These include 1) reduced expression of the CYP24A1 gene, coding for 1-alpha hydroxylase, which is responsible for conversion of vitamin-D to its active form; 2) decreased vitamin D production secondary to reduced vitamin-D receptors in adipocytes [32,33]; 3) increased sequestration in adipocytes and reduced bioavailability [34]; 4) increased 24-hydroxylase activity leading to enhanced catabolism of vitamin D [35]; and secondary hyperparathyroidism leading to increased lipogenesis and volumetric dilution [36]. Here, CYP24A1 is linked to secondary hyperparathyroidism.