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Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: 15 January 2027 | Viewed by 3326

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Prof. Dr. István Takács

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Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 2/a Korányi S. Str, 1083 Budapest, Hungary
Interests: calcium metabolism; bone metabolism; genetics of bone diseases; vitamin D metabolism; pathophysiology; genetic of thyroid diseases; general health sciences; theoretical medicine
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Dear Colleagues,

Vitamin D deficiency is highly prevalent worldwide. Efforts to address this public health issue are mostly hindered by the heterogeneity of nutritional and clinical vitamin D guidelines. The importance of vitamin D extends far beyond musculoskeletal health. In fact, vitamin D is a precursor to the hormone 1,25-dihydroxyvitamin D, also known as the D hormone. Because the receptor (VDR) of this steroid hormone is expressed in most human cells, some scholars have proposed that vitamin D plays a more widespread role in general health. This idea is supported by several experimental and epidemiological studies. The general dilemma regarding the potential extraskeletal health benefits of vitamin D is that vitamin D requirements for skeletal health may differ from requirements for certain extraskeletal health benefits.

This Special Issue will include manuscripts focusing on assessing vitamin D status (i.e., deficiency, normal, or high levels) and investigating associations or causal relationships with health benefits or disease outcomes. Additionally, we accept manuscripts investigating vitamin D supplementation in healthy individuals or patient populations with vitamin D deficiency compared to individuals with normal vitamin D status.

Prof. Dr. István Takács
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

25(OH)D level
1,25(OH)2D level
vitamin D deficiency
vitamin D supplementation treatment
prevention

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Published Papers (4 papers)

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Research

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16 pages, 2122 KB

Open AccessArticle

Clinical Reclassification of Vitamin D Status Across Three Automated Immunoassays After Comparability Study

by Adina Huțanu, Ana-Maria Fotache (Țurcan), Oana Roxana Oprea, Andreea Truța, Andrea Márta Fodor and Minodora Dobreanu

Nutrients 2026, 18(14), 2267; https://doi.org/10.3390/nu18142267 - 10 Jul 2026

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Abstract

Background/Objectives: Variability between routine laboratory immunoassays for total 25-hydroxyvitamin D (25(OH) vitamin D) measurement may impact clinical interpretation, particularly around clinical decision thresholds. The aim of the study was to evaluate the analytical comparability and clinical interchangeability between three automated immunoassay platforms using chemiluminescent assays (CLIA) and electrochemiluminescent assay (ECLIA) principles for total 25(OH) vitamin D and to evaluate the assay-dependent impact on patient reclassification. Methods: A total of 83 serum samples were analyzed using three automated immunoassay platforms and the between method comparability was assessed. Additionally, clinical agreement and reclassification rate were evaluated at two clinical decision thresholds, 20 ng/mL for insufficiency and 12 ng/mL for severe deficiency. Results: The comparability analysis revealed a systematic difference between methods, with a high reclassification rate between ECLIA compared to CLIA methods. Additionally, the expanded measurement uncertainty generates a clinically relevant gray zone around the clinically relevant thresholds. Conclusions: Routinely used immunoassays for total 25(OH) vitamin D measurement in clinical laboratories are not fully interchangeable, furthermore the measurement uncertainty contributes to patient reclassification, especially around the threshold of 20 ng/mL. Full article

(This article belongs to the Special Issue Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond)

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17 pages, 488 KB

Open AccessArticle

Serum 25-Hydroxyvitamin D Status and 12-Week Functional Outcomes After Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Retrospective Cohort Study

by Ki-Hyeok Ku and Eo Jin Park

Nutrients 2026, 18(13), 2152; https://doi.org/10.3390/nu18132152 - 2 Jul 2026

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Abstract

Background/Objectives: Serum 25-hydroxyvitamin D [25(OH)D] is a clinically used biomarker of vitamin D nutritional status, although it is also influenced by sunlight exposure, supplementation, season, and other host factors. Short-term functional status after extracorporeal shock wave therapy (ESWT) for lateral epicondylitis varies. We evaluated whether serum 25(OH)D level and status were associated with 12-week functional outcomes among ESWT-treated patients. Methods: This single-center retrospective cohort included 62 adults with lateral epicondylitis who received outpatient ESWT and had baseline and 12-week assessments. Baseline variables included grip strength ratio, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, serum 25(OH)D measured using the Architect 25-OH D vitamin kit, common extensor tendon (CET) thickness, age, sex, and body mass index. Multivariable linear regression was used in an analysis-of-covariance framework. Serum 25(OH)D was assessed continuously and as <20 versus ≥20 ng/mL in exploratory threshold analysis. Results: Serum 25(OH)D was 21.0 ± 8.4 ng/mL; 30 patients (48.4%) had <20 ng/mL, 22 (35.5%) had 20–29.9 ng/mL, and 10 (16.1%) had ≥30 ng/mL. QuickDASH decreased from 42.0 ± 17.4 to 27.0 ± 13.7, and grip strength ratio increased from 0.58 ± 0.14 to 0.76 ± 0.14. Higher serum 25(OH)D was associated with lower 12-week QuickDASH after adjustment (β per 10 ng/mL = −4.04, 95% CI −7.17 to −0.91; p = 0.012). Additionally, 25(OH)D <20 ng/mL was associated with higher 12-week QuickDASH (β = 6.43, 95% CI 1.17 to 11.69; p = 0.017). Serum 25(OH)D was not clearly associated with 12-week grip strength ratio. Conclusions: Lower serum 25(OH)D, interpreted as a vitamin D nutritional-status marker rather than as a nutrition-specific causal exposure, was associated with worse 12-week patient-reported function, but not grip strength ratio. The <20 ng/mL threshold analysis was exploratory and was not powered for subgroup inference. These findings should be interpreted as observational and hypothesis-generating. Full article

