October 8, 2008
MEDIA CONTACT: Ekaterina Pesheva
PHONE: 410-516-4996
E-MAIL: epeshev1@jhmi.edu
Correcting Vitamin D Deficiency
Older cystic fibrosis (CF) patients have an elevated risk for fractures, which appear related to deficiencies in vitamin D. Known to play a crucial role in bone formation, vitamin D and other nutrients are poorly absorbed in CF patients. At Hopkins Children’s, pediatric pulmonology fellow Deanna Green is leading a second retrospective study charting the effectiveness of vitamin D supplement strategies in children, with the hopes of preventing fractures down the road. In an earlier retrospective study of 2003-2006 data, published in the October 2008 issue of The Journal of Pediatrics, lead author Green and colleagues in Hopkins’ pediatric cystic fibrosis clinic confirmed that 50 000 international units of the common supplement ergocalciferol -- given once, twice or even three times a week for 8 weeks-- was inadequate in treating most of their pediatric patients with vitamin D deficiency. Vitamin D deficiency is defined as having a blood level of 25-hydroxy-vitamin D less than 30 ng/ml by a Cystic Fibrosis Foundation (CFF) consensus statement published in 2002. Since 2007, the Hopkins clinic has increased the treatment frequency to 50 000 international units once a day for 28 days, followed by tests of blood serum levels to check the vitamin D level. The youngest patient treated with this newest schedule was 3-months-old and the oldest was 21 years. “We’ve found this is a more effective treatment,” says Green. “However, now, as we review the data, we’re concerned, that the levels of Vitamin D in our treated patients may be too high. Some levels after treatment are now considerably above 60 ng/ml, the recommended highest level, and clinicians often consider 80 very high.” Director of the Johns Hopkins CF Center and primary investigator for the October 2008 paper, Peter Mogayzel and his colleagues are considering other treatments to identify the middle ground to effectively treat vitamin D deficiency. Possibilities include additional sunlight and UV exposure for children with vitamin D deficiencies (which involves approximately half of all patients followed in the CF clinic) or the supplement cholecalciferol (vitamin D3), which appears to be absorbed differently than ergocalciferol (vitamin D2). 
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