Screening for vitamin D insufficiency in pediatric cancer survivors

Authors

  • Adam J. Esbenshade MD, MSCI,

    Corresponding author
    1. Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
    2. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
    • Correspondence to: Adam Esbenshade, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Hematology and Oncology, 2020 Pierce Avenue, 397 PRB, Nashville, TN 37232.

      E-mail: adam.esbenshade@vanderbilt.edu

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  • Jenna Sopfe MD,

    1. Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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  • Zhiguo Zhao MS,

    1. Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
    2. Center for Quantitative Sciences, Vanderbilt University, Nashville, Tennessee
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  • Zeda Li MS,

    1. Center for Quantitative Sciences, Vanderbilt University, Nashville, Tennessee
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  • Kristin Campbell PNP,

    1. Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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  • Jill H. Simmons MD,

    1. Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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  • Debra L. Friedman MD, MS

    1. Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
    2. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Corticosteroids increase risk for decreased bone mineral density, which can be worsened by vitamin D insufficiency (VDI) or deficiency (VDD).

Procedure

In the Vanderbilt cancer survivorship clinic, we obtained screening total 25-hydroxy vitamin D levels (VDL) in 171 cancer survivors <23 years old who were treated with prolonged corticosteroids for their cancer, and compared this group to a control group of 97 healthy pediatric patients.

Results

VDD was diagnosed in 15.8% and VDI in 34.5% of cancer survivors and VDD/VDI combined was associated with body mass index (BMI) >85th percentile (Odds ratio [OR] = 5.4; P < 0.001), older age (OR = 2.2; P = 0.012), non-Caucasian or Hispanic race (OR = 4.5; P = 0.008) and summer versus winter season (OR = 0.12; P < 0.001). In multivariable analysis, VDI/VDD prevalence did not differ from the control group (VDI/VDD (43.3%)). In the combined survivor/control group multivariable analysis, cancer diagnosis did not increase VDI/VDD risk, but significant associations persisted with elevated BMI (P < 0.001), age (P = 0.004), non-Caucasian or Hispanic race (P < 0.001), and seasonality (P < 0.001).

Conclusion

VDD/VDI is equally common in pediatric cancer survivors treated with corticosteroids and healthy children. The impact of VDD/VDI in cancer survivors may be greater due to risk for impaired bone health superimposed on that conferred from corticosteroid exposure. Thus, screening VDLs should be obtained in pediatric cancer survivors treated with corticosteroids, particularly in those with elevated BMI, older age, or non-Caucasian race. Prospective studies evaluating the impact of interventions to minimize VDD/VDI on long-term bone health in survivors are required. Pediatr Blood Cancer 2014;61:723–728. © 2013 Wiley Periodicals, Inc.

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