A Simple Regimen to Correct Vitamin D Deficiency In Transfusion-Dependent Thalassemia with High-Dose Ergocalciferol

Abstract 4261

Osteoporosis in thalassemia is extremely common and preventive approaches are required to avoid serious complications in adults. Vitamin D deficiency, which contributes to suboptimal bone mineralization, is frequently observed in thalassemia despite routine prescription for supplementation with 400–800 IU vitamin D per day. Screening for vitamin D status was conducted in 71 patients with thalassemia, of which 52 were transfusion-dependent and 19 were transfusion-independent (including 11 patients with hemoglobin H or H Constant Spring disease). Baseline assessment of plasma 25-OH vitamin D revealed 57 (80.3%) patients were either deficient (<20 ng/mL, 47.9%) or insufficient (20-30 ng/mL, 32.4%). Significantly more patients in the transfusion-independent group were deficient in vitamin D compared with transfusion-dependent group (78.9% versus 36.5%, p=0.003). The mean parathyroid hormone level in patients with 25-OH D <20 ng/mL was 35.4 ± 19.6 pg/mL compared to 28.2 ± 17.1 pg/mL in those with ≥20 ng/mL (p=NS). We studied the efficacy of supervised adminstration of high-dose (50,000 IU) oral ergocalciferol every 3 weeks during transfusion visits in 20 patients with transfusion-dependent thalassemia. The mean 25-OH D level increased from 14.0 to 22.9 ng/mL (p<0.001) over a four-month period. A single dose of ergocalciferol given every 3 weeks increased the plasma 25-OH D level by 2.2 ± 2.3 ng/mL. No patient developed toxic 25-OH D level (>80 ng/mL) during the course of the study. These results show that vitamin D deficiency remains widespread despite daily low-dose supplementation. Non-transfused patients are at even greater risk of vitamin D deficiency, which may reflect less attention to nutrition in this group compared to the transfusion-dependent patients. We have found that supervised high-dose oral ergocalciferol supplementation is simple, safe, non-invasive and predictable method to improve vitamin D status in thalassemia.