Prevalence and risk factors for vitamin D deficiency in long‐term childhood cancer survivors

Abstract

Background: Childhood cancer survivors (CCS) have increased risk of developing chronic health conditions, including musculoskeletal disorders. Little is known regarding vitamin D deficiency (VDD, <20 ng/ml) and its association with bone mineral density (BMD) in long-term CCS. We evaluated the prevalence and risk factors for VDD in a large, diverse population of long-term CCS, and examined the association between VDD and BMD in patients who underwent guideline-recommended dual-energy X-ray absorptiometry (DXA) screening. Methods: This cross-sectional study included 446 consecutive CCS seen from March 2018 to September 2020. Univariate analyses examined associations between CCS demographics, socioeconomic status, and treatment exposures and VDD. Multivariable logistic regressions identified factors associated with odds of VDD and reduced BMD.Results: Median age at evaluation was 27.5 years (range 7-67 years); median time from completing therapy was 14.2 years (range 2-65 years). Fifty percent were female, and 45% were Hispanic. Twenty-four percent had VDD. In multivariable analysis, overweight and obese BMI were associated with VDD (overweight: OR 1.78, 95% CI 1.03-3.07, p = 0.04; obese: OR 2.40, 95% CI 1.39-4.13, p < 0.01; reference: normal/underweight), as was Hispanic or black race/ethnicity (OR 2.40, 95% CI 1.41-4.09, p < 0.01; reference: non-Hispanic white). In the 118 CCS with DXA results, VDD was independently associated with reduced BMD (OR 3.58, 95%CI 1.33-9.59, p = 0.01).Conclusions: CCS have a high prevalence of VDD. High BMI and Hispanic or black race/ethnicity were associated with VDD. Survivors with VDD had a greater than threefold risk of reduced BMD. Risk-based screening may facilitate timely interventions to mitigate VDD and improve BMD in CCS.

Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…The main treatment-related risk factors for low BMD include C(S)RT (highquality evidence), 6,9,32,38,51,54,64,68 total body irradiation (TBI) (high-quality evidence), 9,45,54,64,65 and corticosteroids (administered as anti-cancer treatment, moderatequality evidence) 6,9,51,54,68 . Survivors treated with higher doses of C(S)RT (low-quality evidence) 32 and corticosteroids (moderate-quality evidence) 32,46,69 are at greater risk of low BMD.…”

“…321-323 and 326-328). Survivor characteristics and health behaviors associated with low BMD include low BMI (high-quality evidence), 6,9,40,42,51,54,56,64,68,69 male sex (high-quality evidence), 6,9,32,[40][41][42]45,51,54,56,64,65,68 White race (moderate-quality evidence),40,41,51,65,68 lack of physical activity (moderate-quality evidence), 11,40,51,56 and current or prior smoking (moderate-quality evidence). 6,9,56,61 We found conflicting evidence for the association between alcohol consumption 61 and low BMD.…”

“…However, we found an increased risk of low BMD for survivors with biochemical vitamin D deficiency (25OHD levels <20 ng/ml) (low-quality evidence). 65 None of the included studies assessed the risk of low BMD in relation to biochemical vitamin B deficiency, hyperthyroidism, or consumption of carbonated beverages.…”

Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives

“…The common alterations in both CCS and cancer patients during therapy are in the metabolism of calcium, vitamin D, and magnesium [ 39 ], key micronutrients for bone growth [ 46 ]. It has been reported that the 25% of pediatric cancer patients show deficiency of vitamin D [ 47 ] and this condition increases the risk of low BMD by more than 3-fold [ 48 ]. Vitamin D influences bone mass [ 49 ], by modulating the differentiation of bone cells and bone mineralization [ 50 ].…”

Vitamin D Deficiency in Childhood Cancer Survivors: Results from Southern Thailand

“…There are few studies on vitamin D deficiency in CCSs. Previous studies have reported the prevalence of vitamin D deficiency in CCSs, varying from 14% to 48% [ 17 , 18 , 19 , 20 , 21 ]. Considering that there is limited information on vitamin D deficiency among CCSs in tropical regions with an abundance of sunlight, such as southern Thailand, this study aims to identify the prevalence and clinical risk factors of vitamin D deficiency in CCSs in southern Thailand.…”