone and overall health. The dietary reference intakes for vitamin D are chosen with a margin of safety and 'overshoot' the targeted serum value to ensure the specified levels of intake achieve the desired serum 25-hydroxyvitamin D levels in almost all persons. No contributions to serum 25-hydroxyvitamin D level are assumed from sun exposure and the recommendations are fully applicable to people with dark skin or negligible exposure to sunlight.

The Institute found serum 25-hydroxyvitamin D concentrations above 30 ng/ml (75 nmol/l) are "not consistently associated with increased benefit". Serum 25-hydroxyvitamin D levels above 50 ng/ml (125 nmol/l) may be cause for concern. However, the desired range of serum 25-hydroxyvitamin D is between 20 and 50 ng/ml.

The risk of cardiovascular disease is lower when vitamin D ranged from 20 to 60 nmol/l (8 to 24 ng/ml). A "threshold effect" appears to occur once a level of 60 nmol/l (24 ng/ml) has been reached i.e., levels of vitamin D over 60 nmol/l did not show added benefit.

Allowable health claims

Apart from the above discussion on health effects or scientific evidence for lowering disease risk, governmental regulatory agencies stipulate for the food industry health claims allowable as statements on packaging.

European Food Safety Authority (EFSA)

• normal function of the immune system
• normal inflammatory response
• normal muscle function
• reduced risk of falling in people over age 60

US Food and Drug Administration (FDA)

• may reduce the risk of osteoporosis

Health Canada

• adequate calcium and regular exercise may help to achieve strong bones in children and adolescents and may reduce the risk of osteoporosis in older adults. An adequate intake of vitamin D is also necessary

Other possible agencies with claim guidance: Japan FOSHU and Australia-New Zealand.

Dietary sources

Vitamin D is found in few dietary sources. Sunlight exposure is the primary source of vitamin D for majority of people, other than supplements.

While some studies have found that vitamin D3 raises 25(OH)D blood levels faster and remains active in the body longer, others contend that vitamin D2 sources are equally bioavailable and effective as D3 for raising and sustaining 25(OH)D.

Vitamin D₂

Main article: Ergocalciferol

Low values in mushrooms for vitamin D below indicate incidental exposure to sunlight which activates synthesis of vitamin D2. When fresh mushrooms or dried powders are purposely exposed to artificial sunlight by use of an industrial ultraviolet lamp, vitamin D levels can be controlled at much higher levels.

Content of vitamin D

• Mushrooms, portobello, exposed to ultraviolet light, raw: Vitamin D₂: 11.2 μg (446 IU)
• Mushrooms, portobello, exposed to ultraviolet light, grilled: Vitamin D₂: 13.1 μg (524 IU)
• Mushrooms, shiitake, dried: Vitamin D₂: 3.9 μg (154 IU)
• Mushrooms, shiitake, raw: Vitamin D₂: 0.4 μg (18 IU)
• Mushrooms, portobello, raw: Vitamin D₂: 0.3 μg (10 IU)
• Mushroom powder, any species, illuminated with sunlight or artificial ultraviolet light sources

Vitamin D₂, or ergocalciferol found in fungi, is synthesized from viosterol, which in turn is activated when ultraviolet light stimulates ergosterol.

Human bioavailability of vitamin D₂ from vitamin D₂-enhanced button mushrooms via UV-B irradiation is effective in improving vitamin D status and not different from a vitamin D₂ supplement. Vitamin D₂ from UV-irradiated yeast baked into bread or mushrooms is bioavailable and increases blood levels of 25(OH)D.

By visual assessment or using a chromometer, no significant discoloration of irradiated mushrooms, as measured by the degree of "whiteness", was observed. Claims have been made that a normal serving (approx. 3 oz or 1/2 cup, or 60 grams) of fresh mushrooms treated with ultraviolet light have increased vitamin D content to levels up to 80 micrograms or 2700 IU if exposed to just 5 minutes of UV light after being harvested.

Plants

• Alfalfa (Medicago sativa subsp. sativa), shoot: 4.8 μg (192 IU) vitamin D₂, 0.1 μg (4 IU) vitamin D₃ (per 100 g).

