Vitamin D Status and Its Correlation with Bone Mineral Density in Long Term Survivors After Childhood Hematopoietic Stem Cell Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4472-4472
Author(s):  
Amy Garee ◽  
Micah Skeens ◽  
Sasigarn Bowden ◽  
Manmohan Kamboj ◽  
Sally Wildman ◽  
...  
Keyword(s):  
Vitamin D ◽  
Whole Body ◽  
P Value ◽  
Vitamin D Status ◽  
Mineral Density ◽  
Hematopoietic Stem ◽  
Vitamin D Levels ◽  
Z Scores ◽  
Long Term Survivors

Abstract Abstract 4472 Introduction: Children undergoing hematopoietic stem cell transplantation (HSCT) are at risk of developing vitamin D deficiency (VDD). However, data on vitamin D status and its correlation with bone mineral density (BMD) in the long term survivors after childhood HSCT is limited. The aim of this study was to determine the prevalence of VDD among long term survivors after HSCT in childhood, and to evaluate the correlations between vitamin D and BMD. Methods: A retrospective study was carried out in patients seen in Long Term follow-up Clinic (LTFC) at our institution from January 2011 to July 2012. Vitamin D deficiency (VDD) and insufficiency (VDI) were defined as serum 25-hydroxyvitamin D (25-OHD) <15 ng/mL and 15–30 ng/mL, respectively. BMD was measured using dual-energy radiograph absorptiometry (Hologic Delphi). Lumbar, total body, and hip BMD Z scores were determined using manufacturer's normative data based on age. Spearman's correlation was performed to assess correlation between serum 25-OHD levels and different BMD variables. Results: Ninety eight patients underwent 103 HSCTs between 1990 and 2010. Fifty two (53%) patients were > 5 years out of transplant. A total of 114 vitamin D levels were recorded for the 98 patients, the median 25-OHD level was 26 (range 7 – 68 ng/mL). In 68/114 (60%) observations the 25-OHD levels were less than < 30ng/mL. Of these, 10 (9%) patients had VDD (levels < 15ng/mL, while 58 (51%) had VDI. There were no significant correlations between 25-OHD levels and age at HSCT, gender, underlying diagnosis, type of transplant, or development of acute or chronic GVHD (Table 2). There was a trend towards lower 25-OHD levels after non-TBI based conditioning regimen (p = 0.047). BMD was performed in 83 patients (85%). Low BMD was found in nearly one-third to half of patients tested: 29%, 54%, and 33% of the patients had BMDlumbar, BMDhip and BMDWB Z scores of < −1.0, respectively, while 5%, 9% and 5% of the patients had BMDlumbar, BMDhip and BMDWB Z scores < −2.5, respectively. The median Z scores of the BMDlumbar, BMDhip, and the BMDWB were −0.3 (range −4.2 to 2.4), −1.1 (range −3.3 to 1.9), and −0.4 (range −5.4 to 2.7) respectively. In patients with BMD < −2.5 and < −1.0, the corresponding median 25-OHD was 26 (range 7 – 62 ng/mL) and there was no significant association. Spearman correlation between 25-OHD D level, BMDWB and BMDlumbar showed a correlation coefficient of −0.24 (p value: 0.0409) and −0.22 (p value: 0.0546) respectively. There was no correlation between normal vitamin D levels, VDI and VDD with BMD of the hip, lumbar spine and whole body. Discussion: Low 25-OHD (<30ng/mL) was common (60%) in long term survivors after HSCT during childhood. Similar to other reports, VDD and VDI was seen in 9%, and 51% of the patients respectively. There was only a weak correlation of the 25-OHD levels with BMD of whole body and the lumbar spine, suggesting that factors other than hypovitaminosis D might have contributed to low BMD. There was a small trend of lower 25-OHD levels after non-TBI based conditioning. Disclosures: No relevant conflicts of interest to declare.

scholarly journals MON-387 Association Between Vitamin D Level and Bone Mineral Density in Korean Adolescents

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kyungchul Song ◽  
Han saem CHOI ◽  
Junghwan Suh ◽  
Ah Reum Kwon ◽  
Hyun-wook Chae ◽  
...  
Keyword(s):  
Physical Activity ◽  
Vitamin D ◽  
Lean Mass ◽  
Calcium Intake ◽  
Whole Body ◽  
Vitamin D Status ◽  
Mineral Density ◽  
Femur Neck ◽  
Vitamin D Levels ◽  
Z Scores

