Promoting bone health in children and adolescents following solid organ transplantation.
bisphosphonates; bone; calcium; magnesium; metabolic bone disease; phosphorous; physical activity; solid organ transplant; vitamin D
Solid organ transplantation in children and adolescents provides many benefits through improving critical organ function, including better growth, development, cardiovascular status, and quality of life. Unfortunately, bone status may be adversely affected even when overall status is improving, due to issues with pre-existing bone disease as well as medications and nutritional challenges inherent post-transplantation. For all children and adolescents, bone status entering adulthood is a critical determinant of bone health through adulthood. The overall health and bone status of transplant recipients benefits from attention to regular physical activity, good nutrition, adequate calcium, phosphorous, magnesium and vitamin D intake and avoidance/minimization of soda, extra sodium, and obesity. Many immunosuppressive agents, especially glucocorticoids, can adversely affect bone function and development. Minimizing exposure to "bone-toxic" medications is an important part of promoting bone health in children post-transplantation. Existing guidelines detail how regular monitoring of bone status and biochemical markers can help detect bone abnormalities early and facilitate valuable bone-directed interventions. Attention to calcium and vitamin D supplementation, as well as tapering and withdrawing glucocorticoids as early as possible after transplant, can provide best bone outcomes for these children. Dual-energy X-ray absorptiometry can be useful to detect abnormal bone mass and fracture risk in this population and newer bone assessment methods are being evaluated in children at risk for poor bone outcomes. Newer bone therapies being explored in adults with transplants, particularly bisphosphonates and the RANKL inhibitor denosumab, may offer promise for children with low bone mass post-transplantation.
Kusumi K; Shaikhkhalil A; Patel HP; Mahan John D
Pediatric Transplantation
2020
2020-12-19
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/petr.13940" target="_blank" rel="noreferrer noopener">10.1111/petr.13940</a>
An overview of rickets in children
prevention; vitamin D; mutations; animal-model; phosphate; chronic kidney disease; phosphorus; d-receptor; d-resistant rickets; hereditary hypophosphatemic rickets; hypocalcemia; hypophosphatemia; targeted ablation; vitamin-d-deficiency; x-linked hypophosphatemia
Rickets is a common bone disease worldwide that is associated with disturbances in calcium and phos- phate homeostasis and can lead to short stature and joint deformities. Rickets can be diagnosed based on history and physical examination, radiological features, and biochemical tests. It can be classified into 2 major groups based on phosphate or calcium levels: phosphopenic and calcipenic. Knowledge of cate- gorization of the type of rickets is essential for prompt diagnosis and proper management. Nutritional rickets is a preventable disease through adequate intake of vitamin D through both dietary and sunlight exposure. There are other subtypes of rickets, such as vitamin D-dependent type 1 rickets and vitamin D- dependent type 2 rickets (due to defects in vitamin D metabolism), renal rickets (due to poor kidney function), and hypophosphatemic rickets (vitamin D-resistant rickets secondary to renal phosphate wasting wherein fibroblast growth factor -23 (FGF-23) often plays a major role), which requires closer monitoring and supplementation with activated vitamin D with or without phosphate supplements. An important development has been the introduction of burosumab, a human monoclonal antibody to FGF- 23, which is approved for the treatment of X -linked hypophosphatemia among children 1 year and older.
Chanchlani R; Nemer P; Sinha R; Nemer L; Krishnappa V; Sochett E; Safadi F; Raina R
Kidney International Reports
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ekir.2020.03.025" target="_blank" rel="noreferrer noopener">10.1016/j.ekir.2020.03.025</a>
Improving Vitamin D Levels in Hospitalized Individuals at Risk of Falls.
Ohio; Aged; Accidental Falls; Human; Chi Square Test; Fisher's Exact Test; Retrospective Design; OHIO; ACCIDENTAL falls; CHI-squared test; DIETARY supplements; DISEASE complications; FISHER exact test; HOSPITAL care of older people; RETROSPECTIVE studies; THERAPEUTIC use of vitamin D; VITAMIN D; VITAMIN D deficiency; Dietary Supplementation; Hospitalized; Vitamin D – Blood; Vitamin D Deficiency – Complications; Vitamin D – Therapeutic Use
The article reports on research which was conducted to investigate vitamin D levels and vitamin D supplementation in hospital patients at risk of falls. Researchers evaluated the vitamin D levels of 190 patients. They found that 63.7% were vitamin D deficient, that 40.4% of patients with deficiency were aged 65 and older and that screening for vitamin D deficiency and vitamin D supplementation were suboptimal.