Vitamin D₃

Main article: Cholecalciferol

In some countries, staple foods are artificially fortified with vitamin D.

• Vegan sources
  • Lichen
    • Cladina arbuscula specimens grown under different natural conditions: The contents of vitamin D₃ range from 0.67 to 2.04 μg g⁻¹ dry matter in the thalli of C. arbuscula specimens grown under different natural conditions.
• Animal sources
  • Fish liver oils, such as cod liver oil, 4.5 g (1 teaspoon) provides 450 IU (100 IU/g)
  • Fatty fish species, such as:
    • Salmon, cooked, 85 g (3 oz) provides 444 IU (5.2 IU/g)
    • Mackerel, cooked, 85 g, 390 IU (4.6 IU/g)
    • Tuna, canned in oil, 100 g, 269 IU (2.7 IU/g)
    • Sardines, canned in oil, drained, 100 g (3.5 oz), 193 IU (1.9 IU/g)
  • Cooked egg yolk provides 44 IU if egg weighs 61 g (0.7 IU/g)
  • Beef liver, cooked, 85 g, provides 42 IU (0.5 IU/g)

Industrial production

Vitamin D₃ (cholecalciferol) is produced industrially by exposing 7-dehydrocholesterol to UVB light, followed by purification. The 7-dehydrocholesterol is a natural substance in fish organs, especially the liver, or in wool grease (lanolin) from sheep. Vitamin D₂ (ergocalciferol) is produced in a similar way using ergosterol from yeast or mushrooms as a starting material.

Effects of cooking

Vitamin D is not entirely stable against heat typically occurring in cooking. While the exact rate depends on the cooking process, typically between 10% and 50% of Vitamin D is lost.

References

Further reading

• NIH Vitamin D Fact Sheet for Health Professionals from the U.S. National Institutes of Health
• Disagreement among experts about the correct vitamin D dose. (Nature News, July 6, 2011)

External links

• Vitamin D in children from the Royal National Orthopaedic Hospital Trust

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人におけるビタミンD欠乏症：定義、臨床症状、および治療 vitamin d deficiency in adults definition clinical manifestations and treatment
• 2. ビタミンDの概要 overview of vitamin d
• 3. 小児および思春期におけるビタミンD不足および欠乏 vitamin d insufficiency and deficiency in children and adolescents
• 4. 骨粗鬆症におけるカルシウムおよびビタミンDの補充 calcium and vitamin d supplementation in osteoporosis
• 5. ビタミンDと骨外健康 vitamin d and extraskeletal health

English Journal

• Bilateral femoral neck insufficiency fractures secondary to vitamin D deficiency and concurrent corticosteroid use--a case report.

• Carter T1, Nutt J, Simons A.Author information 1Department of Orthogeriatrics, Birmingham Heartlands Hospital, Birmingham, UK, tjcarter@doctors.org.uk.AbstractWe present a rare case of a 67-year-old Indian female who was found to have bilateral insufficiency of the neck of femur fractures secondary to osteomalacia from vitamin D deficiency, with her symptoms exacerbated by a course of oral steroids prescribed for suspected polymyalgia rheumatica.
• Archives of osteoporosis.Arch Osteoporos.2014 Dec;9(1):172. doi: 10.1007/s11657-014-0172-5. Epub 2014 Feb 11.
• We present a rare case of a 67-year-old Indian female who was found to have bilateral insufficiency of the neck of femur fractures secondary to osteomalacia from vitamin D deficiency, with her symptoms exacerbated by a course of oral steroids prescribed for suspected polymyalgia rheumatica.INTRODUCT
• PMID 24515953

• Effect of vitamin D in fracture healing in a child: case report.

• Parchi P1, Andreani L, Piolanti N, Niccolai F, Cervi V, Lisanti M.Author information 11st Orthopedic Division, Department of Traslational Research and New Technology in Medicine and Surgery, University of Pisa, via Paradisa 2, 56125, Pisa, Italy, parchip@tiscali.it.AbstractIn this report, we describe the effect of vitamin D and calcium supplementation on fracture healing in a young boy with a hypovitaminosis D who had a radius refracture. The radiographic evaluation of the callus formation shows a clear effect of vitamin D on fracture healing in absence of additional variables.
• Archives of osteoporosis.Arch Osteoporos.2014 Dec;9(1):170. doi: 10.1007/s11657-013-0170-z. Epub 2014 Jan 23.
• In this report, we describe the effect of vitamin D and calcium supplementation on fracture healing in a young boy with a hypovitaminosis D who had a radius refracture. The radiographic evaluation of the callus formation shows a clear effect of vitamin D on fracture healing in absence of additional
• PMID 24452512

• Effect of a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma non-hip fracture: a systematic review.

