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Calcium and Vitamin D Supplementation Improve Bone Density in HIV-Infected Children on Antiretroviral Therapy: Presented at PAS

By Rabiya S. Tuma, PhD

SAN FRANCISCO, C.A. -- May 10, 2006 -- Calcium and vitamin D supplementation improves bone density in children with HIV being treated with antiretroviral therapy, according to data from a retrospective cohort study.

"Large randomized controlled trials are needed to study this intervention in a prospective manner," said Ethan Leonard, MD, assistant professor of pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, who presented the work here on May 2^nd at the annual meeting of the Pediatric Academic Societies (PAS).

Dr. Leonard noted that this is the first study to show that supplementation improves bone health in this patient population.

The retrospective review evaluated children who were 9 years of age or older treated for HIV at the tertiary pediatric hospital. Children received 500 mg of calcium carbonate and 200 IU of ergocalciferol twice daily. Younger patients received half this dose.

Dr. Leonard and colleagues identified 26 patients who had had at least 2 bone density tests using dual energy X-ray absorptiometry (DEXA). Of those, 18 patients received calcium and vitamin D supplements. Supplementation was at the discretion of the treating physician.

Mean baseline lumbar Z-score was significantly lower in the treatment group (-2.3, 95% confidence interval [CI], -4.3, -1.1) than in the non-treatment group (-0.9, 95% CI, -1.7, 0.3). Additionally, mean baseline bone mineral density (BMD) was lower in the treatment group (0.6 g/cm², 95% CI, 0.3, 0.8) compared with the non-treatment group (0.7 g/cm², 95% CI, 0.5, 1.0).

After a median of 26 months on therapy, the second DEXA evaluation showed improvement in the treatment group. The mean Z-score for the treatment group had increased significantly to -1.5 (95% CI, -3.3, 1.0) and the mean BMD increased to (0.7 g/cm², 95% CI, 0.5, 1.0).

Over the same period of time, there was no significant change in the non-treatment group, with a mean Z-score of -1.1 (95% CI, -1.8, 0.3) at the second DEXA evaluation and a mean BMD of 0.8 g/cm² (95% CI, 0.5, 1.0).

Multiple regression analysis showed that the only variable that correlated with improve bone health was supplementation of calcium and vitamin D. Body mass index did not correlate with improvement.

"Pediatricians should be aware of the high prevalence of decreased bone mineral density in HIV infected children," Dr. Leonard said.

Antiretroviral therapy was previously shown to disrupt bone metabolism in patients with HIV. However, the problem may be more serious in children who are infected from birth and on antiretroviral therapy throughout their lives.


[Presentation title: Calcium and Vitamin D Supplementation Ameliorate Bone Loss in HIV Infected Children. Abstract 5523.131]

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