Associations of low Vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children

Denise L. Jacobson, Charles B. Stephensen, Tracie L Miller, Kunjal Patel, Janet S. Chen, Russell B. Van Dyke, Ayesha Mirza, Gertrud U. Schuster, Rohan Hazra, Angela Ellis, Sean S. Brummel, Mitchell E. Geffner, Margarita Silio, Stephen A. Spector, Linda A. DiMeglio

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Abstract

Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. Methods: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. Results: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. Conclusions: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalJournal of Acquired Immune Deficiency Syndromes
Volume76
Issue number1
DOIs
StatePublished - Sep 1 2017

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Parathyroid Hormone
Vitamin D
Bone Density
HIV
Confidence Intervals
Bone and Bones
Linear Models
Statistical Models
Acquired Immunodeficiency Syndrome
Spine
Cohort Studies

Keywords

  • 25-hydroxy-Vitamin D
  • bone mineral density
  • children
  • HIV infection
  • parathyroid hormone

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Associations of low Vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children. / Jacobson, Denise L.; Stephensen, Charles B.; Miller, Tracie L; Patel, Kunjal; Chen, Janet S.; Van Dyke, Russell B.; Mirza, Ayesha; Schuster, Gertrud U.; Hazra, Rohan; Ellis, Angela; Brummel, Sean S.; Geffner, Mitchell E.; Silio, Margarita; Spector, Stephen A.; DiMeglio, Linda A.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 76, No. 1, 01.09.2017, p. 33-42.

Research output: Contribution to journalArticle

Jacobson, DL, Stephensen, CB, Miller, TL, Patel, K, Chen, JS, Van Dyke, RB, Mirza, A, Schuster, GU, Hazra, R, Ellis, A, Brummel, SS, Geffner, ME, Silio, M, Spector, SA & DiMeglio, LA 2017, 'Associations of low Vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children', Journal of Acquired Immune Deficiency Syndromes, vol. 76, no. 1, pp. 33-42. https://doi.org/10.1097/QAI.0000000000001467
Jacobson, Denise L. ; Stephensen, Charles B. ; Miller, Tracie L ; Patel, Kunjal ; Chen, Janet S. ; Van Dyke, Russell B. ; Mirza, Ayesha ; Schuster, Gertrud U. ; Hazra, Rohan ; Ellis, Angela ; Brummel, Sean S. ; Geffner, Mitchell E. ; Silio, Margarita ; Spector, Stephen A. ; DiMeglio, Linda A. / Associations of low Vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 76, No. 1. pp. 33-42.
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abstract = "Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. Methods: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. Results: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76{\%} vs. 64{\%}) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95{\%} confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95{\%} CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95{\%} CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95{\%} CI, 0.81 to 1.24). High PTH was 3.17 (95{\%} CI, 1.25 to 8.06) times more likely in PHIV children. Conclusions: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.",
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author = "Jacobson, {Denise L.} and Stephensen, {Charles B.} and Miller, {Tracie L} and Kunjal Patel and Chen, {Janet S.} and {Van Dyke}, {Russell B.} and Ayesha Mirza and Schuster, {Gertrud U.} and Rohan Hazra and Angela Ellis and Brummel, {Sean S.} and Geffner, {Mitchell E.} and Margarita Silio and Spector, {Stephen A.} and DiMeglio, {Linda A.}",
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T1 - Associations of low Vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children

AU - Jacobson, Denise L.

AU - Stephensen, Charles B.

AU - Miller, Tracie L

AU - Patel, Kunjal

AU - Chen, Janet S.

AU - Van Dyke, Russell B.

AU - Mirza, Ayesha

AU - Schuster, Gertrud U.

AU - Hazra, Rohan

AU - Ellis, Angela

AU - Brummel, Sean S.

AU - Geffner, Mitchell E.

AU - Silio, Margarita

AU - Spector, Stephen A.

AU - DiMeglio, Linda A.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. Methods: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. Results: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. Conclusions: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

AB - Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. Methods: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. Results: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. Conclusions: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

KW - 25-hydroxy-Vitamin D

KW - bone mineral density

KW - children

KW - HIV infection

KW - parathyroid hormone

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