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Vitamin D deficiency in children with haemophilia
Author(s) -
GOWDA MADHU,
MASSEY GITA,
KUMAR ANIL RAMASWAMY,
KHAN ASADULLAH,
NOLTE MELINDA,
KUHN JANICE
Publication year - 2009
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.2009.01996_5.x
Subject(s) - medicine , vitamin d and neurology , vitamin d deficiency , haemophilia , osteoporosis , bone mineral , haemophilia a , bone density , osteomalacia , vitamin , calcium , pediatrics , endocrinology , gastroenterology
Background: Recent studies have shown that children with severe haemophilia could have moderately reduced bone density compared with gender‐ and age‐matched control subjects. Patients with more established changes resulting from haemophilic joint disease exhibited the lowest bone mineral density. The reason for this includes factors such as lack of weight‐bearing physical activity, lower height and weight reached by these patients, muscle atrophy and hepatitis C seropositivity. A lower peak bone density reached during late adolescence and young adulthood predisposes to the development of osteoporosis in the later years. Objective: While Vitamin D and calcium supplementation has been recommended by many authors for haemophiliacs, there are no studies looking at Vitamin D levels in these patients. The aim of this study was to evaluate for the prevalence of Vitamin D deficiency and the need for supplementation in the haemophiliac patients in our centre. Methods: The 25‐hydroxy Vitamin D3 (25‐OH D3), calcium, phosphorus and PTH levels were measured in patients between the ages of 1–18 years during their regular visits to the haemophilia centre. A 25‐OH D3 level of >30ng mL −1 is considered as adequate, levels of 21–29 ng mL −1 indicates a relative insufficiency and a level <20ng mL −1 is defined by most experts as being absolutely Vitamin D deficient. Results: Of the 33 patients, 21 of them were Vitamin D deficient (63.6%). Calcium, phosphorus and PTH levels did not correlate with Vitamin D levels. Conclusions: Vitamin D deficiency is highly prevalent in patients with haemophilia in our centre, and given their propensity to develop osteopenia, Vitamin D supplementation is essential in this group of patients. As the calcium, phosphorus and PTH level do not correlate with Vitamin D levels, evaluation of Vitamin D deficiency needs the measurement of serum 25‐hydroxy D3 level. The reasons for a deficiency of Vitamin D in these patients, the amount of supplementation needed and the effect of supplementation of Vitamin D on attaining the peak bone mass density of these patients need to be explored further.
Vitamin D status in patients with haemophilia (25‐OH D3 level)
>30 ng mL −1 (normal) 21–29 ng mL −1 (relative insufficiency) <20 ng mL −1 (severe insufficiency)<30 ng mL −1 (vitamin D deficiency)Haemophilia A&B (# of patients) 12 9 12 21/33 = 63.6%