Intervention Review

Vitamin D supplementation for improving bone mineral density in children

  1. Tania M Winzenberg1,*,
  2. Sandi Powell1,
  3. Kelly A Shaw2,
  4. Graeme Jones1

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 6 OCT 2010

Assessed as up-to-date: 29 SEP 2009

DOI: 10.1002/14651858.CD006944.pub2


How to Cite

Winzenberg TM, Powell S, Shaw KA, Jones G. Vitamin D supplementation for improving bone mineral density in children. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD006944. DOI: 10.1002/14651858.CD006944.pub2.

Author Information

  1. 1

    University of Tasmania, Menzies Research Institute, Hobart, TAS, Australia

  2. 2

    Southern Cross University and Menzies Research Institute, University of Tasmania, ASLaRC Aged Services Unit, Coffs Harbour, Tasmania, Australia

*Tania M Winzenberg, Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia. tania.winzenberg@utas.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 6 OCT 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Results of randomised controlled trials (RCTs) of vitamin D supplementation to improve bone density in children are inconsistent.

Objectives

To determine the effectiveness of vitamin D supplementation for improving bone mineral density in children, whether any effect varies by sex, age or pubertal stage, the type or dose of vitamin D given or baseline vitamin D status, and if effects persist after cessation of supplementation.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 3, 2009), MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), AMED (1985 to present) and ISI Web of Science (1945 to present) on 9 August 2009, and we handsearched key journal conference abstracts.

Selection criteria

Placebo-controlled RCTs of vitamin D supplementation for at least three months in healthy children and adolescents (aged from one month to < 20 years) with bone density outcomes.

Data collection and analysis

Two authors screened references for inclusion, assessed risk of bias, and extracted data. We conducted meta-analyses and calculated standardised mean differences (SMD) of the percent change from baseline in outcomes in treatment and control groups. We performed subgroup analyses by sex, pubertal stage, dose of vitamin D and baseline serum vitamin D and considered these as well as compliance and allocation concealment as possible sources of heterogeneity.

Main results

We included six RCTs (343 participants receiving placebo and 541 receiving vitamin D) for meta-analyses. Vitamin D supplementation had no statistically significant effects on total body bone mineral content (BMC), hip bone mineral density (BMD) or forearm BMD. There was a trend to a small effect on lumbar spine BMD (SMD 0.15, 95% CI -0.01 to 0.31, P = 0.07). There were no differences in effects between high and low serum vitamin D studies at any site though there was a trend towards a larger effect with low vitamin D for total body BMC (P = 0.09 for difference). In low serum vitamin D studies, significant effects on total body BMC and lumbar spine BMD were approximately equivalent to a 2.6% and 1.7 % percentage point greater change from baseline in the supplemented group.

Authors' conclusions

These results do not support vitamin D supplementation to improve bone density in healthy children with normal vitamin D levels, but suggest that supplementation of deficient children may be clinically useful. Further RCTs in deficient children are needed to confirm this.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Vitamin D for improving bone density in children

This summary of a Cochrane Review, presents what we know from research about the effect of vitamin D supplements on bone density in children.    

The review shows that in healthy children generally, vitamin D supplementation does not improve bone density at the hip, lumbar spine, forearm or in the body as a whole. 

Some of the evidence suggests that vitamin D supplements may improve bone density in children who have low levels of vitamin D but this is uncertain. 

We do not have precise information about side effects and complications but the available information suggests that vitamin D supplements are well tolerated. 

What is osteoporosis and what is vitamin D?

Osteoporosis is a condition where bones are weak, brittle and break easily. The risk of osteoporosis and fractures (breaks) in later life depends on how much bone is built when a child and how much bone is lost when an adult. One way to prevent osteoporosis and fractures in later life is to build stronger bones when young. Vitamin D plays an important role in improving the body’s absorption of calcium from food, reducing losses of calcium from the body and getting calcium deposited into to bone to improve the quantity of bone developed. Therefore it is thought that if vitamin D levels in the body are low in childhood, less bone will be developed and that improving vitamin D levels by supplements would result in more bone being developed. Bone density is a major measure of bone strength and the amount of bone mineral present at different sites and so is used to measure the effects of interventions, like vitamin D supplementation, to improve bone health.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Suplementos de vitamina D para mejorar la densidad mineral ósea en niños

Los resultados de los ensayos controlados aleatorios (ECA) de los suplementos de vitamina D para mejorar la densidad ósea en los niños son inconsistentes.

Objetivos

Determinar la efectividad de los suplementos de vitamina D para mejorar la densidad mineral ósea en los niños, si cualquier efecto varía según el sexo, la edad o el estadio puberal, el tipo o la dosis de vitamina D administrado o de los niveles de vitamina D al inicio, y si los efectos persisten después de dejar de administrar los suplementos.

Estrategia de búsqueda

Se realizaron búsquedas en el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL Número 3, 2009), MEDLINE (1966 al presente), EMBASE (1980 al presente), CINAHL (1982 al presente), AMED (1985 al presente) y la ISI Web of Science (1945 al presente) el 9 de agosto de 2009 y se realizaron búsquedas manuales en los resúmenes de congresos y revistas importantes.

Criterios de selección

ECA controlados con placebo de suplementos de vitamina D durante al menos tres meses en niños y adolescentes sanos (desde un mes a < 20 años de edad) con resultados relacionados con la densidad ósea.

Obtención y análisis de los datos

Dos autores revisaron la elegibilidad de los ensayos, evaluaron el riesgo de sesgo y extrajeron los datos. Se realizaron metanálisis y se calcularon las diferencias de medias estandarizadas (DME) del porcentaje de cambio con relación al inicio de los resultados en los grupos con el tratamiento y de control. Se realizaron análisis de subgrupos por el sexo, el estadio puberal, la dosis de la vitamina D y la vitamina D sérica al inicio, y se consideraron al igual que el cumplimiento y ocultación de la asignación como fuentes posibles de heterogeneidad.

Resultados principales

Se incluyeron seis ECA (343 pacientes recibieron placebo y 541 recibieron vitamina D) en los metanálisis. Los suplementos de vitamina D no tuvieron efectos estadísticamente significativos sobre el contenido mineral óseo (CMO) corporal total, la densidad mineral ósea de la cadera (DMO) o del antebrazo. Hubo una tendencia a un efecto pequeño sobre la DMO de la columna lumbar (DME 0,15; IC del 95%: −0,01 a 0,31; p = 0,07). No hubo diferencias de los efectos entre los estudios de vitamina D sérica alta y baja en cualquier sitio, aunque hubo una tendencia hacia un efecto mayor con la vitamina D baja en el CMO corporal total (p = 0,09 de la diferencia). En los estudios con vitamina D sérica baja, los efectos significativos sobre el CMO corporal total y la DMO de la columna lumbar fueron aproximadamente equivalentes a un 2,6% y 1,7% porcentaje puntual mayor de cambio con relación al valor inicial en el grupo con suplementos.

Conclusiones de los autores

Estos resultados no apoyan la administración de suplementos de vitamina D para mejorar la densidad ósea en los niños sanos con niveles de vitamina D normal, pero indican que los suplementos en los niños con deficiencias pueden ser clínicamente útiles. Se necesitan más estudios en niños con deficiencias para confirmar esta afirmación.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano