Skip to main content
Top
Published in: Current Rheumatology Reports 2/2011

Open Access 01-04-2011

Vitamin D Supplementation in the Pediatric Rheumatology Clinic

Authors: Emily von Scheven, Jon M. Burnham

Published in: Current Rheumatology Reports | Issue 2/2011

Login to get access

Abstract

Vitamin D is capturing the attention of healthy and chronically ill populations for its potential skeletal and nonskeletal benefits. New information suggesting a role in immune modulation has led to a surge of interest among rheumatologists. Although the epidemiologic data are limited, it appears that many children with rheumatic conditions are at risk of vitamin D deficiency. However, understanding this phenomenon requires an appreciation for how vitamin D status is assessed, and options for supplementation. Although a “more-is-better” attitude is tempting when considering the medicinal effects of a nutritional supplement, we suggest a cautious approach and suggest that further studies are needed to clarify the potential benefits and risks among children with rheumatic conditions.
Literature
2.
go back to reference Chen, T.C., et al., Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys, 2007. 460(2): p. 213–7.PubMedCrossRef Chen, T.C., et al., Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys, 2007. 460(2): p. 213–7.PubMedCrossRef
3.
go back to reference Heaney, R.P., Vitamin D endocrine physiology. J Bone Miner Res, 2007. 22 Suppl 2: p. V25–7. Heaney, R.P., Vitamin D endocrine physiology. J Bone Miner Res, 2007. 22 Suppl 2: p. V25–7.
4.
go back to reference Adams, J.S. and M. Hewison, Update in vitamin D. J Clin Endocrinol Metab. 95(2): p. 471–8. Adams, J.S. and M. Hewison, Update in vitamin D. J Clin Endocrinol Metab. 95(2): p. 471–8.
6.
go back to reference Bischoff-Ferrari, H., Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol, 2009. 23(6): p. 789–95.PubMedCrossRef Bischoff-Ferrari, H., Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol, 2009. 23(6): p. 789–95.PubMedCrossRef
7.
go back to reference El-Hajj Fuleihan, G., et al., Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab, 2006. 91(2): p. 405–12.PubMedCrossRef El-Hajj Fuleihan, G., et al., Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab, 2006. 91(2): p. 405–12.PubMedCrossRef
8.
go back to reference Viljakainen, H.T., et al., A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res, 2006. 21(6): p. 836–44.PubMedCrossRef Viljakainen, H.T., et al., A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res, 2006. 21(6): p. 836–44.PubMedCrossRef
9.
go back to reference Ward, K.A., et al., A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. J Clin Endocrinol Metab. 95(10): p. 4643–51. Ward, K.A., et al., A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. J Clin Endocrinol Metab. 95(10): p. 4643–51.
10.
go back to reference Norman, A.W., et al., Vitamin D deficiency inhibits pancreatic secretion of insulin. Science, 1980. 209(4458): p. 823–5.PubMedCrossRef Norman, A.W., et al., Vitamin D deficiency inhibits pancreatic secretion of insulin. Science, 1980. 209(4458): p. 823–5.PubMedCrossRef
11.
go back to reference Takiishi, T., et al., Vitamin D and diabetes. Endocrinol Metab Clin North Am. 39(2): p. 419–46, table of contents. Takiishi, T., et al., Vitamin D and diabetes. Endocrinol Metab Clin North Am. 39(2): p. 419–46, table of contents.
12.
go back to reference Chiu, K.C., et al., Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr, 2004. 79(5): p. 820–5.PubMed Chiu, K.C., et al., Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr, 2004. 79(5): p. 820–5.PubMed
13.
go back to reference Reis, J.P., et al., Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics, 2009. 124(3): p. e371–9.PubMedCrossRef Reis, J.P., et al., Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics, 2009. 124(3): p. e371–9.PubMedCrossRef
14.
go back to reference Ashraf, A., et al., Threshold for effects of vitamin D deficiency on glucose metabolism in obese female African-American adolescents. J Clin Endocrinol Metab, 2009. 94(9): p. 3200–6.PubMedCrossRef Ashraf, A., et al., Threshold for effects of vitamin D deficiency on glucose metabolism in obese female African-American adolescents. J Clin Endocrinol Metab, 2009. 94(9): p. 3200–6.PubMedCrossRef