• Bell K1, Strand H, Inder WJ.Author information 1Department of Diabetes and Endocrinology, The University of Queensland, Brisbane, Queensland, Australia, kate.bell@health.qld.gov.au.AbstractThe aim of this study was to identify the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. A dedicated osteoporosis health professional improved investigation and management of osteoporosis. Osteoporosis management was enhanced, leading to the potential for future fracture prevention.
• Archives of osteoporosis.Arch Osteoporos.2014 Dec;9(1):167. doi: 10.1007/s11657-013-0167-7. Epub 2014 Jan 23.
• The aim of this study was to identify the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. A dedicated osteoporosis health professional improved investigation and management of osteoporosis. Osteoporosis manageme
• PMID 24452511

Japanese Journal

• 栄養障害患者に対する微量元素・ビタミン投与 (特集 栄養障害患者の治療)

• 内分泌・糖尿病・代謝内科 = Endocrinology, diabetology & metabolism 43(6), 481-487, 2016-12
• NAID 40021047698

• 血清葉酸ならびにビタミンB₁₂測定の標準化に関する近年の進歩

• ビタミン = Vitamins 90(12), 581-589, 2016-12
• NAID 40021044195

• Contents of Volume 62

• Journal of nutritional science and vitaminology 62(6), 437-442, 2016-12
• NAID 40021041848

Related Links

• VITAMIN D: Uses, Side Effects, Interactions and Warnings ...

Find patient medical information for VITAMIN D on WebMD including its uses, effectiveness, side effects and safety, interactions, user ratings and products that have it. ... Vitamin D is a vitamin. It can be found in small ...

• Vitamin D — Health Professional Fact Sheet

Information for health professionals about Vitamin D, recommended intakes, sources, intake status, risks of inadequacy or excess, current research on Vitamin D and health, and potential interactions. ... * Serum concentrations of 25 ...

Related Pictures

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★リンクテーブル★

リンク元	「高カルシウム血症」「ビタミンD」
拡張検索	「1α,25-dihydroxyvitamin D3」「1,25-dihydroxyvitamin D3」「25-hydroxyvitamin D2」「25-hydroxy vitamin D」
関連記事	「D」

「高カルシウム血症」

　　[★]

英

hypercalcemia

同

高Ca血症

関

カルシウム、低カルシウム血症

研修医当直御法度 症例帳 p.32

• 組織へのカルシウム蓄積を引き起こしうる (BPT.27)

病因

• 1. 原発性副甲状腺機能亢進症(甲状腺腺腫などによるPTHの分泌亢進)
• 2. 腫瘍に随伴

• 2-1. 肺の扁平上皮癌、成人性Ｔ細胞白血病→PTH関連蛋白(PTHrP)の分泌
• 2-2. 腫瘍の骨転移により、破骨細胞が骨破壊。

• 3. サルコイドーシス、肉芽細胞→異所性1,25(OH)2D3が発生する。

• 肉芽の構成成分であるマクロファージがビタミンD3を産生？

• 4. サイアザイド系利尿薬や骨粗しょう症の薬として1,25(OH)2D3製剤。

• 4-1. サイアザイド系利尿薬

• チアジド系利尿薬の慢性使用により体液量が減少し、近位尿細管での再吸収が亢進するため (GOO.755)　？？
• チアジド系利尿薬自体のDCTでの作用による；NCCTを阻害すると細胞内のNa濃度低下、これにより側底膜でのNa+-Ca2+交換系が亢進することでCa2+の再吸収↑ (GOO.755) 　→　ループ利尿薬と違ってチアジド系利尿薬ははCaを排泄しない！！ see.利尿薬

• 5. 家族性低Ca尿性高Ca血症
• 6. その他(リチウム？？？？ (ICU.558))

ECGP.223

• 7. ビタミンA, ビタミンDの中毒
• 8. 腎不全
• 9. 副腎不全

USMLEより

• Caused by calcium ingestion (milk-alkali syndrome), hyperparathyroid, hyperthyroid, iatrogenic (thiazides), multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D, Excess vitamin A, sarcoidosis.

