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

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Kathryn Carson, ScM

      Affiliations

    • Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • ,
  • Amanda Leonard, MPH, RD, CDE

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • J. Erin Davis, RD

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Beryl Rosenstein, MD

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Pamela Zeitlin, MD, PhD

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Peter Mogayzel Jr, MD, PhD

      Affiliations

    • Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD
    • Corresponding Author InformationReprint 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 ,Revised 20 March 2008 ,Accepted 24 April 2008.

References 

  1. Lark RK, Lester GE, Ontjes DA, Blackwood AD, Hollis BW, Hensler MM, et al. Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients. Am J Clin Nutr. 2001;73:602–606
  2. Aris RM, Merkel PA, Bachrach LK, Borowitz DC, Boyle MP, Elkin SL, et al. Guide to bone health and disease in cystic fibrosis. J Clin Endocrinol Metab. 2005;90:1888–1896
  3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281
  4. Haworth CS, Selby PL, Webb AK, Dodd ME, Musson H, McL Niven R, et al. Low bone mineral density in adults with cystic fibrosis. Thorax. 1999;54:961–967
  5. Conway SP, Morton AM, Oldroyd B, Truscott JG, White H, Smith AH, et al. Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis; prevalence and associated factors. Thorax. 2000;55:798–804
  6. Mortensen LA, Chan GM, Alder SC, Marshall BC. Bone mineral status in prepubertal children with cystic fibrosis. J Pediatr. 2000;136:648–652
  7. Consensus Conferences. Concepts in CF care. Guide to bone health and disease in cystic fibrosis. Bethesda, MD: Cystic Fibrosis Foundation; 2002.
  8. Boyle M, Noschese ML, Watts SL, Davis ME, Stenner SE, Lechtzin N. Failure of high dose ergocalciferol to correct vitamin D deficiency in adults with cystic fibrosis. Am J Respir Crit Care Med. 2005;172:212–217
  9. Haworth CS, Jones AM, Adams JE, Selby PL, Webb AK. Randomized double blind placebo controlled trial investigating the effect of calcium and vitamin D supplementation on bone mineral density and bone metabolism in adult patients with cystic fibrosis. J Cyst Fibros. 2004;3:233–236
  10. Chavasse RJ, Francis J, Balfour-Lynn I, Rosenthal M, Bush A. Serum vitamin D levels in children with cystic fibrosis. Pediatr Pulmonol. 2004;38:119–122
  11. Henderson RC, Lester G. Vitamin D levels in children with cystic fibrosis. South Med J. 1997;90:378–383
  12. Hubbard VS, Farrell PM, di Sant'Agnese PA. 25-hydroxycholecalciferol levels in patients with cystic fibrosis. J Pediatr. 1979;94:84–86
  13. Grey V, Lands L, Harpreet P, Drury D. Monitoring of 25-OH Vitamin D levels in children with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2000;30:314–319
  14. Virella-Lowell I, Bowman C, Wagner C, Hollis B. Successful supplementation of vitamin D in cystic fibrosis. Pediatr Pulmonol Suppl. 2006;29:396
  15. Hart M, Potter E, Prestridge A, McColley S. Individualized vitamin D repletion in pediatric patients with cystic fibrosis. Pediatr Pulmonol Suppl. 2006;29:382
  16. Rovner AJ, Stalling VA, Schall JI, Zemel BS. Vitamin D insufficiency is common in children, adolescents and young adults with CF despite routine oral supplementation. Am J Clin Nutr. 2007;86:1694–1699
  17. Wanner TJ, Lechtzin N, Davis ME, Watts S, Podliska MZ, Boyle MP, et al. Very high dose ergocalciferol is effective for correcting vitamin D deficiency in adults with cystic fibrosis. Pediatr Pulmonol Suppl. 2006;29:392
  18. Sermet-Gaudelus I, Souberbielle JC, Ruiz JC, Vrielynck S, Heuillon B, Azhar I, et al. Low bone mineral density in young children with cystic fibrosis. Am J Respir Crit Care Med. 2007;175:951–957
  19. Greer FR. Vitamin D and health in the 21st century: bone and beyond (Issues in establishing vitamin D recommendations for infants and children). Am J Clin Nutr. 2004;80:1759–62S
  20. Hochberg Z, Bereket A, Davenport M, Delemarre-Van de Wall HA, De Schepper J, Levine MA, et al. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm Res. 2002;58:39–51
  21. Gordon CM, Bachrach LK, Carpenter TO, Karsenty G, Rauch F. Bone health in children and adolescents: a symposium at the annual meeting of the pediatric academic societies/Lawson Wilkins Pediatric endocrine society, May 2003. Curr Probl Pediatr Adolesc Health Care. 2004;34:226–242
  22. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–5391
  23. Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93:677
  24. Stephenson A, Brotherwood M, Robert R, Atenafu E, Corey M, Tullis E. Cholecalciferol significantly increases 25-hydroxyvitamin D concentrations in adults with cystic fibrosis. Am J Clin Nutr. 2007;85:1307–1311
  25. Chandra P, Wolfenden LL, Ziegler TR, Tian J, Luo M, Stecenko AA, et al. Treatment of vitamin D deficiency with UV light in patients with malabsorption syndromes: a case series. Photodermatol Photoimmunol Photomed. 2007;23:179–185

 The authors declare no potential conflicts of interest.

PII: S0022-3476(08)00368-5

doi: 10.1016/j.jpeds.2008.04.058

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

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