Sickle cell bone disease: Response to vitamin D and calcium

• Published in: American journal of hematology Vol. 83; no. 4; pp. 271 - 274
• Main Authors: Adewoye, Adeboye H., Chen, Tai C., Ma, Qianli, McMahon, Lillian, Mathieu, Jeff, Malabanan, Alan, Steinberg, Martin H., Holick, Michael F.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2008; Wiley-Liss
• Subjects: Adult; Anemia, Sickle Cell - blood; Anemia, Sickle Cell - complications; Anemias. Hemoglobinopathies; Biological and medical sciences; Bone Density; Bone Resorption - blood; Bone Resorption - drug therapy; Bone Resorption - etiology; Calcium Carbonate - administration & dosage; Calcium Carbonate - therapeutic use; Collagen Type I - blood; Diseases of red blood cells; Drug Therapy, Combination; Ergocalciferols - administration & dosage; Ergocalciferols - therapeutic use; Femur Neck - chemistry; Hematologic and hematopoietic diseases; Humans; Lumbar Vertebrae - chemistry; Medical sciences; Osteocalcin - blood; Osteomalacia - blood; Osteomalacia - drug therapy; Osteomalacia - etiology; Osteoporosis - blood; Osteoporosis - drug therapy; Osteoporosis - etiology; Parathyroid Hormone - blood; Peptides - blood; Pilot Projects; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - drug therapy; Osteoarticular system; Hemoglobinopathy; Hemolytic anemia; Sickle cell anemia; Calcium; Hematology; Vitamin D; Hemopathy; Bone; Inorganic element; Genetic disease
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.21085

Bone disease with osteoporosis and osteomalacia are common in sickle cell disease (SCD). Some patients have vitamin D deficiency and low bone mineral density (BMD). The role of vitamin D and calcium supplementation to restore bone health in SCD has not been well studied. In 14 adults with SCD, we measured 25(OH)D (25‐hydroxyvitamin D) and BMD at the femoral neck, lumbar spine, and distal third of the ulna plus radius, along with markers of bone resorption (CTx; C‐terminal component of pro‐collagen type I) and bone formation (osteocalcin) before and after 12 months of vitamin D2 and calcium carbonate treatment. Pretreatment, all patients were vitamin D deficient with a mean 25(OH)D level of 10.7 ± 4.7 ng/ml, had low BMD at the lumbar spine (L‐spine), 0.87 ± 0.11 g/cm2 (mean Z‐score of –2.6 3 ± 0.71 SD and T score of –2.31 ± 0.75 SD), femoral neck, 0.8 ± 0.18 g/cm2 (mean Z‐score –1.36 ± 0.84, T‐score –1.14 ± 0.75), and the distal radius and ulna, 0.6 ± 0.17 g/cm2 (mean Z‐score –1.18 ± 0.79, T‐score –1.01 ± 0.74) and had elevated CTx (0.87 ± 0.5 ng/ml) and osteocalcin levels (12.3 ± 3.7 ng/μl). After treatment, all patients corrected their 25(OH)D level (38.8 ± 13.9 ng/ml) (P < 0.001) with a 3.6% ± 3.9% increase in BMD at the L‐spine (P = 0.009), 4.6% ± 8.5% increase at the femoral neck (P = 0.05) and 6.5% ± 12.6% increase at the distal radius plus ulna (P = 0.09). CTx, osteocalcin, and PTH(i) levels were unchanged. Treatment of adult SCD with vitamin D and calcium can restore 25(OH)D levels to normal and improve BMD, but, markers of bone resorption remained unchanged. Screening for vitamin D deficiency and BMD in SCD patients seems warranted. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.