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As a nuclear receptor, VDR binds to the active metabolite 1,25-dihydroxyvitamin D3 to regulate gene expression, thereby governing calcium absorption and maintaining bone health [104, 105]

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This bidirectional relationship is clinically significant as anxiety and depression exacerbate pain perception, leading to poorer treatment outcomes, more severe symptoms, and reduced quality of life (Roughan et al., 2021)