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The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: a systematic review

The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: a systematic review
The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: a systematic review
Objective:

HIV-positive children, adolescents, and young adults are at increased risk poor musculoskeletal outcomes. Increased incidence of vitamin D deficiency in youth living with HIV may further adversely affect musculoskeletal health. We investigated the impact of vitamin D supplementation on a range of musculoskeletal outcomes among individuals aged 0–25 years living with HIV.

Methods:

A systematic review was conducted using databases: PubMed/Medline, CINAHL, Web of Knowledge, and EMBASE. Interventional randomised control trials, quasi-experimental trials, and previous systematic reviews/meta-analyses were included. Outcomes included: BMD, BMC, fracture incidence, muscle strength, linear growth (height-for-age Z-score [HAZ]), and biochemical/endocrine biomarkers including bone turnover markers.

Results:

Of 497 records, 20 studies met inclusion criteria. Thirteen studies were conducted in North America, one in Asia, two in Europe, and four in Sub-Saharan Africa. High-dose vitamin D supplementation regimens (1,000–7,000 IU/day) were successful in achieving serum 25-hydroxyvitamin-D (25OHD) concentrations above study-defined thresholds. No improvements were observed in BMD, BMC, or in muscle power, force and strength; however, improvements in neuromuscular motor skills were demonstrated. HAZ was unaffected by low-dose (200–400 IU/day) supplementation. A single study found positive effects on HAZ with high-dose supplementation (7,000 vs 4,000IU/day).

Conclusions:

Measured bone outcomes were unaffected by high-dose vitamin D supplementation, even when target 25OHD measurements were achieved. This may be due to: insufficient sample size, follow-up, intermittent dosing, non-standardised definitions of vitamin D deficiency, or heterogeneity of enrolment criteria pertaining to baseline vitamin D concentration. High-dose vitamin D may improve HAZ and neuromuscular motor skills. Adequately powered trials are needed in settings where HIV burden is greatest.
1932-6203
Penner, Justin
17dff1a6-7686-4baa-ac1d-babdad305c6c
Ferrand, Rashida A.
9441b7cd-4eb5-4665-aa69-357911fd2c87
Richards, Ceri
89008087-1395-4029-9e6e-dc0254e7c38e
Ward, Kate A.
39bd4db1-c948-4e32-930e-7bec8deb54c7
Burns, James E.
2c30b328-4fa5-4262-b784-96941bb9d6ad
Gregson, Celia L.
30fae822-e733-4e67-b11a-e46dfb1b269a
Penner, Justin
17dff1a6-7686-4baa-ac1d-babdad305c6c
Ferrand, Rashida A.
9441b7cd-4eb5-4665-aa69-357911fd2c87
Richards, Ceri
89008087-1395-4029-9e6e-dc0254e7c38e
Ward, Kate A.
39bd4db1-c948-4e32-930e-7bec8deb54c7
Burns, James E.
2c30b328-4fa5-4262-b784-96941bb9d6ad
Gregson, Celia L.
30fae822-e733-4e67-b11a-e46dfb1b269a

Penner, Justin, Ferrand, Rashida A., Richards, Ceri, Ward, Kate A., Burns, James E. and Gregson, Celia L. (2018) The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: a systematic review. PLoS ONE, 13 (11). (doi:10.1371/journal.pone.0207022).

Record type: Article

Abstract

Objective:

HIV-positive children, adolescents, and young adults are at increased risk poor musculoskeletal outcomes. Increased incidence of vitamin D deficiency in youth living with HIV may further adversely affect musculoskeletal health. We investigated the impact of vitamin D supplementation on a range of musculoskeletal outcomes among individuals aged 0–25 years living with HIV.

Methods:

A systematic review was conducted using databases: PubMed/Medline, CINAHL, Web of Knowledge, and EMBASE. Interventional randomised control trials, quasi-experimental trials, and previous systematic reviews/meta-analyses were included. Outcomes included: BMD, BMC, fracture incidence, muscle strength, linear growth (height-for-age Z-score [HAZ]), and biochemical/endocrine biomarkers including bone turnover markers.

Results:

Of 497 records, 20 studies met inclusion criteria. Thirteen studies were conducted in North America, one in Asia, two in Europe, and four in Sub-Saharan Africa. High-dose vitamin D supplementation regimens (1,000–7,000 IU/day) were successful in achieving serum 25-hydroxyvitamin-D (25OHD) concentrations above study-defined thresholds. No improvements were observed in BMD, BMC, or in muscle power, force and strength; however, improvements in neuromuscular motor skills were demonstrated. HAZ was unaffected by low-dose (200–400 IU/day) supplementation. A single study found positive effects on HAZ with high-dose supplementation (7,000 vs 4,000IU/day).

Conclusions:

Measured bone outcomes were unaffected by high-dose vitamin D supplementation, even when target 25OHD measurements were achieved. This may be due to: insufficient sample size, follow-up, intermittent dosing, non-standardised definitions of vitamin D deficiency, or heterogeneity of enrolment criteria pertaining to baseline vitamin D concentration. High-dose vitamin D may improve HAZ and neuromuscular motor skills. Adequately powered trials are needed in settings where HIV burden is greatest.

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More information

Accepted/In Press date: 22 October 2018
e-pub ahead of print date: 15 November 2018

Identifiers

Local EPrints ID: 426481
URI: https://eprints.soton.ac.uk/id/eprint/426481
ISSN: 1932-6203
PURE UUID: 70bb34db-f3cf-4d25-9bbc-dbd3faa8193d
ORCID for Kate A. Ward: ORCID iD orcid.org/0000-0001-7034-6750

Catalogue record

Date deposited: 28 Nov 2018 17:30
Last modified: 20 Jul 2019 00:33

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