15.
go back to reference Pittas, A.G., et al., Systematic review: vitamin D and cardiometabolic outcomes. Ann Intern Med. 152(5): p. 307–14. Pittas, A.G., et al., Systematic review: vitamin D and cardiometabolic outcomes. Ann Intern Med. 152(5): p. 307–14.
16.
go back to reference Giovannucci, E., et al., 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med, 2008. 168(11): p. 1174–80.PubMedCrossRef Giovannucci, E., et al., 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med, 2008. 168(11): p. 1174–80.PubMedCrossRef
17.
go back to reference Wang, T.J., et al., Vitamin D deficiency and risk of cardiovascular disease. Circulation, 2008. 117(4): p. 503–11.PubMedCrossRef Wang, T.J., et al., Vitamin D deficiency and risk of cardiovascular disease. Circulation, 2008. 117(4): p. 503–11.PubMedCrossRef
18.
go back to reference Dobnig, H., et al., Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med, 2008. 168(12): p. 1340–9.PubMedCrossRef Dobnig, H., et al., Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med, 2008. 168(12): p. 1340–9.PubMedCrossRef
19.
go back to reference Kilkkinen, A., et al., Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol, 2009. 170(8): p. 1032–9.PubMedCrossRef Kilkkinen, A., et al., Vitamin D status and the risk of cardiovascular disease death. Am J Epidemiol, 2009. 170(8): p. 1032–9.PubMedCrossRef
20.
go back to reference Liu, P.T., et al., Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science, 2006. 311(5768): p. 1770–3.PubMedCrossRef Liu, P.T., et al., Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science, 2006. 311(5768): p. 1770–3.PubMedCrossRef
21.
go back to reference Gauzzi, M.C., et al., Suppressive effect of 1alpha,25-dihydroxyvitamin D3 on type I IFN-mediated monocyte differentiation into dendritic cells: impairment of functional activities and chemotaxis. J Immunol, 2005. 174(1): p. 270–6.PubMed Gauzzi, M.C., et al., Suppressive effect of 1alpha,25-dihydroxyvitamin D3 on type I IFN-mediated monocyte differentiation into dendritic cells: impairment of functional activities and chemotaxis. J Immunol, 2005. 174(1): p. 270–6.PubMed
22.
go back to reference Pelajo, C.F., J.M. Lopez-Benitez, and L.C. Miller, Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev. 9(7): p. 507–10. Pelajo, C.F., J.M. Lopez-Benitez, and L.C. Miller, Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev. 9(7): p. 507–10.
23.
go back to reference •• Adams, J.S. and M. Hewison, Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab, 2008. 4(2): p. 80–90. This is an excellent review of the potential mechanisms underlying a role for vitamin D in autoimmune diseases.PubMedCrossRef •• Adams, J.S. and M. Hewison, Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab, 2008. 4(2): p. 80–90. This is an excellent review of the potential mechanisms underlying a role for vitamin D in autoimmune diseases.PubMedCrossRef
24.
go back to reference Penna, G., et al., 1,25-Dihydroxyvitamin D3 selectively modulates tolerogenic properties in myeloid but not plasmacytoid dendritic cells. J Immunol, 2007. 178(1): p. 145–53.PubMed Penna, G., et al., 1,25-Dihydroxyvitamin D3 selectively modulates tolerogenic properties in myeloid but not plasmacytoid dendritic cells. J Immunol, 2007. 178(1): p. 145–53.PubMed
25.
go back to reference Adorini, L., N. Giarratana, and G. Penna, Pharmacological induction of tolerogenic dendritic cells and regulatory T cells. Semin Immunol, 2004. 16(2): p. 127–34.PubMedCrossRef Adorini, L., N. Giarratana, and G. Penna, Pharmacological induction of tolerogenic dendritic cells and regulatory T cells. Semin Immunol, 2004. 16(2): p. 127–34.PubMedCrossRef
26.
