Vitamin D

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Vitamin D


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High Yield Notes

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Vitamin D

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USMLE® Step 1 style questions USMLE

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The human body obtains vitamin D either from the diet or from sun exposure. Which of the following represents the conversion of vitamin D derived from dietary animal sources to its active form in the kidney?  

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Calciferol (vitamin D) p. 613


Vitamin D and p. 353

Parathyroid hormone (PTH) p. 336

vitamin D and p. 336

Vitamin D

functions p. 68

hypervitaminosis lab values p. 474

osteoporosis prophylaxis p. 472

PTH and p. 338

signaling pathways for p. 353

solubility of p. 63

Vitamin D (calciferol)

calcitriol production p. 613


The blood calcium level stays stable thanks to three hormones: Vitamin D, parathyroid hormone, and calcitonin.

We’ll focus on Vitamin D, which along with parathyroid hormone, helps increase calcium levels, whereas calcitonin helps lower them.

The majority of the extracellular calcium, the calcium in the blood and interstitium, is split almost equally into calcium that’s diffusible and calcium that’s not diffusible.

Diffusible calcium is small enough to diffuse across cell membranes and there are two subcategories.

The first is free-ionized calcium, which is involved in all sorts of cellular processes like neuronal action potentials, contraction of skeletal, smooth, and cardiac muscle, hormone secretion, and blood coagulation, all of which are tightly regulated by enzymes and hormones.

The second category is complexed calcium, which is where the positively charged calcium is ionically linked to tiny negatively charged molecules like oxalate and phosphate, which are small anions, that are found in our blood.

The complexed calcium forms a molecule that’s electrically neutral but unlike free-ionized calcium it’s not useful for cellular processes.

Finally there’s the non-diffusible calcium which is bound to large negatively charged proteins like albumin.

The resulting protein-calcium complex is too large and charged to cross membranes, so the non-diffusible calcium is also uninvolved in cellular processes.

Now, after parathyroid hormone, the metabolically active form of vitamin D, also called calcitriol, is the second most important hormone involved in regulating blood calcium.

Vitamin D is a steroid hormone, which means that it’s made from cholesterol and it’s fat-soluble.

Active vitamin D starts out as one of two metabolically inactive molecules.

Either vitamin D2, or ergocalciferol, which comes from plant sources in our diet, and vitamin D3, or cholecalciferol, which can either come from animal products in our diet, but can also be made in skin cells that are exposed to sunlight.


Vitamin D is a steroid hormone which function is to promote mineralization of new bone. This is accomplished by increasing calcium and phosphate absorption by the intestine and kidneys, and stimulating osteoclast activity in bone, to promote bone remodeling. These actions are carried out together with parathyroid hormone, which shares many of the effects of vitamin D. Vitamin D can be acquired as an inactive intermediate through diet or by synthesis in the skin. Its physiologically active form is found only after hydroxylation in the kidneys by the enzyme 1-alpha-hydroxylase to 1,25-dihydroxycholecalciferol.


  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  5. "Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease" The American Journal of Clinical Nutrition (2004)
  6. "Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline" The Journal of Clinical Endocrinology & Metabolism (2011)
  7. "Noncalcemic Actions of Vitamin D Receptor Ligands" Endocrine Reviews (2005)

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