Aims This study was undertaken following observation of a number of fractures in the paediatric oncology population at a district general hospital (DGH), some, after minimal trauma. Research indicates that children with cancer are at an increased risk of skeletal morbidity including osteopenia and pathological fractures.
The recently published RCPCH ‘Guide for Vitamin D in Childhood’ (2013) highlights the extent and importance of vitamin D deficiency which is thought to affect a quarter of UK children. Vitamin D is central to bone metabolism and is an important variable in the assessment of bone health. Children with cancer are subject to a range of risk factors which make them particularly vulnerable to vitamin D deficiency however there is a dearth of data examining vitamin D levels in this population.
This project examined the vitamin D status of children at a DGH with known oncological disease. The hospital runs a general paediatric service and a level 1 Paediatric Oncology Shared Care Oncology service.
Methods Vitamin D levels were obtained from the hospital database for paediatric oncology patients attending the DGH between 1/1/2011 and 1/1/2013. Data were obtained for 21 patients in total; results were reviewed in the context of laboratory standard values.
Results Initial vitamin D levels varied from <10 to 120 nmol/L. The average value was 46.6 ± 7.6 nmol/L. <25 nmol/L corresponds to severe deficiency, <50 nmol/L is deficient and >75 nmol/L desirable. Results are shown in Figure 1. Fourteen of the 21 patients (67%) were vitamin D deficient, of which 8 (38%) were severely deficient. Five of the 21 patients (24%) had desirable vitamin D levels. For patients in whom multiple measurements had been made, many remained deficient despite being prescribed supplements.
Conclusions This study suggests paediatric oncology patients may be at greater risk of vitamin D deficiency than the general population and that this deficiency may be difficult to treat. Further work should probe risk factors for deficiency in this population and investigate the most appropriate means by which to screen for, and manage, this deficiency.