Effect of calcium and vitamin D supplementation on bone mineral accrual among HIV-infected Thai adolescents with low bone mineral density

Author List
Thanyawee Puthanakit
Orasri Wittawatmongkol
Voraporn Poomlek
Tavitiya Sudjaritruk
Chantaphat Brukesawan
Torsak Bunupuradah
Sirintip Sricharoenchai
Thongsuai Chuanjaroen
Wasana Prasitsuebsai
Kulkanya Chokephaibulkit


Background: The benefits of calcium and vitamin D supplementation for low bone mass remains controversial. This study assessed the changes in bone mineral density (BMD) during periods without and with calcium and vitamin D supplementation among HIV-infected adolescents with low BMD. Method: Perinatally HIV-infected Thai adolescents aged 12–20 years were enrolled into Phase 1 (pre-supplementation) to evaluate longitudinal change of BMD. We provided education about appropriate dietary intake and exercise. Lumbar spine (L2–L4) BMD and vitamin D status (25-hydroxyvitamin D [25(OH)D]) were assessed at baseline and at 12–24 month intervals. Participants with a BMD Z-score≤−2 were enrolled into Phase 2 (supplementation) that provided calcium 600 mg plus cholecalciferol 200 IU twice daily for 6 months. BMD and 25(OH)D were re-assessed at the end of study. Results: Ninety-four participants were enrolled into the Phase 1. Median age (IQR) was 14.3 (13.0–15.5) years, with 67% at Tanner stage 3–5, 89% with a plasma HIV-1 RNA<50 copies/mL. During Phase 1 and a 22.7-month follow-up, median L2–L4 BMD Z-scores remained unchanged (−1.06 vs −1.08, P=0.08), but 25(OH)D levels increased (24.7 vs 26.7 ng/mL, P=0.01). Twenty-six (28%) adolescents had low BMD and were enrolled into Phase 2, with 24 (92%) completing follow-up. The median L2–L4 BMD Z-scores (−2.59 vs −1.70; P<0.001) and calcium level (9.3 vs 9.5 mg/dL, P=0.04) significantly improved. There was an increase in BMD Z-scores during the 6-months post-supplementation as compared to the 21-month pre-supplementation period (0.65 vs −0.50, P=0.03). Conclusion: HIV-infected adolescents with low BMD had improved bone health after calcium and vitamin D supplementation. A randomised controlled trial is warranted to confirm the benefits of these supplements.

Article Category

HIV cure research

Article Type

Original research

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