ABSTRACT
Background: Bone pain frequency and optimal methods of vitamin D [VD] administration in adult patients with sickle cell anemia [SCA] are unclear
Objective: To assess bone pain frequency and level of VD in adult SCA patients after vitamin D medication
Setting: Salmaniya Medical Complex, Bahrain
Design: A Prospective Controlled Trial
Method: The study was performed from 1 January 2013 to 31 December 2014. Sixty-nine SCA patients were studied and compared with an age and gender-matched control group. Bone pain frequency was assessed using Visual Analogue Scale [VAS]. Measurement of serum level of VD, parathormone [PTH], calcium and alkaline phosphatase [ALP] at baseline, one and three months after treatment. Vitamin D Deficiency [VDD] was defined as <50 nmol/L. The mean difference of biochemical and clinical parameters was compared using paired Student t-test
Result: Fifty-one [74%] patients from the study group and 14 [20.3%] patients from the control group had VDD. Twenty-six [37.7%] patients were treated with IM injection of 600,000 IU once and 25 [36.2%] were treated with oral capsule of 50,000 IU weekly. Patients on IM treatment had pain frequency of 56 episodes per month before treatment, which was reduced to 43 [P<0.05] after one month; further reduction to 34 episodes [P<0.01] was achieved after three months. Patients on oral medication had pain frequency of 57 episodes per month before treatment, which reduced to 50 episodes after one month [P<0.05] and 40 after 3 months [P<0.01]. Vitamin D level increased to 54.15 +/- 2.73 in one month compared to 19.55 +/- 9.63 nmol/ml [P<0.05] before treatment. Patients on oral medication had VD increment of 31.64 +/- 4.44 compared to 22.11 +/- 9.46 nmol/ml [P<0.05] after one month and 53.69 +/- 2.37 nmol/ml after three months [P<0.001]
Conclusion: Frequency of bone pain was reduced significantly in adult SCA patients with VDD after one month of treatment of vitamin D3 injection with normalization of serum level