Endocrine Abstracts

JOINT532

Background: Antiepileptic drugs (AEDs) are well known to affect bone health adversely, most importantly due to vitamin D deficiency associated with use of AEDs. It is rational to monitor vitamin D status in such children to detect vitamin D deficiency/insufficiency and then to replenish vitamin D (cholecalciferol). Currently there is no consensus regarding the recommended dose of vitamin D supplementation in children receiving AEDs.

Objectives: Our objective was to detect vitamin D insufficiency in children on AEDs at baseline and then, to determine the effectiveness of two internationally accepted vitamin D (cholecalciferol) supplementation dosage (1200 IU daily vs. 400 IU daily) on bone health and vitamin D status in children on AEDs.

Methods: A Randomized controlled trial on subjects receiving antiepileptic drugs and attending Neurology outpatient department at SGPGIMS, Lucknow. We supplemented cholecalciferol in subjects receiving AEDs and having vitamin D insufficiency (serum 25OHD < 20 ng/ml) in two randomized oral dosage groups 1 and 2 (1200 IU daily vs. 400 IU daily, respectively) along with 500 mg of elemental calcium. Subsequently, we analyzed the changes in serum 25OHD and other bone health markers (Serum calcium, phosphorus, alkaline phosphatase, intact PTH, P1NP and beta CrossLaps) at the baseline and at 3 months between the two groups.

Results: Out of 70 participants, 60 (86%) were found to have vitamin D insufficiency (25OHD<50 nmol/l). At 3 months follow-up, the group 1 had achieved vitamin D sufficiency status in all participants (23/23) whereas only 18/25 (70%) participants in the group 2 achieved vitamin D sufficiency status. The 25OHD level (mean±SD, nmol/l) was significantly higher in group 1 as compared to group 2 (80.5±24.2 vs. 50.1±14.5; P<0.001). Group 1 had significantly lower intact PTH level (mean±SD, pmol/l) (3.4±1.4 vs. 5.2±1.8; P<0.01), significantly lower ALP level (186±68 vs. 298±145; P<0.01) and significantly lower beta CrossLaps level (1186±208 vs. 1592±428; P<0.001), when compared to group 2. On paired t-test to analyze the changes (from the baseline to the 3 months follow-up), revealed that the changes towards improvement in the serum 25OHD level, ALP, intact PTH and beta CrossLaps were significantly more in group 1. The intervention was safe as none developed toxic levels of serum 25OHD (>250 nmol/l), hypercalcemia and nephrocalcinosis.

Conclusion: A higher oral vitamin D replacement dose (1200 IU per day) is safe and achieves a better vitamin D level and vitamin D sufficiency state along with significantly improved biochemical markers of bonehealth.