(This article belongs to the Special Issue Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond)

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16 pages, 695 KB

Open AccessArticle

Vitamin D Sufficiency Revisited: Evidence of a Dose–Response Effect for MASLD in Adults at Risk

by Gediz Dogay Us, Francesco Innocenti, Ozgur Muhammet Koc, Volkan Demirhan Yumuk, Zeynep Banu Gungor and Ger H. Koek

Nutrients 2026, 18(4), 599; https://doi.org/10.3390/nu18040599 - 11 Feb 2026

Cited by 2 | Viewed by 976

Abstract

Background and Aims: Vitamin D plays a pivotal role in liver health, influencing multiple steps in the development of steatosis, fibrosis, and extrahepatic complications in metabolic dysfunction-associated steatotic liver disease (MASLD). However, serum vitamin D concentrations that confer optimal hepatic protection in MASLD remain unclear. We therefore aimed to investigate the association between vitamin D status and MASLD and to explore whether higher vitamin D concentrations confer incremental protection beyond current sufficiency cut-offs. Method: We conducted a multicenter cross-sectional study of 1039 adults with at least one cardiometabolic risk factor for MASLD diagnosis, recruited between 2022 and 2024. Participants that reported excessive alcohol intake (>30 g/day for men, >20 g/day for women) and other etiologies of liver disease were excluded. Serum vitamin D levels were measured, with ≥20 ng/mL defined as sufficiency. MASLD (controlled attenuation parameter [CAP] ≥ 248 dB/m) and significant fibrosis (liver stiffness measurement [LSM] ≥ 8 kPa) were assessed using vibration-controlled transient elastography. Missing vitamin D values were imputed with multiple imputation. Associations between vitamin D status, MASLD and fibrosis were examined using multivariable logistic regression models adjusted for potential confounders. Results: Participants had a mean age of 52.2 ± 13.0 years; 51.6% were male and mean BMI was 30.1 ± 5.8 kg/m². Vitamin D sufficiency and obesity were present in 81.2% (95% CI: 78.4–84.9) and 54.7% (95% CI: 51.3–58.0), respectively. Vitamin D sufficiency was associated with lower odds of MASLD (crude OR = 0.47, 95% CI: 0.33–0.67) and significant fibrosis (crude OR = 0.46, 95% CI: 0.28–0.76). After adjusting for potential confounders, the association between Vitamin D sufficiency and MASLD remained clinically relevant but did not reach statistical significance (adjusted OR = 0.60, 95% CI: 0.36–1.03, p = 0.06). In contrast, the association between Vitamin D sufficiency and significant fibrosis was both clinically relevant and statistically significant (adjusted OR = 0.48, 95% CI: 0.246–0.916, p = 0.03). When Vitamin D was categorized into quartiles, participants in the highest quartile (≥44 ng/dL) had 61% lower odds of MASLD in the adjusted model (adjusted OR = 0.39, 95% CI: 0.21–0.71) compared with participants in the lowest quartile (≤22 ng/mL). No significant dose-dependent associations were observed for fibrosis. Conclusions: Vitamin D levels showed a dose-dependent decrease in the odds of MASLD among at-risk adults. While the protective effect on fibrosis was not dose-dependent, these findings collectively suggest vitamin D as a potentially modifiable factor in MASLD prevention and management. Full article

(This article belongs to the Special Issue Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond)

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Review

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18 pages, 2100 KB

Open AccessReview

Impact of Vitamin D Concentration on Postoperative Outcomes and Complications Following Total Knee Arthroplasty: A Scoping Review of the Literature

by Daniel Jaglarz, Tomasz Strzemecki, Rafał Pankowski, Nina Janowska, Piotr Sypień, Ewa Tramś, Rafał Kamiński and Dariusz Grzelecki

Nutrients 2026, 18(11), 1828; https://doi.org/10.3390/nu18111828 - 5 Jun 2026

Viewed by 951

Abstract

Background/Objectives: Despite its beneficial effect on the healing of bone fractures and in the treatment of osteoporosis, there is still a lack of evidence on the impact of clinical outcomes after a total joint arthroplasty (TJA). This review aims to establish the role of vitamin D in clinical outcomes after a total knee arthroplasty (TKA). Methods: In this review, PubMed, Scopus and Web of Science databases were cross-checked by two reviewers independently. The inclusion criteria were original human studies published in English from 2014 to 2024. For identification-relevant studies, the search terms used were as follows: “Vitamin D” and “total knee arthroplasty” or “total knee replacement” or “total joint arthroplasty” or “total joint replacement”. Case reports, letters and expert consensuses were excluded from the analysis. Finally, 19 studies were included in this review. Results: A literature review shows that vitamin D may have an impact on patients treated for osteoarthritis (OA) of the knee with a significant prevalence of hypovitaminosis in orthopedic patients. The influence was observed for periprosthetic joint infections: PJI patients have significantly lower vitamin D levels than primary ones. Also, a greater incidence of revision knee surgery due to PJIs in the deficient group compared to the non-deficient group at a one-year follow-up was found, of up to a 2-fold increase. This affects the clinical outcome with a lower Knee Society Score (KSS) functional score in the vitamin D-deficient group. Conclusions: The current data suggest that the vitamin D metabolism pathway and its implications in orthopedic patients, especially those treated with TKA surgery, may be a significant factor that improves clinical and functional outcomes. A possible relation between a low preoperative concentration of vitamin D and its impact on the outcomes, such as the length of the hospital stay, implant survival, and risk of complications, is needed to support these findings in multicenter, prospective studies and randomized controlled trials. Full article

(This article belongs to the Special Issue Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond)

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