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Bone biomarkers increased equally by daily, weekly, or monthly Vitamin D (CKD in children in this case) – Nov 2022

Changes in bone biomarkers in response to different dosing regimens of cholecalciferol supplementation in children with chronic kidney disease

Pediatr Nephrol. 2022 Nov 2. doi: 10.1007/s00467-022-05790-0
Nivedita Kamath 1 , Arpana Iyengar 2 , Hamsa V Reddy 2 , Jyoti Sharma 3 , Jyoti Singhal 3 , Sudha Ekambaram 4 , Susan Uthup 5 , Sumithra Selvam 6 , Mandy Wan 7 , Anja Rahn 8 , Dagmar Christiane-Fischer 8 , Rukshana Shroff 9

Background: The effect of different dosing regimens of cholecalciferol supplementation on bone biomarkers has not been studied in children with chronic kidney disease (CKD).

Methods: This is a post hoc analysis of a multi-center randomized controlled trial which included children with CKD stages 2-4 with vitamin D deficiency (25-hydroxy vitamin D (25OHD) < 30 ng/ml) randomized 1:1:1 to receive an equivalent dose of oral cholecalciferol as daily, weekly or monthly treatment. Markers of bone formation (bone alkaline phosphatase (BAP), procollagen I N terminal peptide (PINP)), bone resorption (tartarate-resistant acid phosphatase 5b (TRAP), C terminal telopeptide (CTX)), and osteocyte markers (intact fibroblast growth factor 23 (iFGF23), sclerostin) and soluble klotho were measured at baseline and after 3 months of intensive replacement therapy. The change in biomarkers and ratio of markers of bone formation to resorption were compared between treatment arms. BAP and TRAP were expressed as age- and sex-specific z-scores.

Results: 25OHD levels increased with cholecalciferol supplementation, with 85% achieving normal levels. There was a significant increase in the BAP/TRAP ratio (p = 0.04), iFGF23 (p = 0.004), and klotho (p = 0.002) with cholecalciferol therapy, but this was comparable across all three therapy arms. The BAPz was significantly higher in the weekly arm (p = 0.01). The change in 25OHD (Δ25OHD) inversely correlated with ΔPTH (r = - 0.4, p < 0.001).

Conclusions: Although cholecalciferol supplementation was associated with a significant increase in bone formation, the three dosing regimens of cholecalciferol supplementation have a comparable effect on the bone biomarker profile, suggesting that they can be used interchangeably to suit the patient's needs and optimize adherence to therapy. A higher resolution version of the Graphical abstract is available as Supplementary information.

VitaminDWiki - 30+ studies found the less frequent Vitamin D was Better than Daily

VitaminDWiki - 6 studies in both categories Kidney and non-daily dosing

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VitaminDWiki - 3 studies in both categories Bone and non-daily dosing

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