Abstract
Vitamin D is important for bone health. An inadequate supply of vitamin D to the body is associated with a higher fracture risk in the elderly. Young adults with type 1 diabetes are reported to have a lower peak bone mass than healthy individuals, which could possibly lead to an increased fracture risk in the future. The prevalence of vitamin D deficiency in healthy young people is high. Thus, optimal supply of vitamin D may be of particular importance for bone health in children with type 1 diabetes. In this prospective cross-sectional study we measured serum 25-hydroxy-vitamin D, iPTH, total and ionised calcium, phosphate, and alkaline phosphatase in 129 Swiss children and adolescents with type 1 diabetes. Of the 129 subjects 78 (60.5%) were vitamin D deficient, defined as a 25-hydroxy-vitamin-D level below 50 nmol/L. During the winter this number rose to 84.1%. 25-hydroxy-vitamin-D levels showed marked seasonal fluctuations, whereas there was no correlation with diabetes control. Despite the high prevalence of vitamin D deficiency, we found a low prevalence of secondary hyperparathyroidism in vitamin D deficient diabetic children and adolescents. Prevalence of vitamin D deficiency in diabetic children and adolescents is high. Therefore, screening for vitamin D deficiency and supplementation in children with low vitamin D levels may be considered.
Highlights
Vitamin D has a major impact on bone health
Vitamin D deficiency is common in healthy children at a variety of different latitudes [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18] and in children with type 1 diabetes mellitus (T1D), in whom the highly variable prevalence ranges between 15–65% at the end of winter [19,20,21]
In adolescents 25-hydroxy-vitamin D (25D) levels below 40 nmol/L are associated with unphysiologically high intact parathyroid hormone levels and low mean forearm bone mineral density [17]
Summary
Severe vitamin D deficiency is associated with rickets in the growing skeleton [1] and osteomalacia in adults [2]. In adults the use of biomarkers such as serum PTH concentration or intestinal calcium absorption rate has recently been recommended to define biologically relevant circulating 25D levels [1]. This recommendation is based on the observation that both the intestinal calcium absorption rate increases significantly with rising 25D concentrations until a concentration of 75 nmol/L is reached and PTH levels start to increase even at 25D concentrations below 75 nmol/L [24, 25]. As stated, a 25D cut-off value of above 75 nmol/L for vitamin D sufficiency and a 25D cut-off value below 50 nmol/L for vitamin D deficiency were adopted in our study [1, 20, 25]
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