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Vitamin D from the diet or skin synthesis is biologically inactive; enzymatic conversion (hydroxylation) in the liver and kidney is required for activation. As vitamin D can be synthesized in adequate amounts by most mammals exposed to sufficient sunlight, it is not an essential dietary factor, and so not technically a vitamin.[3] Instead it could be considered as a hormone, with activation of the vitamin D pro hormone resulting in the active form, calcitriol, which then produces effects via a nuclear receptor in multiple different locations.[3] Cholecalciferol is converted in the liver to calcifediol (25 hydroxycholecalciferol); ergocalciferol is converted to 25 hydroxyergocalciferol. These two vitamin D metabolites (called 25 hydroxyvitamin D or 25(OH)D) are measured in serum to determine a person’s vitamin D status.[4][5] Calcifediol is further hydroxylated by the kidneys to form calcitriol (also known as 1,25 dihydroxycholecalciferol), the biologically active form of vitamin D.[6] Calcitriol circulates as a hormone in the blood, having a major role regulating the concentration of calcium and phosphate, and promoting the healthy growth and remodeling of bone.

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