ESPEYB21 13. Global Health for the Paediatric Endocrinologist Endocrinology (7 abstracts)
13.7. Vitamin D supplements for fracture prevention in schoolchildren in Mongolia: analysis of secondary outcomes from a multicentre, double-blind, randomised, placebo-controlled trial
Ganmaa D , Khudyakov P , Buyanjargal U , Tserenkhuu E , Erdenenbaatar S , Achtai CE , Yansanjav N , Delgererekh B , Ankhbat M , Tsendjav E , Ochirbat B , Jargalsaikhan B , Enkhmaa D & Martineau AR
Lancet Diabetes Endocrinol. 2024 Jan;12(1):29-38.PMID: 38048799.
Brief Summary: This multicenter, double-blind, randomized, placebo-controlled trial evaluated the effects of vitamin D supplementation (14,000 IU D3 weekly for 3 years) on fracture risk and other bone health indicators in 8,851 schoolchildren aged 6–13 years in 18 public schools in Mongolia, where vitamin D deficiency is highly prevalent with a high fracture burden.
Vitamin D3 doses were given during weekly face-to-face visits in schools. Families completed a questionnaire detailing socioeconomic, lifestyle and dietary factors that may influence vitamin D status, and intake of foods contributing to dietary calcium. There were similar numbers in the vitamin D group (4,176) and the placebo group (4,172) for the fracture and safety analyses.
Widespread vitamin D deficiency was noted at baseline. 95.5% of children had a serum 25-hydroxyvitamin D [25(OH)D] concentrations < 50 nmol/L; mean baseline was 29.6 nmol/L in both groups. Over the 3-year follow-up, 268 children (6.4%) in the vitamin D group and 253 (6.1%) on placebo reported one or more fractures. There was no difference in fracture risk between groups (adjusted risk ratio 1.10). A sub-study used a radial quantitative ultrasound measure of bone density and bone strength (radial speed of sound) at baseline, 1, 2 and 3 years. There was no difference in bone strength between groups. A second sub-study (50 children per group) performed biochemical analysis and found no effect modification by sex, baseline vitamin D concentration, or calcium intake on fracture risk or SOS.
Weekly vitamin D supplementation with apparently appropriate doses (equal to 2000 IU daily) increased serum vitamin D levels and suppressed PTH, but did not reduce the risk of fractures in this population. These negative findings, particularly in an area with high rates of vitamin D deficiency, indicate that routine supplementation of vitamin D may not be an effective public health strategy.
References: 1. Wu F, Fuleihan GE, Cai G, et al. Vitamin D supplementation for improving bone density in vitamin D-deficient children and adolescents: systematic review and individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2023; 118: 498-506.2. GBD 2019 Fracture Collaborators. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev 2021; 2: e580-92.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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