DA
donato agnusdei
University of Siena
Siena, Italy
About this Research Topic
Background
Vitamin D and its active metabolites play a crucial role in the bone and mineral metabolism, orchestrating calcium–phosphate balance through finely tuned interactions with PTH and FGF23. Despite decades of research, critical questions persist regarding optimal diagnostic thresholds, vitamin D status in population-specific targets, and appropriate supplementation strategies across different metabolic bone diseases. As evidence grows on the genetic, and environmental factors influencing vitamin D responsiveness, the need for tailored, evidence-based approaches has never been more pressing.
This Research Topic aims to advance the understanding of vitamin D and its active metabolites multifaceted role in metabolic bone diseases, linking molecular mechanisms, translational evidence, and clinical applications. The main aim is to integrate basic and clinical insights to refine diagnostic tools, define actionable thresholds, and develop precision dosing algorithms that optimize skeletal integrity and minimize adverse effects. Particular emphasis is placed on clarifying the interplay between vitamin D metabolism and the calcium–PTH–FGF23 axis, and on evaluating formulation-specific effects (D₂, D₃, calcifediol, active metabolites) in both primary and secondary bone disorders.
We welcome submissions that explore the impact of vitamin D across the spectrum of metabolic bone diseases - from osteoporosis, osteomalacia, and CKD–MBD, to endocrine and oncology therapy-related bone loss - addressing both mechanistic underpinnings and clinical outcomes.
Key Themes May Include (but are not limited to):
• Mechanisms and Signalling Pathways: VDR activation, intestinal and renal vitamin D transport, calcium–PTH–FGF23 feedback loops, and genetic or epigenetic modifiers (e.g., VDR, GC/DBP, CYP, KL/FGF23).
• Diagnostics and Thresholds: Standardization and comparison of LC-MS/MS vs. immunoassays; evaluation of free vs. total 25(OH)D and 1,25(OH)₂D; integration of biomarker and imaging data (BMD, HR-pQCT, TBS, 3D-DXA) for precision diagnosis.
• Risk Stratification and Personalization: Development of predictive models incorporating mineral profiles, PTH/FGF23 dynamics, and pharmacogenetic markers; application of AI-driven or digital monitoring tools for dose optimization.
• Interventions and Clinical Outcomes: Comparative efficacy of vitamin D₂/D₃, calcifediol, and active vitamin D metabolites; dosing frequency (daily vs. intermittent); combination therapies with antiresorptives or bone anabolic agents; impact on BMD, fracture risk, and patient-reported outcomes.
• Disease Contexts: Primary and secondary osteoporosis, osteomalacia, CKD–MBD, hypoparathyroidism, diabetes- and thyroid-related bone disease, obesity, malabsorption syndromes, post-bariatric surgery, pregnancy, metastatic bone diseases.
Dr. Agnusdei declares shares of Eli Lilly & Company as a retired employee. The other Topic Editors declare no conflicts of interest related to this Research Topic.
Article types and fees
This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:
- Case Report
- Clinical Trial
- Editorial
- FAIR² Data
- General Commentary
- Hypothesis and Theory
- Methods
- Mini Review
- Opinion
Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.
Keywords: Vitamin D Metabolism, Calcium–PTH–FGF23 Axis, Metabolic Bone Diseases, Diagnostic Thresholds, Precision Supplementation, Vitamin D Responsiveness, Active Vitamin D Metabolites
Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
