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Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children.

*Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA;†USDA Western Human Nutrition Research Center, University of California, Davis, CA;‡Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine at the University of Miami, Miami, FL;§Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA;‖Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA;¶Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA;#Department of Pediatrics, University of Florida, Jacksonville, FL;**Nutrition Department, University of California, Davis, CA;††Maternal and Pediatric Infectious Disease (MPID) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD;‡‡Frontier Science & Technology Research Foundation, Amherst, NY;§§The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA;‖‖Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA; and¶¶Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.

Journal of acquired immune deficiency syndromes (1999). 2017;(1):33-42
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Abstract

BACKGROUND Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. METHODS PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. RESULTS PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. CONCLUSIONS PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

Methodological quality

Publication Type : Comparative Study ; Multicenter Study

Metadata

MeSH terms : Parathyroid Hormone