Effect of Vitamin D Replacement on Musculoskeletal Parameters in School Children: A Randomized Controlled Trial

Fuleihan, Ghada El‐Hajj; Nabulsi, Mona; Tamim, Hani; Maalouf, Joyce; Salamoun, Mariana; Khalifé, Hassan; Choucair, Mahmoud; Arabi, Asma; Vieth, Reinhold

doi:10.1210/jc.2005-1436

Cited by 334 publications

(316 citation statements)

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“…Our observational follow-up study merged the low-dose and highdose vitamin D groups, because no significant differences were noted between the two arms, during the intervention. (12) Data collection…”

Section: Subjectsmentioning

confidence: 99%

“…The adjustment for percent lean mass was because of the known effect of vitamin D on muscle and was shown in the original intervention trial. (12) We also adjusted for bone area and height changes to adjust for growth and pubertal maturation. These adjustments were implemented in the repeated measures two-way ANOVA and in the multivariate analyses.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…(5) Several trials have investigated means to maximize peak bone mass through lifestyle measures, by increasing physical activity or emphasizing on dairy products consumption or supplementation of calcium and vitamin D. (1,(6)(7)(8)(9) Two randomized trials using calcium-fortified milk demonstrated increments in bone mass in adolescent Chinese girls and Gambian boys, but could not demonstrate residual effect after trial completion. (10,11) Our group had previously reported on the beneficial effects of vitamin D supplementation in adolescent girls, (12) but not boys, (13) on bone mineral content (BMC), bone mineral density (BMD), and lean mass, in a 1-year trial that compared two doses of vitamin D (low dose ¼ 200 IU/day; high dose ¼ 2000 IU/day) to placebo. The increments were comparable at both doses, although there was a trend for larger increments in bone mass at the high dose, in premenarcheal girls.…”

Section: Introductionmentioning

confidence: 99%

“…The increments were comparable at both doses, although there was a trend for larger increments in bone mass at the high dose, in premenarcheal girls. (12) To our knowledge, no previous studies have investigated the putative residual effects of vitamin D on the musculoskeletal parameters, after trial completion, if any, in adolescents. We hypothesize that vitamin D beneficial effect on muscle mass, BMD, and BMC in adolescents persists between treatment arms 1 year after trial completion (follow-up).…”

Section: Introductionmentioning

confidence: 99%

“…We would anticipate that the most substantial increments would be noted in premenarcheal girls, as noted in the main trial. (12) …”

Section: Introductionmentioning

confidence: 99%

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Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion

Ghazal

Al-Shaar

Maalouf

et al. 2016

Journal of Bone and Mineral Research

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We showed a beneficial effect of vitamin D supplementation on musculoskeletal parameters in adolescent girls in a 1-year, randomized, double-blinded placebo-controlled trial (RCT). Our objective for this study was to investigate the residual effect of vitamin D supplementation on bone mineral content (BMC), bone mineral density (BMD), at the lumbar spine and hip, lean mass, and height, 1 year after trial completion. We performed post hoc analyses in 167 adolescents, 86 girls and 81 boys, age 13.9 AE 2 years, who received vitamin D or placebo during the trial, and continued into the follow-up trial. Musculoskeletal parameters were measured at baseline, 12 months (intervention), and 24 months (follow-up). ANOVA and t tests were used to compare results between the placebo group and the merged vitamin D arms (200 or 2000 IU/day), by gender. Baseline characteristics were comparable between treatment groups at entry into the extension. Girls who had received vitamin D during the trial, had significantly larger hip BMC increments compared to those assigned to placebo, at 24 months compared to study entry, but not 24 compared to 12 months, which persisted in adjusted analyses. There were no significant differences in bone mass changes between treatment groups in boys, at 24 months compared to 12 months or to baseline. The beneficial effect of vitamin D supplementation on hip bone mass, achieved in girls during the trial, persisted 1 year after trial completion. These net cumulative increments, 1 year after discontinuation of supplementation, may have important implications on optimizing peak bone mass accretion in adolescent girls.

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Section: Subjectsmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…We would anticipate that the most substantial increments would be noted in premenarcheal girls, as noted in the main trial. (12) …”

Section: Introductionmentioning

confidence: 99%

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Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion

Ghazal

Al-Shaar

Maalouf

et al. 2016

Journal of Bone and Mineral Research

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Vitamin D Supplementation

2010

Arch Intern Med

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Navigating the debateThere is no evidence to support blanket ■ supplementation with vitamin D for the total population Severe vitamin D deficiency is a serious health ■ concern, however, there is only weak evidence that mild deficiency is clinically significant Vitamin D testing is expensive and there is no ■ consensus on the optimal vitamin D serum level. Monitoring vitamin D levels is also considered unnecessary.The best way to increase vitamin D levels for ■ the general population is short (non-burning) bouts of sunlight exposure to 20% of the body (i.e. arms and legs) Supplementation can be recommended for ■ asymptomatic people, who are at high-risk of vitamin D deficiency, without the need for serum testing Vitamin D toxicity is rare and requires excessive ■ and prolonged supplementation, however, emerging data suggest possible adverse effects associated with sustained high levels Key concepts BPJ | Issue 36 | 27 Vitamin D: why all the confusion? Vitamin D is required by everyone to regulate the body's calcium balance. This homeostasis is achieved by influencing calcium absorption, mainly in the small intestine. Vitamin D is important for bone mineralisation and general muscle and bone health. Severe deficiency can result in hypocalcaemic seizures and weak or misshapen bones -rickets in children, osteomalacia and osteoporosis in adults. 1 Normally, vitamin D is produced in the skin following exposure to UVB which then becomes metabolically active following reactions in the liver and kidney. Despite vitamin D being essential for maintaining good health, there is disagreement as to what the optimal level of vitamin D is, as international recommendations vary. This has lead to uncertainty in exactly how to interpret serum levels when individuals are tested. In recent years low vitamin D levels have been associated with a host of non-musculoskeletal conditions, such as cancer, autoimmune diseases, diabetes, multiple sclerosis and heart disease, although studies often produce mixed results. 1, 2 Consequently, a number of groups have begun advocating blanket supplementation as a form of catch-all prophylaxis. Requests by patients to have vitamin D levels assessed are also increasing despite a lack of evidence that vitamin D improves any non-musculoskeletal outcomes. 3

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Vitamin D Supplementation—Reply

Pietras¹,

Holick²

2010

Arch Intern Med

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Effect of Vitamin D Replacement on Musculoskeletal Parameters in School Children: A Randomized Controlled Trial

Abstract: Vitamin D replacement had a positive impact on musculoskeletal parameters in girls, especially during the premenarcheal period.

Cited by 334 publications

References 38 publications

Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion

Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion

Vitamin D Supplementation

Vitamin D Supplementation—Reply

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