ESPE Abstracts

Background: There is no agreement on the optimal treatment of children with vitamin D deficiency or insufficiency without obvious signs of rickets.

Objective and hypotheses: To compare the efficacy and side effects of two different stoss therapy regimens (10 000 IU/kg and 300 000 IU vitamin D₃) in children with vitamin D deficiency or insufficiency without rickets.

Method: A total of 64 children and adolescents who had vitamin D deficiency or insufficiency without rickets were retrospectively studied. Serum levels of calcium, phosphate, alkaline phosphatase (ALP), 25-OH-D, parathyroid hormone, spot urine calcium/creatinine ratio before and after treatment and renal ultrasonography (USG) outcomes were evaluated in two groups. A serum level of 25- hydroxyvitamin D (25-OH-D) between 15 and 20 ng/ml was considered as vitamin D insufficiency and <15 ng/ml levels was considered as vitamin D deficiency.

Results: Thirty-two patients were treated with the dose of 10 000 IU/kg and the remaining 32 patients received 300 000 IU single dose oral vitamin D₃. No significant difference was found in the levels of 25-OH-D between the two groups at presentation (10.8±4.9 and 8.8±3.6 ng/ml, respectively). The mean level of 25-OH-D was significantly higher in 10 000 IU/kg group at the second week of therapy, but vitamin D levels were not different between the groups at the post-treatment 4 and 12 weeks. 25-OH-D level was found below optimal level (≧30 ng/ml) in 66.5% and below 20 ng/ml in 21.8% of the patients at the third month of therapy in both groups. None of the patients in both groups developed hypercalcemia or hypercalciuria. Nephrolithiasis was detected only in one patient in the 10 000 IU/kg group.

Conclusion: 10 000 IU/kg and 300 000 IU single dose vitamin D₃ are not superior to each other. However, the optimal serum level of 25-OH-D cannot be maintained for more than three months.