Prevalence of Vitamin D Insufficiency in Adult Hematopoietic Cell Transplant (HCT) Patients with Documented Osteopenia or Osteoporosis after Steroid Exposure: A Quality Assurance Study

Abstract

Background: Steroid exposure is a known risk factor for osteopenia and osteoporosis. Vitamin D insufficiency is a known factor that contributes to bone loss. Low concentrations of vitamin D are associated with impaired calcium absorption, negative calcium balance and a compensatory rise in parathyroid hormone, which results in excessive bone resorption. Historically at Seattle Cancer Care Alliance, adult allogeneic HCT patients treated with steroids routinely have a Dual Energy X-ray Absorptiometry (DEXA) scan at departure. While many patients were found to have osteopenia or osteoporosis, it was unknown how many of these patients were additionally vitamin D deficient. Objective: The aims of this quality assurance study were: 1) to identify the prevalence of vitamin D insufficiency in adult HCT patients with osteopenia or osteoporosis post-HCT and 2) to evaluate the need to change standard practice guidelines at our center to assess for vitamin D insufficiency more regularly in at-risk groups. Design: We identified all allogeneic HCT patients with postHCT steroid exposure and documented osteopenia or osteoporosis on departure DEXA scan over a six month period. A serum 25-OH vitamin D level was drawn on patients meeting these criteria. Results: 40 adults met inclusion criteria: 22 males and 18 females. All patients were receiving 1500 mg calcium and 800 international units vitamin D3 daily with combination of diet, multivitamin and/or supplements per standard practice guidelines at Seattle Cancer Care Alliance. All patients were counseled by a registered dietitian to ensure adequate calcium and vitamin D intake. 4 patients had deficient 25-OH vitamin D levels (25-OH vitamin D 30 ng/mL). The prevalence of insufficiency or deficiency was 73% (29/ 40). Stratified by age, the prevalence of insufficiency or deficiency was: