title: Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL).
abstract: BACKGROUND
  We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation.
  
  
  METHODS
  This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000 mg/day calcium and 800 International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes.
  
  
  RESULTS
  Pre-randomization LS-BMD below the mean was associated with male gender (P = 0.0024), White race (P = 0.0003), lower body mass index (P < 0.0001), and cumulative glucocorticoid doses of ≥ 5,000 mg (P = 0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33 ± 0.57) or placebo (0.28 ± 0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50 ± 0.66 and 0.37 ± 0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30 ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P = 0.78).
  
  
  CONCLUSIONS
  Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry).
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: S C
authors.initials: SC
authors.lastname: Kaste
authors.forename: A
authors.initials: A
authors.lastname: Qi
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: H
authors.initials: H
authors.lastname: Surprise
authors.forename: E
authors.initials: E
authors.lastname: Lovorn
authors.forename: J
authors.initials: J
authors.lastname: Boyett
authors.forename: R J
authors.initials: RJ
authors.lastname: Ferry
authors.forename: M V
authors.initials: MV
authors.lastname: Relling
authors.forename: S A
authors.initials: SA
authors.lastname: Shurtleff
authors.forename: C H
authors.initials: CH
authors.lastname: Pui
authors.forename: L
authors.initials: L
authors.lastname: Carbone
authors.forename: M M
authors.initials: MM
authors.lastname: Hudson
authors.forename: K K
authors.initials: KK
authors.lastname: Ness
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density; D002136:Calcium, Dietary / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002762:Cholecalciferol / Q000008:administration & dosage*; D003376:Counseling; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D044623:Nutrition Therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000178:diet therapy*; D017741:Survivors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002136:Calcium, Dietary; D002762:Cholecalciferol
keywords: ALL; childhood cancer survivor; cholecalciferol; controlled trial; vitamin D