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Randomized Controlled Trial
. 2015 Apr;62(4):687-92.
doi: 10.1002/pbc.25370. Epub 2015 Jan 28.

Bone loss and vitamin D deficiency in children undergoing hematopoietic cell transplantation

Lori J Bechard  1 , Catherine Gordon, Henry A Feldman, Robert Venick, Kathleen Gura, Eva C Guinan, Christopher Duggan
Affiliations
Randomized Controlled Trial

Bone loss and vitamin D deficiency in children undergoing hematopoietic cell transplantation

Lori J Bechard et al. Pediatr Blood Cancer. 2015 Apr.

Abstract

Background: Hematopoietic cell transplantation (HCT) may be detrimental to bone health and vitamin D status in children.

Procedure: We conducted a prospective, multicenter cohort study to identify changes in bone health markers during the first 100 days after allogeneic HCT in 26 children. Bone mineral density (BMD), bone mineral content (BMC), and serum 25-hydroxyvitamin D (25OHD) concentrations were measured at baseline, 30 days, and 100 days after HCT.

Results: Mean (SD) BMD and BMC Z-scores (-0.48 ± 1.09 and -0.98 ± 1.26, respectively) were normal at baseline. Repeated-measures analysis revealed significant declines in BMD and BMC Z-scores over the 100 day study period, when adjusted for age, sex, Tanner stage, lean mass, fat mass, resting energy expenditure, total energy intake, insulin sensitivity, serum phosphorus, and inpatient steroid intake. Adjusted mean (SE) 25OHD concentrations declined from 29.2 (3.1) ng/ml at baseline, to 17.7 (1.8) ng/ml at 100 days after HCT. Vitamin D deficiency (25OHD <20 ng/ml) was present in 50% of patients 100 days after HCT.

Conclusions: Significant bone loss and vitamin D deficiency occur in children in the first 100 days following allogeneic HCT. Strategies to diminish acute bone loss during HCT in children are needed.

Keywords: bone demineralization; bone density; hematopoietic cell transplantation; vitamin D.

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Figures

Fig. 1
Fig. 1
Changes in bone mineral indicators over time in a cohort of children following HCT. Error bars = ±1 standard error; adjusted for age, sex, Tanner stage, lean mass, fat mass, REE, energy intake, insulin sensitivity, inpatient steroid intake, and serum phosphorus; *significant decline from baseline; time trend significant at P < 0.0001 for BMD Z-score, P = 0.007 for BMC Z-score.
Fig. 2
Fig. 2
Changes in serum 25OHD over time in children after HCT. Error bars = ±1 standard error; adjusted for age, sex, Tanner stage, lean mass, fat mass, REE, energy intake, insulin sensitivity, serum phosphorus, inpatient steroid intake, and vitamin D intake; *significant decline from baseline; time trend significant, P = 0.001. Dashed line indicates level of vitamin D deficiency, 20 ng/ml.
See this image and copyright information in PMC

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