Abstract Introduction Fractures are common in pediatric population, and lower bone density increases the risk of fracture. Most bone acquisition happens during youth, so juvenile bone mineral density (BMD) assessment is important. There are many factors associated with low BMD, including vitamin D status, calcium intake, low body weight, and physical activity. Among these, our investigation focused on the association of BMD with vitamin D in adolescents. Methods This study investigated data of 1,063 adolescents aged 12-18 years from the fifth and sixth Korea National Health and Nutritional Examination Survey (2009-2011). The association of various factors (vitamin D level, calcium intake, body mass index (BMI), lean mass, fat mass, and physical activity) with BMD Z-scores in whole body, lumbar spine, total femur, and femur neck were analyzed. We defined vitamin D deficiency (≤ 12 ng/mL), vitamin D insufficiency (12-20 ng/mL), and sufficiency (&gt; 20ng/mL) according to the 25-hydroxyvitamin D (25-OHD) level. We analyzed association between BMD and vitamin D levels after adjusting for other factors. Results The mean 25-OHD level of subjects was low (16.28 ng/ml). Of all subjects, 21.9% were vitamin D deficient, and 58.5% were vitamin D insufficient. Among the vitamin D groups, the vitamin D sufficient group had significantly higher BMD Z-scores than the vitamin D deficient group in whole body, lumbar spine, and femur neck. The sufficient vitamin D group had higher BMD Z-score than the vitamin D insufficient group in femur neck, and the vitamin D insufficient group had higher BMD Z-score than the vitamin D deficient group in whole body. Among various factors, vitamin D status, calcium intake, BMI, lean mass, fat mass, and physical activity were positively associated with BMD Z-scores. In particular, lean mass was the strongest independent factor. Vitamin D levels were positively associated with the BMD Z-scores even after adjusting for other factors. Conclusions Vitamin D deficiency and insufficiency were common among adolescents. This study suggested that vitamin D level was positively associated with BMD, and that sufficient vitamin D level was needed to prevent low BMD. Vitamin D status is an important factor of BMD in adolescents.

scholarly journals Long-term iron polymaltose infusions associated with hypophosphataemic osteomalacia: a report of two cases and review of the literature

2016 ◽  
Vol 8 (1-2) ◽  
pp. 14-19 ◽  
Author(s):  
Ramy H. Bishay ◽  
Kirtan Ganda ◽  
Markus J. Seibel
Keyword(s):  
Vitamin D ◽  
Fibroblast Growth Factor 23 ◽  
Normal Serum ◽  
Whole Body ◽  
Insufficiency Fractures ◽  
Mineral Density ◽  
Vitamin D Levels ◽  
Parenteral Iron ◽  
Hypophosphataemic Osteomalacia

Iron-induced hypophosphataemic osteomalacia remains under-recognized as a potential complication of parenteral iron therapy. We here report two cases of symptomatic hypophosphataemic osteomalacia with multiple insufficiency fractures in the context of chronic gastrointestinal blood loss, necessitating monthly iron polymaltose infusions over prolonged periods of time. Respective blood tests revealed severe hypophosphataemia [0.29 and 0.43; normal range (NR) 0.8–1.5 mmol/l] in the presence of normal serum calcium and 25-hydroxy vitamin D levels. Urinary fractional phosphate excretion was elevated (16% and 24%; NR < 5%) and the tubular maximum phosphate reabsorption was reduced, consistent with renal phosphate wasting. Serum fibroblast growth factor 23 (FGF23) obtained in one patient was significantly elevated at 285 pg/ml (NR < 54 pg/ml). Bone mineral density was significantly reduced and whole-body bone scans revealed metabolic bone disease and multiple insufficiency fractures consistent with osteomalacia. Cessation of iron infusions resulted in clinical and biochemical improvement within 2 months in one patient whereas the second patient required phosphate and calcitriol supplementation to improve symptomatically. Iron-induced hypophosphataemic osteomalacia is thought to be due to reduced degradation of FGF23, resulting in phosphaturia and reduced synthesis of 1,25-dihydroxy vitamin D. Monitoring of patients on long-term parenteral iron is recommended to avoid clinically serious adverse effects.

scholarly journals Bone mineral density and explanatory factors in children and adults with juvenile dermatomyositis at long term follow-up; a cross sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Henriette Schermacher Marstein ◽  
Kristin Godang ◽  
Berit Flatø ◽  
Ivar Sjaastad ◽  
Jens Bollerslev ◽  
...  
Keyword(s):  
Bone Turnover ◽  
Inflammatory Markers ◽  
Juvenile Dermatomyositis ◽  
Inflammatory Myopathy ◽  
Disease Onset ◽  
Whole Body ◽  
Mineral Density ◽  
Z Scores