go back to reference Daniel, C., et al., Immune modulatory treatment of trinitrobenzene sulfonic acid colitis with calcitriol is associated with a change of a T helper (Th) 1/Th17 to a Th2 and regulatory T cell profile. J Pharmacol Exp Ther, 2008. 324(1): p. 23–33.PubMedCrossRef Daniel, C., et al., Immune modulatory treatment of trinitrobenzene sulfonic acid colitis with calcitriol is associated with a change of a T helper (Th) 1/Th17 to a Th2 and regulatory T cell profile. J Pharmacol Exp Ther, 2008. 324(1): p. 23–33.PubMedCrossRef
27.
go back to reference Giarratana, N., et al., A vitamin D analog down-regulates proinflammatory chemokine production by pancreatic islets inhibiting T cell recruitment and type 1 diabetes development. J Immunol, 2004. 173(4): p. 2280–7.PubMed Giarratana, N., et al., A vitamin D analog down-regulates proinflammatory chemokine production by pancreatic islets inhibiting T cell recruitment and type 1 diabetes development. J Immunol, 2004. 173(4): p. 2280–7.PubMed
28.
go back to reference Chen, S., et al., Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol, 2007. 179(3): p. 1634–47.PubMed Chen, S., et al., Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol, 2007. 179(3): p. 1634–47.PubMed
29.
go back to reference Garland, C.F. and F.C. Garland, Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol, 1980. 9(3): p. 227–31.PubMedCrossRef Garland, C.F. and F.C. Garland, Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol, 1980. 9(3): p. 227–31.PubMedCrossRef
30.
go back to reference Toner, C.D., C.D. Davis, and J.A. Milner, The vitamin D and cancer conundrum: aiming at a moving target. J Am Diet Assoc. 110(10): p. 1492–500. Toner, C.D., C.D. Davis, and J.A. Milner, The vitamin D and cancer conundrum: aiming at a moving target. J Am Diet Assoc. 110(10): p. 1492–500.
31.
go back to reference Bultink, I.E., et al., Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum, 2005. 52(7): p. 2044–50.PubMedCrossRef Bultink, I.E., et al., Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum, 2005. 52(7): p. 2044–50.PubMedCrossRef
32.
go back to reference • Wright, T.B., et al., Hypovitaminosis D is associated with greater body mass index and disease activity in pediatric systemic lupus erythematosus. J Pediatr, 2009. 155(2): p. 260–5. This was an observational study characterizing the vitamin D status of children with SLE and the interaction with obesity.PubMedCrossRef • Wright, T.B., et al., Hypovitaminosis D is associated with greater body mass index and disease activity in pediatric systemic lupus erythematosus. J Pediatr, 2009. 155(2): p. 260–5. This was an observational study characterizing the vitamin D status of children with SLE and the interaction with obesity.PubMedCrossRef
33.
go back to reference Ben-Zvi, I., et al., The impact of vitamin D on dendritic cell function in patients with systemic lupus erythematosus. PLoS One. 5(2): p. e9193. Ben-Zvi, I., et al., The impact of vitamin D on dendritic cell function in patients with systemic lupus erythematosus. PLoS One. 5(2): p. e9193.
34.
go back to reference Mowry, E.M., et al., Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol. 67(5): p. 618–24. Mowry, E.M., et al., Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol. 67(5): p. 618–24.
35.
go back to reference •• Wagner, C.L. and F.R. Greer, Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 2008. 122(5): p. 1142–52. This article lists the American Academy of Pediatrics’ recommendations for vitamin D intake in children.PubMedCrossRef •• Wagner, C.L. and F.R. Greer, Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 2008. 122(5): p. 1142–52. This article lists the American Academy of Pediatrics’ recommendations for vitamin D intake in children.PubMedCrossRef
36.
go back to reference Bischoff-Ferrari, H.A., et al., Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr, 2006. 84(1): p. 18–28.PubMed Bischoff-Ferrari, H.A., et al., Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr, 2006. 84(1): p. 18–28.PubMed
37.
go back to reference Holick, M.F., High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc, 2006. 81(3): p. 353–73.PubMedCrossRef Holick, M.F., High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc, 2006. 81(3): p. 353–73.PubMedCrossRef
38.
