title: Determining vitamin D status: a comparison between commercially available assays.
abstract: BACKGROUND
  Vitamin D is not only important for bone health but can also affect the development of several non-bone diseases. The definition of vitamin D insufficiency by serum levels of 25-hydroxyvitamin D depends on the clinical outcome but might also be a consequence of analytical methods used for the definition. Although numerous 25-hydroxyvitamin D assays are available, their comparability is uncertain. We therefore aim to investigate the precision, accuracy and clinical consequences of differences in performance between three common commercially available assays.
  
  
  RESULTS
  Serum 25-hydroxyvitamin D levels from 204 twins from the Swedish Twin Registry were determined with high-pressure liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry (HPLC-APCI-MS), a radioimmunoassay (RIA) and a chemiluminescent immunoassay (CLIA). High inter-assay disagreement was found. Mean 25-hydroxyvitamin D levels were highest for the HPLC-APCI-MS technique (85 nmol/L, 95% CI 81-89), intermediate for RIA (70 nmol/L, 95% CI 66-74) and lowest with CLIA (60 nmol/L, 95% CI 56-64). Using a 50-nmol/L cut-off, 8% of the subjects were insufficient using HPLC-APCI-MS, 22% with RIA and 43% by CLIA. Because of the heritable component of 25-hydroxyvitamin D status, the accuracy of each method could indirectly be assessed by comparison of within-twin pair correlations. The strongest correlation was found for HPLC-APCI-MS (r = 0.7), intermediate for RIA (r = 0.5) and lowest for CLIA (r = 0.4). Regression analyses between the methods revealed a non-uniform variance (p<0.0001) depending on level of 25-hydroxyvitamin D.
  
  
  CONCLUSIONS
  There are substantial inter-assay differences in performance. The most valid method was HPLC-APCI-MS. Calibration between 25-hydroxyvitamin D assays is intricate.
authors.affiliation: Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, [corrected] Uppsala, Sweden. greta.snellman@surgsci.uu.se
authors.forename: Greta
authors.initials: G
authors.lastname: Snellman
authors.forename: Håkan
authors.initials: H
authors.lastname: Melhus
authors.forename: Rolf
authors.initials: R
authors.lastname: Gedeborg
authors.forename: Liisa
authors.initials: L
authors.lastname: Byberg
authors.forename: Lars
authors.initials: L
authors.lastname: Berglund
authors.forename: Lisa
authors.initials: L
authors.lastname: Wernroth
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001681:Biological Assay / Q000379:methods*; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D007118:Immunoassay; D008163:Luminescent Measurements; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D011863:Radioimmunoassay; D015203:Reproducibility of Results; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D