Treatment of vitamin D deficiency in transfusion-dependent thalassemia

The survival of patients with thalassemia major has progressively improved with advances in therapy; however, osteoporosis remains a frequent, unresolved issue [1]. Adequate circulating levels of vitamin D are essential for optimal skeletal health and reducing fracture risk [2]. Vitamin D insufficiency is reported in the majority of patients with thalassemia in the USA [3] and elsewhere [4–10], despite routine prescription of 400–1,000 IU vitamin D per day. In this study, assessment of serum 25-hydroxy vitamin D (25-OH D) levels in 96 patients with thalassemia revealed that 70 (73%) were either deficient ( 80 ng/ml was observed over the course of the observation period. There were 18 individuals who attained a 25-OH D level >30 ng/ml at the end of their supplementation period and continued daily supplementation of 400–1,000 IU vitamin D thereafter. When retested at an average of 8 months (1–21 months) later, the serum 25-OH D had dropped significantly and collectively for all but two of them, from a mean of 34.4 ± 3.7 to 26.9 ± 6.8 ng/ml (P < 0.001). The rate of decline was on an average 1.5 ng/ml per month. Hence, patients who had inadequate vitamin D status on screening were likely to require ongoing high-dose supplementation. In contrast, the