The control of calcium metabolism is dominated by the D vitamins which have different origins and relative activities. Calcitriol (1, 25-dihydroxycholecalciferol) probably mediates most of the actions of vitamin D, though possibly 25-hydroxycholecalciferol may be important in maintaining normal mineralisation.1 Calcitriol is normally synthesised by two hydroxylation steps (see figure), first in the liver and then in the kidney, from the vitamin D3 (cholecalciferol) produced in the skin or taken in the diet. Calcitriol (Rocaltrol - Roche) is now available on prescription, as is lα-OH vitamin D3 (alfacalcidol - One-Alpha - Leo).2 This article discusses their use.
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