Prater Janna; Greene Giesele R; Rowland Douglas Y; Chaiban Joumana T
Journal of the American Geriatrics Society
2014
2014-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.13060" target="_blank" rel="noreferrer noopener">10.1111/jgs.13060</a>
Prolonged Clostridium difficile Infection May Be Associated With Vitamin D Deficiency.
*adult; *gastroenterology; *immunonutrition; *life cycle; *nutrition; *research and diseases; *sepsis; *vitamins; 80 and over; 80 and Over; Aged; Clostridium Infections – Etiology; Clostridium Infections – Mortality; Clostridium Infections – Physiopathology; Clostridium Infections/*etiology/mortality/physiopathology; Diarrhea – Microbiology; Diarrhea – Physiopathology; Diarrhea/microbiology/physiopathology; Female; Humans; Iatrogenic Disease – Epidemiology; Iatrogenic Disease/epidemiology; Length of Stay; Male; Middle Age; Middle Aged; Nutritional Status; Psychological Tests; Recurrence; Retrospective Design; Retrospective Studies; Sepsis – Epidemiology; Sepsis/epidemiology; Severity of Illness Index; Severity of Illness Indices; Vitamin D; Vitamin D – Blood; Vitamin D Deficiency – Blood; Vitamin D Deficiency – Complications; Vitamin D Deficiency/blood/*complications; Vitamin D/analogs & derivatives/blood
BACKGROUND: Clostridium difficile infection (CDI) is one of the leading causes of hospital-acquired infections, creating a financial burden for the U.S. healthcare system. Reports suggest that vitamin D-deficient CDI patients incur higher healthcare-associated expenses and longer lengths of stay compared to nondeficient counterparts. The objective here was to evaluate the relationship between vitamin D level and CDI recurrence. MATERIALS AND METHODS: A retrospective chart review was conducted for 112 patients with vitamin D level drawn within 3 months of CDI diagnosis. Recurrence, severity of disease, 30-day mortality, and course of CDI were assessed. RESULTS: The vitamin D-deficient group included 56 patients, and the normal group included 56 patients. The mean age of vitamin D-deficient and -sufficient groups was 68 +/- 15.7 and 71 +/- 14.4 years, respectively. The mean 25(OH) D level in the deficient group was 11.7 +/- 4.6 ng/mL, and it was 36.2 +/- 16.2 ng/mL in the normal group. A longer course of diarrhea was apparent in the vitamin D-deficient group compared to the normal group: 6.1 days (95% confidence interval [CI], 4.9-7.2) vs 4.2 days (95% CI, 3.5-4.9; P = .01). Sepsis rate was 24% in vitamin D-deficient group and 13% in normal group (P = .03). There were no differences in CDI recurrence, length of stay, severity of illness, and mortality with respect to vitamin D status. CONCLUSION: There may be an association between course of diarrhea and increased rate of sepsis in vitamin D-deficient CDI patients.
Wong Ken Koon; Lee Rebecca; Watkins Richard R; Haller Nairmeen A
JPEN. Journal of parenteral and enteral nutrition
2016
2016-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0148607114568121" target="_blank" rel="noreferrer noopener">10.1177/0148607114568121</a>
An update on the association of vitamin D deficiency with common infectious diseases.
