Effects of Vitamin D Supplementation on Bone Mineral Density and Bone Markers in HIV-Infected Youth

Abstract

Background Low bone mineral density (BMD) is a significant co-morbidity in HIV. However, studies evaluating vitamin D supplementation on bone health in this population are limited. This study investigates changes in bone health parameters after 12 months of supplementation in HIV-infected youth with vitamin D insufficiency. Methods This is a randomized, active-control, double-blind trial investigating changes in bone parameters with 3 different vitamin D3 doses [18,000 (standard/control dose), 60,000 (moderate dose) and 120,000 IU/monthly (high dose)] in HIV-infected youth 8–25 years old with baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations <30 ng/mL. Bone mineral density and bone turnover markers were measured at baseline and 12 months. Results One hundred and two subjects enrolled. Over 12 months, serum 25(OH)D concentrations increased with all doses, but the high dose (i.e. 120,000 IU/monthly) maintained serum 25(OH)D concentrations in an optimal range (≥30 ng/mL or ≥20 ng/mL) throughout the study period for more subjects (85% and 93%, respectively) compared to either the moderate (54% and 88%, respectively) or standard dose (63% and 80%, respectively). All dosing groups showed some improvement in BMD; however, only the high-dose arm showed significant decreases in bone turnover markers for both procollagen type 1 amino-terminal propeptide (−3.7 ng/mL; P=0.001) and B-CrossLaps (−0.13 ng/mL; P=0.0005). Conclusions High dose vitamin D supplementation (120,000 IU/month) given over 12 months decreases bone turnover markers in HIV-infected youth with vitamin D insufficiency, which may represent an early, beneficial effect on bone health. High vitamin D doses are needed to maintain optimal serum 25(OH)D concentrations.

Is it possible to predict a risk of osteoporosis in patients with juvenile idiopathic arthritis? A study of serum levels of markers of bone turnover

“…Influence of vitamin D on bone development in adolescents may be dose-dependent, though. In a study of HIV-infected youth, decrease in the levels of markers of bone resorption was reported only in a group receiving monthly 120 000 IU (Eckard et al, 2017).…”

Bone health in HIV-infected children and adolescents

“…Few randomized, placebo-controlled trials of vitamin D supplementation have been conducted in HIV-infected children and adolescents 24–28 , and only two studies to date have evaluated bone changes with supplementation 24,27 . In Eckard, et al , authors investigated changes in BMD after 12 months of supplementation in 102 HIV-infected youth 8–26 years old on ART with baseline 25(OH)D ≤30 ng/mL 27 .…”

“…In Eckard, et al , authors investigated changes in BMD after 12 months of supplementation in 102 HIV-infected youth 8–26 years old on ART with baseline 25(OH)D ≤30 ng/mL 27 . In this randomized, active-control, double-blind trial, HIV-infected subjects receiving either 60,000 or 120,000 IU/month had significant increases in BMD at the LS and hip over the 12 months.…”

The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: A systematic review

“…To achieve a measurement >75 nmol/L, higher supplementation doses (>1,000 IU) than currently recommended were required; though it should be noted that other guidelines such as the Special Advisory Committee on Nutrition (SACN) [ 40 ], IOM [ 74 ], and European Food Safety Agency [ 75 ] guidlines are to achieve population mean levels above the threshold not intended for clinical purposes. Higher mean and trough serum 25OHD values were almost always achieved after supplementation [ 54 , 55 , 57 , 64 , 66 , 70 – 73 , 76 , 77 ]. Higher mean monthly 25OHD values were seen with higher doses of cholecalciferol [ 55 ].…”

“…Maximal physiologic PTH suppression, however, was inconsistently observed after cholecalciferol supplementation. Whilst four studies demonstrated decreased serum PTH [ 54 , 57 , 67 , 72 ], three did not, despite similar cholecalciferol dosing [ 64 , 73 , 77 ]. Decreased PTH appeared to be in part dependent on participants’ exposure to tenofovir (TDF).…”