Abstract Background Juvenile dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children and adolescents. Both the disease and its treatment with glucocorticoids may negatively impact bone formation. In this study we compare BMD in patients (children/adolescence and adults) with long-standing JDM with matched controls; and in patients, explore how general/disease characteristics and bone turnover markers are associated with BMD. Methods JDM patients (n = 59) were examined median 16.8y (range 6.6–27.0y) after disease onset and compared with 59 age/sex-matched controls. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD of the whole body and lumbar spine (spine) in all participants, and of ultra-distal radius, forearm and total hip in participants ≥20y only. Markers of bone turnover were analysed, and associations with outcomes explored. Results Reduced BMD Z-scores (<−1SD) were found in 19 and 29% of patients and 7 and 9% of controls in whole body and spine, respectively (p-values < 0.05). BMD and BMD Z-scores for whole body and spine were lower in all patients and for < 20y compared with their respective controls. In participants ≥20y, only BMD and BMD Z-score of forearm were lower in the patients versus controls. In patients, BMD Z-scores for whole body and/or spine were found to correlate negatively with prednisolone use at follow-up (yes/no) (age < 20y), inflammatory markers (age ≥ 20y) and levels of interferon gamma-induced protein 10 (IP-10) (both age groups). In all patients, prednisolone use at follow-up (yes/no) and age ≥ 20y were independent correlates of lower BMD Z-scores for whole body and spine, respectively. Conclusion In long-term JDM, children have more impairment of BMD than adults in spine and whole-body. Associations with BMD were found for both prednisolone and inflammatory markers, and a novel association was discovered with the biomarker of JDM activity, IP-10.

scholarly journals Vitamin-D status and bone mineral density in asthmatic children on long-term inhaled corticosteroids

2020 ◽  
Vol 35 ◽  
pp. 39-47
Author(s):  
B. Thanuja ◽  
M. R. Savitha
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Mineral ◽  
Inhaled Corticosteroids ◽  
High Dose ◽  
Mineral Density ◽  
Chronic Therapy ◽  
Vitamin D Levels ◽  
The Impact

Asthma is the most common chronic respiratory illness affecting children. Inhaled corticosteroids (ICS) form the main treatment modality in asthma. Reduction in bone mineral density (BMD) is an important adverse effect of steroid usage. This side effect is an established entity with oral corticosteroids but minimal with ICS therapy. However, there are reports regarding the detrimental effect of chronic therapy with ICS. Long-term high-dose budesonide more than 800 μg/day has been shown to reduce the BMD. However, this effect was not consistently seen with moderate doses of 400–800 μg/day. Anticipating the impact of steroids on bone metabolism and monitoring for it is essential. Annual monitoring of Vitamin-D levels and BMD in children on chronic therapy is beneficial for the early detection and management of steroid-induced osteopenia. Judicious ICS use at the lowest effective dose should be tailor-made for every individual.

scholarly journals Does vitamin D status track through adolescence?

2015 ◽  
Vol 102 (5) ◽  
pp. 1025-1029 ◽  
Author(s):  
Machuene A Poopedi ◽  
Shane A Norris ◽  
Lisa K Micklesfield ◽  
John M Pettifor
Keyword(s):  
Vitamin D ◽  
Age Groups ◽  
Vitamin D Status ◽  
Hydroxyvitamin D ◽  
Disease States ◽  
Cast Doubt ◽  
Z Scores ◽  
The Individual ◽  
Time Point

ABSTRACT Background: To our knowledge, no studies have reported on the long-term variability of vitamin D status in adolescents. Objective: To determine whether tracking of vitamin D status occurs in healthy adolescents, we assessed the variability of 25-hydroxyvitamin D [25(OH)D] every 2 y over a 10-y period in a longitudinal cohort of adolescents living in Johannesburg, South Africa (latitude 26°S). Design: Healthy adolescents who had blood samples available on ≥3 occasions between 11 and 20 y of age were included in the study. Of the cohort of 504 children, 99 met the criteria. The mean 25(OH)D concentration at each time point was measured, and the individual 25(OH)D z scores based on year 11 values were used as the reference. All 25(OH)D concentrations for a subject were measured in a single assay. Results: No significant correlation was found between 25(OH)D in the earlier and later years of adolescence, although significant correlations were found between year 11 and year 13 (r = 0.71, P < 0.0001) and between years 15, 17, and 20 (r ≥ 0.65, P < 0.0001). The percentage of adolescents whose 25(OH)D concentration changed by >20 nmol/L from year 11 was calculated for all age groups: 12% of the cohort had a change of >20 nmol/L at 13 y of age compared with 46% at 20 y of age. Just more than one-half (53%) of the cohort changed their category of vitamin D status between the ages of 11 and 20 y, and one-third of adolescents changed from being replete to insufficient over the same period. Conclusions: The data suggest that the measurement of 25(OH)D at a single time point does not reflect the long-term vitamin D status of an adolescent. These findings may cast doubt on the veracity of those studies that suggest an association of vitamin D status with various disease states in which vitamin D status was measured only once.

