It is well-recognized that individuals with African Ancestry have substantially lower (~2-fold) serum 25(OH)D levels compared with other racial/ethnic groups. These differences have been attributed primarily to skin pigmentation. However, the relation between serum 25(OH)D levels and health outcomes is complex and involves a number of variables including diet, sun exposure and hormone status. For example, despite lower average dietary intake of both calcium and vitamin D, and lower serum 25(OH)D levels, African Americans have higher bone mineral density and a 3-fold lower risk of hip fracture relative to European Americans. There are some lines of evidence which suggest that African Americans may have comparatively higher circulating levels of 1,25(OH)2D3, although most studies are small and do not account for age and/or diurnal variation, and this may explain why other studies report no difference.