Adaptive Immunity/immunology; Animals; Communicable Diseases/*diagnosis/drug therapy/*immunology; HIV; Humans; immunite; immunity; Immunity; Innate/immunology; MRSA; pneumonia; pneumonie; SARM; sepsis; Sepsis/diagnosis/drug therapy/immunology; septicemie; therapy; traitement; VIH; vitamin D; Vitamin D Deficiency/*diagnosis/drug therapy/*immunology; Vitamin D/*immunology/therapeutic use; vitamine D
Vitamin D plays an important role in modulating the immune response to infections. Deficiency of vitamin D is a common condition, affecting both the general population and patients in health care facilities. Over the last decade, an increasing body of evidence has shown an association between vitamin D deficiency and an increased risk for acquiring several infectious diseases, as well as poorer outcomes in vitamin D deficient patients with infections. This review details recent developments in understanding the role of vitamin D in immunity, the antibacterial actions of vitamin D, the association between vitamin D deficiency and common infections (like sepsis, pneumonia, influenza, methicillin-resistant Staphylococcus aureus, human immunodeficiency virus type-1 (HIV), and hepatitis C virus (HCV)), potential therapeutic implications for vitamin D replacement, and future research directions.
Watkins Richard R; Lemonovich Tracy L; Salata Robert A
Canadian journal of physiology and pharmacology
2015
2015-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1139/cjpp-2014-0352" target="_blank" rel="noreferrer noopener">10.1139/cjpp-2014-0352</a>
The associations of 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms, and race with risk of incident fracture-related hospitalization: Twenty-year follow-up in a bi-ethnic cohort (the ARIC Study).
*Polymorphism; African Continental Ancestry Group; Aged; Alleles; Epidemiology; Ethnic Groups; European Continental Ancestry Group; Female; Follow-Up Studies; Fracture; Fracture Healing; Genetic Variation; Genotype; Hip Fractures/blood/*ethnology/*genetics; Hospitalization; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Race; Risk Factors; Single Nucleotide; Vitamin D; Vitamin D binding protein polymorphisms; Vitamin D-Binding Protein/*genetics; Vitamin D/*analogs & derivatives/blood
BACKGROUND: Deficient levels of 25-hydroxyvitamin D [25(OH)D] have been associated with increased fracture risk. Racial differences in fracture risk may be related to differences in bioavailable vitamin D due to single nucleotide polymorphism (SNP) variations in the vitamin D binding protein (DBP). METHODS: We measured 25(OH)D levels in 12,781 middle-aged White and Black participants [mean age 57 years (SD 5.7), 25% Black] in the ARIC Study who attended the second examination from 1990-1992. Participants were genotyped for two DBP SNPs (rs4588 and rs7041). Incident hospitalized fractures were measured by abstracting hospital records for ICD-9 codes. We used Cox proportional hazards models to evaluate the association between 25(OH)D levels and risk of fracture with adjustment for possible confounders. Interactions were tested by race and DBP genotype. RESULTS: There were 1122 incident fracture-related hospitalizations including 267 hip fractures over a median of 19.6 years of follow-up. Participants with deficient 25(OH)D (\textless20 ng/mL) had a higher risk of any fracture hospitalization [HR=1.21 (95% CI 1.05-1.39)] and hospitalization for hip fracture [HR=1.35 (1.02-1.79)]. No significant racial interaction was noted (p-interaction=0.20 for any fracture; 0.74 for hip fracture). There was no independent association of rs4588 and rs7041 with fracture. However, there was a marginal interaction for 25(OH)D deficiency with rs7041 among Whites (p-interaction=0.065). Whites with both 25(OH)D deficiency and the GG genotype [i.e., with predicted higher levels of DBP and lower bioavailable vitamin D] were at the greatest risk for any fracture [HR=1.48 (1.10-2.00)] compared to Whites with the TT genotype and replete 25(OH)D (reference group). CONCLUSIONS: Deficient 25(OH)D levels are associated with higher incidence of hospitalized fractures. Marginal effects were seen in Whites for the DBP genotype associated with lower bioavailable vitamin D, but result inconclusive. Further investigation is needed to more directly evaluate the association between bioavailable vitamin D and fracture risk.
Takiar Radhika; Lutsey Pamela L; Zhao Di; Guallar Eliseo; Schneider Andrea L C; Grams Morgan E; Appel Lawrence J; Selvin Elizabeth; Michos Erin D
Bone
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.bone.2015.04.029" target="_blank" rel="noreferrer noopener">10.1016/j.bone.2015.04.029</a>