go back to reference Malabanan, A., I.E. Veronikis, and M.F. Holick, Redefining vitamin D insufficiency. Lancet, 1998. 351(9105): p. 805–6.PubMedCrossRef Malabanan, A., I.E. Veronikis, and M.F. Holick, Redefining vitamin D insufficiency. Lancet, 1998. 351(9105): p. 805–6.PubMedCrossRef
39.
go back to reference Holick, M.F. and T.C. Chen, Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr, 2008. 87(4): p. 1080S–6S.PubMed Holick, M.F. and T.C. Chen, Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr, 2008. 87(4): p. 1080S–6S.PubMed
40.
go back to reference Lenders, C.M., et al., Relation of body fat indexes to vitamin D status and deficiency among obese adolescents. Am J Clin Nutr, 2009. 90(3): p. 459–67.PubMedCrossRef Lenders, C.M., et al., Relation of body fat indexes to vitamin D status and deficiency among obese adolescents. Am J Clin Nutr, 2009. 90(3): p. 459–67.PubMedCrossRef
41.
go back to reference Reed, A., et al., Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases. J Pediatr, 1990. 116(4): p. 574–80.PubMedCrossRef Reed, A., et al., Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases. J Pediatr, 1990. 116(4): p. 574–80.PubMedCrossRef
42.
go back to reference Pepmueller, P.H., et al., Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum, 1996. 39(5): p. 746–57.PubMedCrossRef Pepmueller, P.H., et al., Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum, 1996. 39(5): p. 746–57.PubMedCrossRef
43.
go back to reference •• Kamen, D.L., Vitamin D in lupus—new kid on the block? Bull NYU Hosp Jt Dis. 2010, 68(3): p. 218–22. This is an insightful article examining the newly emerging role for vitamin D.PubMed •• Kamen, D.L., Vitamin D in lupus—new kid on the block? Bull NYU Hosp Jt Dis. 2010, 68(3): p. 218–22. This is an insightful article examining the newly emerging role for vitamin D.PubMed
44.
go back to reference Toloza, S.M., et al., Vitamin D insufficiency in a large female SLE cohort. Lupus. 19(1): p. 13–9. Toloza, S.M., et al., Vitamin D insufficiency in a large female SLE cohort. Lupus. 19(1): p. 13–9.
45.
go back to reference Bischoff-Ferrari, H.A., Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol, 2008. 624: p. 55–71.PubMedCrossRef Bischoff-Ferrari, H.A., Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol, 2008. 624: p. 55–71.PubMedCrossRef
47.
go back to reference Avenell, A., et al., Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev, 2009(2): p. CD000227. Avenell, A., et al., Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev, 2009(2): p. CD000227.
48.
go back to reference Armas, L.A., B.W. Hollis, and R.P. Heaney, Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab, 2004. 89(11): p. 5387–91.PubMedCrossRef Armas, L.A., B.W. Hollis, and R.P. Heaney, Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab, 2004. 89(11): p. 5387–91.PubMedCrossRef
49.
go back to reference Trang, H.M., et al., Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr, 1998. 68(4): p. 854–8.PubMed Trang, H.M., et al., Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr, 1998. 68(4): p. 854–8.PubMed
50.
go back to reference Heaney, R.P., et al., Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr, 2003. 77(1): p. 204–10.PubMed Heaney, R.P., et al., Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr, 2003. 77(1): p. 204–10.PubMed
51.
go back to reference Kilpinen-Loisa, P., et al., High-dose vitamin D supplementation in children with cerebral palsy or neuromuscular disorder. Neuropediatrics, 2007. 38(4): p. 167–72.PubMedCrossRef Kilpinen-Loisa, P., et al., High-dose vitamin D supplementation in children with cerebral palsy or neuromuscular disorder. Neuropediatrics, 2007. 38(4): p. 167–72.PubMedCrossRef
Metadata
Title
Vitamin D Supplementation in the Pediatric Rheumatology Clinic
Authors
Emily von Scheven
Jon M. Burnham
Publication date
01-04-2011
Publisher
Current Science Inc.
Published in
Current Rheumatology Reports / Issue 2/2011
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-010-0161-7

Other articles of this Issue 2/2011

Current Rheumatology Reports 2/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine