Endocrine Abstracts

Objective: To determine effectiveness of supplementing vitamin D alone vs vitamin D+ calcium on bone mass accrual in underprivileged Indian premenarcheal girls.

Methods: A double blind, matched pair, cluster randomization study was carried out in 200 premenarcheal girls (8–12 years) from three public schools. The participants were randomized into two clusters and were allocated to receive either vitamin D (Group A): 30 000 IU oral cholecalciferol every 3 months or vitamin D+ calcium (Group B): 500 mg/day calcium and vitamin D 30 000 IU oral cholecalciferol every 3 months. The supplementation trial was done for the duration of 1 year. Anthropometry, biochemical parameters, total body bone area (TBBA), mineral content (TBBMC) and bone mineral density (TBBMD) by dual energy X-ray absorptiometry were assessed at baseline and at the end of 1 year.

Results: At baseline vitamin D deficiency was observed in 84 (42%) girls. Post supplementation TBBMC, TBBMD and TBBA were significantly increased in both the groups in comparison to baseline. But the corresponding Z scores showed significant improvement only in group B. Mean percent increase in TBBMC was significantly higher in group B (from 841±174 to 1018±226 g, 22.3%) compared to group A (from 793±138 to 935±185 g, 17.6%, P=0.02). Improvement in TBBMC-for-age Z score was higher in the group B (from −1.1±0.9 to −0.9±0.9, 22%) vs group A (from −1.1±0.7 to −1.1±0.8, 13.6%, P=0.03). Similarly increments in TBBMD was significantly higher in group B (from 0.78±0.05 to 0.82±0.06 g/cm², 5.5%) vs group A (from 0.77±0.05 to 0.80±0.05 g/cm², 3.3%, P=0.03). However increase in TBBA was not significantly different between the two groups (14.4% in group B vs 13.8% in group A, P>0.1). No significant difference in mean percent increase in TBBMC were observed across vitamin D categories (<20, 20–30, >30 ng/ml) in both the groups. The increase in height was similar in the two supplemented groups (7.3±1.5 cm in group A vs 7.4±1.4 cm in group B).

Discussion: Low adult bone mass is linked to osteoporosis and fractures and is dependent on the extent of childhood and adolescent bone mineralization. Indices of bone health improved significantly following calcium and vitamin D supplementation.

Conclusion: Calcium along with vitamin D supplementation was more effective in improving bone mass accrual in underprivileged premenarcheal girls than vitamin D alone.