Cholecalciferol versus calcifediol for treating vitamin D deficiency
What it found
In this review of studies in people, cholecalciferol had more scientific evidence behind it than calcifediol for bone and muscle problems, and it lets you take an exact dose in International Units.
The authors say cholecalciferol should be the usual choice, with calcifediol kept for patients who have liver failure or severe gut absorption problems.
What they found
Studies in people
Bone fractures
Several meta-analyses and a large trial in more than 30,000 women found that cholecalciferol with calcium reduced the risk of non-vertebral and hip fractures. A trial of calcifediol in 377 people aged 60 and over did not show fewer fractures than placebo.
Falls and muscle function
Randomised trials and meta-analyses found that cholecalciferol reduced the risk of falls and improved muscle function. One trial in about 200 post-menopausal women found that adding calcifediol to cholecalciferol increased falls compared with cholecalciferol alone.
Other health conditions
Positive randomised trial results with cholecalciferol were reported for atopic dermatitis, COPD, asthma, type 2 diabetes, metabolic syndrome, obesity surgery, primary hyperparathyroidism, high blood pressure, depression, Parkinson's disease, mild cognitive impairment and multiple sclerosis. The authors found no published randomised trials with positive results for calcifediol in any of these conditions.
Blood levels and safety
In trials, intermittent calcifediol raised 25(OH)D levels above 60 ng/mL in some patients, and one study reported average levels of 84.2 ng/mL after 12 months. Cholecalciferol at 4000 IU daily kept average levels around 40 ng/mL, and a single 100,000 IU dose peaked at 42 ng/mL.
Other findings
Dose accuracy
Cholecalciferol is the standard used to define an International Unit, so an exact IU dose can be given. The authors say the IU content of calcifediol cannot be guaranteed because it is not that standard.
How long it lasts
Cholecalciferol stays in the body about 2 months and is stored in fat, so it can be taken daily, weekly, fortnightly or monthly with similar results. Calcifediol lasts about two weeks and may only work well when taken daily.
What the authors conclude
“In summary, the form of vitamin D of choice for exogenous supplementation should be cholecalciferol, with calcifediol reserved for patients with liver failure or severe intestinal malabsorption syndromes.”
Also in their conclusions
- They conclude that cholecalciferol should be used and prescribed in most cases of vitamin D deficiency instead of calcifediol.
- They advise that calcifediol be reserved for patients with liver failure or severe intestinal malabsorption syndromes.
- They state that treatment should aim to keep 25(OH)D levels between about 30 and 50 ng/mL.
How it was done
Vitamin D deficiency is common worldwide and can harm bone and muscle health as well as other parts of the body. The authors wanted to compare the two vitamin D supplements most used in their care setting so doctors can pick the one with the best evidence.
They reviewed published randomised trials, systematic reviews and meta-analyses that used cholecalciferol or calcifediol, plus clinical guidelines and pharmacokinetic studies. They also looked at how each form is dosed, how long it stays in the body, and safety reports.
What it can’t tell you
- This is a review of other studies, so it cannot prove by itself that one form of vitamin D works better than the other.
- Many of the trials did not report baseline vitamin D levels, so it is hard to know how much the results depend on starting levels.
- The authors note that no proper cost-effectiveness study has compared the two forms.
Who paid
- Conflicts
- The authors declare no conflict of interest.
- Authors work at
- University of Las Palmas de Gran Canaria, Spain; Bone Metabolic Unit-Hospital University Insular, Spain; University of Seville, Spain
The paper
- Title
- Cholecalciferol or Calcifediol in the Management of Vitamin D Deficiency
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Sosa Henríquez M, Gómez de Tejada Romero MJ (2020). Cholecalciferol or Calcifediol in the Management of Vitamin D Deficiency. Nutrients. doi:10.3390/nu12061617Free full textPubMed 32486496DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error