Six months of vitamin D supplementation safely improved bone health and functional capacity in children and adolescents with sickle cell disease (SCD), according to a study.
Further research is needed to assess “optimal dosage, duration of supplementation, and long-term effects.” [adverse events]and its effectiveness across different types of SCD, the study researchers wrote: “Safety and efficacy of monthly high-dose vitamin D3 supplementation in children and adolescents with sickle cell disease”“teeth, European Journal of Paediatrics.
Studies have shown that adolescents and children with SCD are deficient in Vitamin D, a nutrient found in some foods that plays an important role in bone health, which can worsen the progression of the disease.
Prescribing vitamin D supplements may improve bone health in patients with SCD, but few studies have evaluated the safety of vitamin D and its impact on health-related quality of life (HRQoL) and grip strength in children and adolescents with SCD, so researchers from Zagazig University in Egypt did just that in a study (NCT06274203) to determine the safety and effectiveness of monthly oral vitamin D3 supplements in children and adolescents with SCD compared with age- and sex-matched healthy children who served as controls. The study enrolled 42 children with SCD (24 boys, 18 girls; mean age 9 years) and 42 healthy controls. Half of the children with SCD had experienced two or more vaso-occlusive crises in the past year, and 14.3% had two or more episodes of acute chest syndrome.
Based on their initial vitamin D levels, children received a low dose of 100,000 international units (IU), a medium dose of 150,000 IU, or a high dose of 200,000 IU.
The primary objective of this study was to evaluate changes in 25(OH) vitamin D3, a form of vitamin D called cholecalciferol, after six months of supplementation. Changes in bone mineral density (BMD), grip strength, and HRQoL were also evaluated. All SCD patients and 33 controls completed the study.
Vitamin D supplementation for 6 months
At the start of the study, SCD patients were thriving at a slower rate than healthy children, as measured by several parameters, including weight, height, and body mass index (BMI), as well as significantly lower grip strength and poorer HRQoL. Four patients had a history of multiple fractures.
The median baseline 25(OH) vitamin D3 level was significantly lower in the SCD group than in the control group (16.5 ng/mL vs. 28 ng/mL).
Participants were adherent to vitamin D supplementation, with an estimated adherence rate of 90% in SCD patients and 87% in the control group.
After 6 months of supplementation, vitamin D3 levels increased significantly in both groups, from 16.5 ng/mL to 30.5 ng/mL in the SCD group and from 28 ng/mL to 45 ng/mL in the control group.
At the end of the study, BMD also improved significantly, as measured by dual-energy X-ray absorptiometry, an imaging technique that uses low-dose X-rays to measure bone density. Patients with SCD also experienced improvements in their physical health and mental well-being, and their pain was significantly reduced.
Both groups showed improvements in grip strength and functional ability, as assessed by the Child Health Assessment Questionnaire (CHAQ).
The researchers observed a positive correlation between vitamin D levels measured six months after starting treatment and grip strength and pain scores. A negative correlation was found between vitamin D levels and CHAQ scores.
No clinical adverse events were reported and there was no need for new additional medications during the study period. Most SCD patients (81%) were treated with hydroxyurea, an approved drug for SCD, and no patients had changes in dosage or treatment regimen during the study period.
“Monthly oral high-dose vitamin D supplementation is safe, well tolerated, and associated with increased vitamin D levels, [hand grip strength]improved HRQL in both children with SCD and healthy subjects, and improved BMD scores in patients with SCD,” the researchers wrote. “Further large-scale randomized controlled trials are needed to develop standard guidelines for optimal dosing and to investigate the impact on clinically important outcomes in children and adolescents with SCD and in healthy subjects.”