• Calcium ingestion
• Hyperparathyroid/Hyperthyroid
• Iatrogenic
• Multiplemyeloma
• Paget's disease
• Addison's disease
• Neoplasms
• Zollinger-Ellison syndrome: ZES単独ではなく、MEN Iによるparathyroid tumorに続発した病態
• Excessive vitamin D
• Excessive vitamin A
• Sarcoidosis

定義

• 血清カルシウムが正常上限を超える場合。

• 疑い：常に≧10.3 mg/dl
• 確実：≧10.5 mg/dl

↑

基準値

• 血清総Ca 8.6-10.1 mg/dl(臨床検査法提要第32版)
• 血清Caイオン 1.15-1.30 mmmol/l(臨床検査法提要第32版), 4.6-5.1 mg/dl

症候

軽度(11-11.5 mg/dL)：通常は無症状。(HIM.285)

重度(>12-13 mg/dL)：傾眠、昏迷、昏睡、消化器症状が出現。(HIM.285)

• 精神・神経症状：錯乱、昏迷、昏睡。イライラ感、うつ傾向(QB.D-339)
• 消化器：食欲不振、悪心・嘔吐、便秘。膵炎、消化性潰瘍。腹部膨満(腸管運動抑制による(QB.D-339))

• 消化性潰瘍：高カルシウム血症は胃酸分泌を促進する
• 急性膵炎：高カルシウム血症は膵液の分泌を亢進する。(YN.B-78)　←　過剰に出ちゃうと炎症が起こってしまうらしい

• 泌尿器：多尿、腎結石(血清Ca 12mg/dLでできやすくなるらしい)　←　多尿は浸透圧利尿による(ICU.558)

• 急性腎不全

• 腎不全は一般的に低カルシウム血症となるが、高カルシウム血症に起因する腎不全は例外。

→高カルシウム血症性腎症 hypercalcemic nephropathy

• 腎の石灰化→髄質に蓄積→尿細管圧迫→尿濃縮力障害　←　続発性尿崩症の原因？？？

• 高カルシウム血症は腎の濃縮力を低下させる(HIM.286)　←　腎集合管におけるADHの作用を阻害(QB.D-339)

• 心血管：血管収縮による高血圧(出典不明！！)。徐脈、房室ブロック、QT短縮(HIM.284)。　←　YN.D-147には血圧上昇、ICU.558には低血圧とある。
• 筋　：筋力低下、筋痛
• 全身：易疲労感

• 異所性石灰化 red eye　強膜にカルシウムが沈着
• 多尿による脱水、高血圧、徐脈

心電図

EAB.114 SP.94,524

• QT短縮、ST短縮　←　活動電位持続時間が短縮したことを示す。QRS幅については延長する場合もある(EAB.114)

• ↑細胞外カルシウム濃度→↑内向きカルシウム電流(↑流入速度)→さらに脱分極するように思えるが↑外向きカリウム電流により打ち消される→正味、カルシウムの移動が無くなるまでの時間が早まる→↓活動電位持続時間

• PR間隔延長？？

高カルシウム血症→QT短縮：　←高カリウム血症

低カルシウム血症→QT延長：　←低カリウム血症　低マグネシウム血症

治療

• 症状が出たときか、症状無く血清Ca 14mg/dL以上の場合(ICU.558)

生理食塩水

• 1. 細胞外液の補充
• 2. ナトリウム利尿によるカルシウム排泄の促進

高カルシウム血症の鑑別

		尿中のCa排泄	PTH	PTHrP	1,25(OH)2D3
原発性甲状腺機能亢進症	↑	↑	↓	→　or　↑
腫瘍のPTH関連蛋白分泌	↑	↓	↑	↓
	 腫瘍の骨破壊	↑	↓	↓	↓
	 肉芽腫症		↓	↓	↓	→　or　↑

