We would like to thank Dr. Zittermann for his interesting comments on our study on circannual rhythms of calcitropic hormones and biochemical markers of bone turnover.1 In his letter, Dr. Zittermann states that in premenopausal women, most of the observed seasonal fluctuations in bone turnover may in fact be caused by a dietary calcium deficit. Although we are unable to provide quantitative data on dietary calcium intake, we do have sufficient information on the participants' nutritional habits to state that during the entire study, the individual calcium intake was within the expected range of a mid-European population (i.e., approximately 800 mg calcium/day). This level is well below the recommended daily intake of 1000 mg calcium2 and may be considered insufficient to maintain a positive calcium balance. Because of the lower vitamin D levels during winter time, this calcium deficit may become even more aggravated, which may cause the observed season-dependent increase in bone resorption. Dr. Zittermann's own study3 seems to support the notion that under calcium replete conditions, variations in calcitropic hormones do not affect bone turnover. One should note, however, that this study was performed in students of nutritional science who actively achieved an optimal calcium intake. In contrast, the purpose of our study was to show seasonal changes of bone turnover in a representative population under “real-life” conditions without interference from any potential physiologic regulator. In such a population, the observed circannual rhythm of bone turnover is very likely to depend on a number of variables that have not been completely identified. However, whereas calcium deficiency may be one of the more important factors, it is very unlikely that seasonal changes in bone turnover are monocausally linked to calcium supplies. Many other factors shown to be associated with unfavorable outdoor conditions, such as reduced physical activity, increased alcohol intake,4 or even increased time spent in front of the television5 may, at least in part, explain the observed phenomenon independent of the actual calcium resource. Data from our study indicate that these factors interrelate and interact with each other but presenting or discussing all of these would be far beyond the scope of our paper. However, the net effect of all these factors seems obvious and was clearly demonstrated: in a western European population with all of its inherent anthropometric, nutritional, and lifestyle characteristics, bone turnover is subject to seasonal changes which, over the years, may contribute to bone loss. In summary, we certainly agree with Dr. Zittermann that in western European populations, nutritional calcium deficiency may be one of the mechanisms underlying the observed circannual changes in bone turnover. We believe, however, that our findings are complex and multifactorial in nature and have therefore initiated prospective investigations that will allow us to dissect some of these variables in more detail.