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Consensus recommends at least 20 ng of Vitamin D for childhood cancer (not nearly enough) – June 2021

Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations

Cancer Med. 2021 Jun 8. doi: 10.1002/cam4.4013
Jenneke E van Atteveld 1, Iris E Verhagen 1, Marry M van den Heuvel-Eibrink 1, Hanneke M van Santen 1 2, Inge M van der Sluis 1, Natascia Di Iorgi 3, Jill H Simmons 4, Leanne M Ward 5, Sebastian J C M M Neggers 1 6

Background: Prevalent vitamin D deficiency (VDD) and low bone mineral density (BMD) have led to vitamin D supplementation for children with cancer, regardless vitamin D status. However, it remains unsettled whether this enhances bone strength. We sought to address this issue by carrying out a systematic review of the literature.

Methods: We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25-hydroxyvitamin D (25OHD) levels and BMD Z-scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology.

Results: Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z-scores, while 25OHD as a continuous variable was not significantly associated with BMD Z-scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence).

Conclusion: There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year-long.

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