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Collectively, these studies indicate that vitamin D signaling (VDR/Nrf2/GPX4), irisin (Nrf2/HO-1), marrow adiposity, and tobacco exposure converge on iron dysregulation, lipid peroxidation, and ferroptosis in osteogenic cells

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For plan sponsors, these differences highlight the importance of balancing efficacy with tolerability, as side-effects can directly influence adherence and total cost of therapy