Current Treatment Recommendations for Correcting Vitamin D Deficiency in Pediatric Patients with Cystic Fibrosis Are Inadequate

Green, Deanna; Carson, Kathryn; Leonard, Amanda; Davis, J. Erin; Rosenstein, Beryl; Zeitlin, Pamela; Mogayzel, Peter

doi:10.1016/j.jpeds.2008.04.058

« Previous Next »The Journal of Pediatrics
Volume 153, Issue 4 , Pages 554-559.e2, October 2008

Current Treatment Recommendations for Correcting Vitamin D Deficiency in Pediatric Patients with Cystic Fibrosis Are Inadequate

Deanna Green, MD
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
Kathryn Carson, ScM
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amanda Leonard, MPH, RD, CDE
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
J. Erin Davis, RD
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
Beryl Rosenstein, MD
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
Pamela Zeitlin, MD, PhD
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
Peter Mogayzel Jr, MD, PhD
- Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
- Reprint requests: Peter J. Mogayzel, Jr, MD, PhD, Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins Hospital, 200 North Wolfe St, Suite 3053, Baltimore, MD 21287-2533

Received 1 October 2007; received in revised form 20 March 2008; accepted 24 April 2008. published online 01 July 2008.

Objectives

To determine the prevalence of vitamin D deficiency (25-hydroxy vitamin D [25-OHD] levels in plasma <30 ng/mL) in pediatric patients with cystic fibrosis (CF), elucidate contributing factors for vitamin D deficiency, and determine the efficacy of ergocalciferol repletion strategies.

Study design

Retrospective chart review of 262 pediatric patients from January 2003 to December 2006 with linear and logistic regression analyses.

Results

Vitamin D deficiency prevalence declined in the years studied from 86.5% to 46.2%. Patients >12 years old were more likely to have deficiency than patients <5 years old (odds ratio [OR], 3.44; 95% CI, 1.73-6.84). Levels obtained in spring and summer were less likely to be deficient compared with those obatined in fall (OR, 0.24; 95% CI, 0.10-0.61; and OR, 0.25; 95% CI, 0.11-0.61; respectively). Success of treatment with 50 000 IU of ergocalciferol once, twice, or 3 times weekly was 33%, 26%, and 43%, respectively. Ergocalciferol, when compared with no treatment, did not significantly increase the proportion of patients with follow-up levels ≥30 ng/mL (χ² P value = .80, .34, and .22, respectively).

Conclusions

The prevalence of vitamin D deficiency is high, but declined with time. Age, forced expiratory volume in 1 second, and season were associated with 25-OHD levels. Despite 33% of patients responding to 50 000 IU of ergocalciferol once a week, this recommendation does not adequately treat most patients with CF who have vitamin D deficiency.

Abbreviations: 25-OHD, 25-hydroxy vitamin D, BMI, Body mass index, CF, Cystic fibrosis, FEV₁, Forced expiratory volume in 1 second, OR, Odds ratio, PI, Pancreatic insufficiency