Over the last decade, significant progress has been made in strategies for the prevention and treatment of vitamin D deficiency thanks to clinical trials and pharmaco-kinetic studies, which have also made it possible to define the pharmacological properties of cholecalciferol and calcifediol.
Although cholecalciferol and calcifediol are often considered and used equally in clinical practice, there are a number of significant differences between them, both pharmacologically and clinically, that need to be taken into account when choosing the most appropriate strategy for treating/preventing vitamin D deficiency and for the prevention of fragility fractures.
In particular, calcifediol has recently been proposed as the drug of choice as an alternative to cholecalciferol in treating vitamin D deficiency, due to a greater potency and rapidity in normalising 25-hydroxy-vitamin D serum concentration. However, a thorough evaluation of the available evidence and in particular of randomised controlled clinical trials, confirms the primacy of cholecalciferol in the prevention and treatment of vitamin D deficiency and in the primary and secondary prevention of fragility fractures in osteoporotic individuals in combination with an antiresorptive or osteoanabolic drug. Therefore, based on current evidence, the use of calcifediol should be limited to particular situations, such as malabsorption syndromes, severe obesity or liver failure.