Predictors of decline in vitamin D status in middle-aged and elderly individuals: a 5-year follow-up study

2020 ◽  
Vol 124 (7) ◽  
pp. 729-735
Author(s):  
Kazutoshi Nakamura ◽  
Kaori Kitamura ◽  
Yumi Watanabe ◽  
Toshiko Saito ◽  
Akemi Takahashi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Seasonal Effects ◽  
Vitamin D Status ◽  
Middle Aged ◽  
Hydroxyvitamin D ◽  
Vitamin D Levels ◽  
Longitudinal Study Design ◽  
25 Hydroxyvitamin D

AbstractLittle is known about predictors of decline in vitamin D status (vitamin D decline) over time. We aimed to determine demographic and lifestyle variables associated with vitamin D decline by sufficiently controlling for seasonal effects of vitamin D uptake in a middle-aged to elderly population. Using a longitudinal study design within the larger framework of the Murakami Cohort Study, we examined 1044 individuals aged between 40 and 74 years, who provided blood samples at baseline and at 5-year follow-up, the latter of which were taken on a date near the baseline examination (±14 d). Blood 25-hydroxyvitamin D (25(OH)D) concentrations were determined with the Liaison® 25OH Vitamin D Total Assay. A self-administered questionnaire collected demographic, body size and lifestyle information. Vitamin D decline was defined as the lowest tertile of 5-year changes in blood 25(OH)D (Δ25(OH)D) concentration (<6·7 nmol/l). Proportions of those with vitamin D decline were 182/438 (41·6 %) in men and 166/606 (27·4 %) in women (P < 0·0001). In men, risk of vitamin D decline was significantly lower in those with an outdoor occupation (P = 0·0099) and those with the highest quartile of metabolic equivalent score (OR 0·34; 95 % CI 0·14, 0·83), and higher in those with ‘university or higher’ levels of education (OR 2·92; 95 % CI 1·04, 8·19). In women, risk of vitamin D decline tended to be lower with higher levels of vitamin D intake (Pfor trend = 0·0651) and green tea consumption (Pfor trend = 0·0025). Predictors of vitamin D decline differ by sex, suggesting that a sex-dependent intervention may help to maintain long-term vitamin D levels.

scholarly journals Effect of inhaled corticosteroids on bone mineral density in asthmatic children

2021 ◽  
Vol 8 (4) ◽  
pp. 672
Author(s):  
Thanuja Basavanagowda ◽  
Savitha Mysore Ramaraj
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Mineral ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
High Dose ◽  
Mineral Density ◽  
Asthmatic Children ◽  
Vitamin D Levels

Background: There is a rise in prevalence of asthma world-over. This study was undertaken as there are controversies regarding the effect of long term inhaled-corticosteroids (ICS) on bone mineral density (BMD).Methods: Asthmatic children belonging to 5-18 year age-group as per the global initiative for asthma guidelines (GINA) guidelines, who were on ICS for a minimum period of 6 months were studied. This study was conducted at a tertiary-care teaching hospital in Mysuru. 60 asthmatic children were compared with 60 non-asthmatic controls. Dual-energy x-ray absorptiometry at 6 sites was used for estimating the BMD and vitamin D levels were measured.Results: 0.771±0.114 g/cm2 was the mean total BMD among children on low dose ICS, while it was 0.613±0.192 and 0.564±0.104 g/cm2 respectively for those on medium and high dose ICS, with p value of 0.026. Children on low dose ICS did not have any impact on BMD, while 18.9% of those on medium and high dose ICS had a reduced total BMD. Trochanteric region was a useful predictor site for monitoring BMD in children on long term ICS with 38.7% and 68.9% being affected when on ICS for 6-12 months and more than 12 months respectively (p=0.018).Conclusions: The ICS of medium and high dose, for a duration of more than 6 months had a reduced total BMD. However, no effect was seen with low dose. Trochanter is a useful site for long term monitoring of BMD in children. There was no correlation between vitamin D levels and control of asthma.

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