title: Screening for vitamin D insufficiency in pediatric cancer survivors.
abstract: BACKGROUND
  Corticosteroids increase risk for decreased bone mineral density, which can be worsened by vitamin D insufficiency (VDI) or deficiency (VDD).
  
  
  METHODS
  In the Vanderbilt cancer survivorship clinic, we obtained screening total 25-hydroxy vitamin D levels (VDL) in 171 cancer survivors <23 years old who were treated with prolonged corticosteroids for their cancer, and compared this group to a control group of 97 healthy pediatric patients.
  
  
  RESULTS
  VDD was diagnosed in 15.8% and VDI in 34.5% of cancer survivors and VDD/VDI combined was associated with body mass index (BMI) >85th percentile (Odds ratio [OR] = 5.4; P < 0.001), older age (OR = 2.2; P = 0.012), non-Caucasian or Hispanic race (OR = 4.5; P = 0.008) and summer versus winter season (OR = 0.12; P < 0.001). In multivariable analysis, VDI/VDD prevalence did not differ from the control group (VDI/VDD (43.3%)). In the combined survivor/control group multivariable analysis, cancer diagnosis did not increase VDI/VDD risk, but significant associations persisted with elevated BMI (P < 0.001), age (P = 0.004), non-Caucasian or Hispanic race (P < 0.001), and seasonality (P < 0.001).
  
  
  CONCLUSIONS
  VDD/VDI is equally common in pediatric cancer survivors treated with corticosteroids and healthy children. The impact of VDD/VDI in cancer survivors may be greater due to risk for impaired bone health superimposed on that conferred from corticosteroid exposure. Thus, screening VDLs should be obtained in pediatric cancer survivors treated with corticosteroids, particularly in those with elevated BMI, older age, or non-Caucasian race. Prospective studies evaluating the impact of interventions to minimize VDD/VDI on long-term bone health in survivors are required.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Esbenshade
authors.forename: Jenna
authors.initials: J
authors.lastname: Sopfe
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Zhao
authors.forename: Zeda
authors.initials: Z
authors.lastname: Li
authors.forename: Kristin
authors.initials: K
authors.lastname: Campbell
authors.forename: Jill H
authors.initials: JH
authors.lastname: Simmons
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013714:Tennessee / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: all; survivorship; vitamin D sufficiency