参考

• http://akimichi.homeunix.net/~emile/aki/html/medical/endocrine/node52.html

国試

• 102G052

「ビタミンD」

　　[★]

英

vitamin D

同

カルシフェロール calciferol

関

カルシトニン、カルシウム、活性化ビタミンD

• first aid step1 2006 p.109,112,114,250(カルシウム代謝),251,255,319,321,381,386,387

概念

• 脂溶性ビタミン

• 植物にはビタミンD2, 動物にはビタミンD3が多く含まれ、ヒトではビタミンD3が重要な役割を果たしている。

• ヒトではビタミンDの前駆体である7-でヒドロキシコレステロールが産生されているが、日照が足りない場合に食物由来のビタミンDが用いられる。(HB.492)

生合成

• 動物では、コレステロールが代謝を受けてプロビタミンD3（7-デヒドロコレステロール）となったあと、皮膚上で紫外線を受けてプレビタミンD3（(6Z)-タカルシオール）、続いてビタミンD3（コレカルシフェロール）へと変わる。さらに肝臓で代謝を受け 25-ヒドロキシビタミンD3へと変化し、最終的に腎臓で代謝されて活性型ビタミンD3（1,25-ジヒドロキシビタミンD3）となる。
• 食物から摂取されるのはビタミンD3、ビタミンD2であり、肝臓、腎臓でhyroxylationを受け活性化する。

生理作用

SP.930

• 腸管：Ca吸収促進　←　糖質コルチコイドに拮抗される
• 骨：PTHとの共存下で骨吸収を促進
• 腎臓：PTHに拮抗して、リン酸の再吸収を促進　→　血中Pi上昇

必要量

http://web116.net/vita-d4.htm

• 目安量：5ug/day
• 上限量：50ug/day

ビタミンD製剤

関

ビタミンＡ及びＤ剤

活性化ビタミンD3製剤は骨粗鬆症の治療として用いられる。

腸管からのカルシウム吸収を促進し、腎臓でのカルシウム再吸収促進、PTH合成・分泌抑制などにより骨吸収を抑制。骨芽細胞に作用し骨形成を促進する。

• アルファカルシドール：(アルファロール、ワンアルファ \67.5、カルフィーナ \8.9)：肝臓での活性化を受ける前の構造(プロドラッグ)をなしている。効果が緩徐で作用時間が長い。
• カルシトリオール：(ロカルトロール \\30.4)：完全に活性化されたビタミンDの構造なので力価が高い分、生体内での持続時間は短い
• エルデカルシトール：(エディロール \99)

• 推奨グレード A行うように強く進められる、B行うように進められる、C行うように進めるだけの根拠が明確ではない

アルファカルシドール　骨密度B 椎体骨折B 非椎体骨折B 大腿骨近位部骨折C

カルシトリオール　　　骨密度B 椎体骨折B 非椎体骨折B 大腿骨近位部骨折C

エルデカルシトール　　骨密度A 椎体骨折A 非椎体骨折B 大腿骨近位部骨折C

臨床関連

• ビタミンD欠乏症

• 幼児期：くる病：骨の発達障害
• 成人　：骨粗鬆症、骨軟化症：骨カルシウムの低下

• ビタミンD過剰症

• 高カルシウム血症により血管収縮による高血圧、軟部組織へのカルシウム沈着。多尿、腎結石、悪心・嘔吐、不整脈

「1α,25-dihydroxyvitamin D3」

　　[★] カルシトリオール。1α,25-ジヒドロキシビタミンD3

「1,25-dihydroxyvitamin D3」

　　[★]

関

1,25-dihydroxycholecalciferol、calcitriol、Rocaltrol

「25-hydroxyvitamin D2」

　　[★]

25-ヒドロキシビタミンD2

関

25-hydroxyergocalciferol

「25-hydroxy vitamin D」

　　[★]

同

25-D

同

25(OH)D

「D」

　　[★]

• アスパラギン酸
• ジヒドロウリジン
• 遠位の distal,
• うつ病 depression
• 下行結腸 descending colon(大腸内視鏡検査の結果を記載するときに用いる)