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Cancer with bisphosphonates was not helped by 200 IU of vitamin D – Oct 2012

Vitamin D deficiency in oncology patients--an ignored condition:

impact on hypocalcemia and quality of life.

Isr Med Assoc J. 2012 Oct;14(10):607-12.
Vitamin D deficiency in oncology patients--an ignored condition: impact on hypocalcemia and quality of life.
Segal E, Felder S, Haim N, Yoffe-Sheinman H, Peer A, Wollner M, Shen-Or Z, Ish-Shalom S.
Metabolic Bone Diseases Unit, Rambam Health Care Campus, Haifa, Israel.

BACKGROUND:
Vitamin D status is not evaluated routinely in cancer patients with bone metastasis who are treated with bisphosphonates.

OBJECTIVES:
To assess the effect of vitamin D status on risk of hypocalcemia and quality of life in these patients.

METHODS:
We performed laboratory tests for routine serum biochemistry, 25(OH)D, plasma parathyroid hormone (PTH) and bone turnover markers (CTX, P1NP) in 54 patients aged 57.5 +/- 13 years treated with intravenous bisphosphonates.

RESULTS:
Most of the patients (n = 44, 77.8%) did not receive calcium and vitamin D supplementation. Their mean serum 25(OH)D levels (12.83 +/- 6.86 ng/ml) correlated with vitamin D daily intake (P = 0.002). In 53 patients (98.1%) 25(OH) D levels were suboptimal (< 30 ng/ml). Albumin-corrected calcium levels correlated with plasma PTH (P = 0.001). No correlation was observed between daily calcium intake and serum calcium (P = 0.45). Hypocalcemia was observed in one patient. Mean plasma PTH was 88.5 - 65 ng/L. Plasma PTH correlated negatively with 25(OH)D serum levels (P = 0.003) and positively with P1NP (P = 0.004). Albumin-corrected calcium correlated negatively with P1NP (mean 126.9 +/- 191 ng/ml) but not with CTX levels (mean 0.265 +/- 0.1 ng/ml) (P < 0.001). There was no correlation among quality of life parameters, yearly sun exposure and 25(OH)D levels (P = 0.99).

CONCLUSIONS:
Vitamin D deficiency is frequent in oncology patients with bone metastasis treated with bisphosphonates and might increase bone damage. Our results indicate a minor risk for the development of severe hypocalcemia in vitamin D-deficient patients receiving bisphosphonate therapy. Although vitamin D deficiency might have some effect on the quality of life in these patients, it was not proven significant.

Comment in
The challenges of using vitamin D in cancer prevention and prognosis. [Isr Med Assoc J. 2012]
PMID: 23193781


Figure 1. Formula for evaluation of sun exposure

[Sun exposure during winter {[[(3-face exposure)*8+(3-neck exposure)*1+(3-cubits exposure)*3.5+(3-arms exposure)*4.5+(3-hands exposure)*1+(3-thighs exposure)*9+(3-cnemises exposure)*9]/72} * {daily sun exposure (minutes) in winter/750 (between 11 pm and 3 am the minutes are multiplied by 3)}*100/3 + 2 x Sun exposure during summer {[(3-face exposure)*8+(3-neck exposure)*1+(3-cubits exposure)*3.5+(3-arms exposure)*4.5+(3-hands exposure)*1+(3-thighs exposure)*9+(3-cnemises exposure)*9]/72} * {daily sun exposure (minutes) in summer/750 (between 11 pm and 3 am the minutes are multiplied by 3)}*100/3] x [ use of sunscreen cream (1-2)] x[ (7-grade of skin color)]

Calcitriol interactions with cells

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1770 Cancer.jpg admin 04 Dec, 2012 11:28 35.35 Kb 817
1769 Oncology - Oct 2012.pdf PDF admin 04 Dec, 2012 11:18 153.48 Kb 517
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