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

• Type of Material: Article
• Authors: Allison Eckard, Emory University; Mary Ann O'Riordan, Case Western Reserve University; Julia C. Rosebush, Emory University; Joshua H. Ruff, Emory University; Ann Chahroudi, Emory University; Danielle Labbato, Case Western Reserve University; Julie E. Daniels, Emory University; Monika Uribe-Leitz, Emory University; Vin Tangpricha, Emory University; Grace A. McComsey, Case Western Reserve University
• Language: English
• Date: 2017-12-15
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 76
• Issue: 5
• Start Page: 539
• End Page: 546
• Grant/Funding Information: This work was made possible by the National Institute of Child Health and Development at the National Institutes of Health [K23 HD069199 to ARE; R01 HD070490 to GAM; K12 HD072245 to AC], Case Western Reserve University’s Center for AIDS Research (P30 AI36219), Emory University’s Center for AIDS Research (P30 AI050409), Emory+Children’s Pediatric Research Center (Immunology and Flow Cytometry Cores), Clinical and Translational Science Award and the Clinical and Translational Science Collaborative of Cleveland (UL1TR000439) from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research.; The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: Immunology; RANDOMIZED CONTROLLED-TRIALS; Science & Technology; ANTIRETROVIRAL THERAPY; Infectious Diseases; CALCIUM; randomized-controlled trial; RISK; PREVENTION; FRACTURE; MASS; vitamin D; bone turnover markers; YOUNG-ADULTS; D DEFICIENCY; IMMUNE-SYSTEM; Life Sciences & Biomedicine; pediatrics and adolescents; HIV; bone mineral density
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

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.