title: Can Stoss Therapy Be Used in Children with Vitamin D Deficiency or Insufficiency without Rickets?
abstract: OBJECTIVE
  Stoss vitamin D treatment has been recommended for its non-skeletal benefits in adults, but there is a lack of data on the optimal dose of vitamin D stoss therapy in children with vitamin D deficiency/insufficiency without rickets. This study aimed to compare efficiency/side effects of two different stoss therapy regimens (10 000 IU/kg and 300 000 IU vitamin D3) administered in children with vitamin D deficiency/insufficiency without rickets.
  
  
  METHODS
  Sixty-four children who had vitamin D deficiency/insufficiency were studied. A serum 25-hydroxyvitamin-D (25-OH-D) level of 15-20 ng/mL was considered as vitamin D insufficient and <15 ng/mL was considered as vitamin D deficient. The patients were divided into two groups according to the stoss therapy doses they received. Serum calcium, phosphate, alkaline phosphatase, 25-OH-D, parathyroid hormone levels, and spot urine calcium/creatinine ratios before/after treatment were recorded. Wrist radiography and renal ultrasonography were performed.
  
  
  RESULTS
  The mean age of the subjects was 10.6±4.4 years. Thirty-two children were treated with a single vitamin D3 dose of 10 000 IU/kg and 32 patients received 300 000 IU. No difference was found in 25-OH-D levels between the two groups at presentation. The mean level of 25-OH-D was higher in the 10 000 IU/kg group at the second week of therapy. There was no difference between the groups at post-treatment weeks 4 and 12. The 25-OH-D was found to be below optimal levels (≥30 ng/mL) in 66.5% and <20 ng/mL in 21.8% of patients at the third month in both groups. None developed hypercalcemia and/or hypercalciuria. Nephrolithiasis was not detected in any patient.
  
  
  CONCLUSIONS
  This study showed that both doses of stoss therapy used in the treatment of vitamin D insufficiency/deficiency are effective and safe. However, an optimal level of 25-OH-D cannot be maintained for more than three months.
authors.affiliation: İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey, E-mail: dr.cmlkcygt@gmail.com.
authors.forename: Cemil
authors.initials: C
authors.lastname: Koçyiğit
authors.forename: Gönül
authors.initials: G
authors.lastname: Çatlı
authors.forename: Gülberat
authors.initials: G
authors.lastname: İnce
authors.forename: Elif Büşra
authors.initials: EB
authors.lastname: Özkan
authors.forename: Bumin Nuri
authors.initials: BN
authors.lastname: Dündar
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D012279:Rickets / Q000150:complications*; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010281:Parathyroid Hormone; D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002118:Calcium
keywords: Vitamin D deficiency; rickets stoss therapy.