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Abstract：
Prevalent vitamin D deficiency (VDD) and low bone mineral density (BMD) have led to vitamin D supplementation for children with cancer, regardless vitamin D status. However, it remains unsettled whether this enhances bone strength. We sought to address this issue by carrying out a systematic review of the literature.
We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25-hydroxyvitamin D (25OHD) levels and BMD Z-scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology.
Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z-scores, while 25OHD as a continuous variable was not significantly associated with BMD Z-scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence).
There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year-long.
We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25-hydroxyvitamin D (25OHD) levels and BMD Z-scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology.
Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z-scores, while 25OHD as a continuous variable was not significantly associated with BMD Z-scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence).
There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year-long.
摘要：
普遍的维生素D缺乏（VDD）和低骨密度（BMD）导致癌症儿童补充维生素D，不管维生素D的状态。然而,这是否能增强骨骼强度还不确定。我们试图通过对文献进行系统回顾来解决这个问题。
我们使用PubMed进行了文献检索，Embase,和Cochrane数据库。包括癌症治疗后长达5年的儿童在内的研究评估了25-羟基维生素D（25OHD）水平与BMDZ评分或骨折之间的关系。以及补充维生素D对BMD或骨折的影响。使用GRADE方法评估证据质量。
19项研究(16项观察性研究和3项干预性研究，主要涉及血液系统恶性肿瘤儿童）。一项分析25OHD作为阈值变量（≤10ng/ml）的研究发现，25OHD水平与BMDZ评分之间存在显着关联。而在14项观察性研究中，25OHD作为连续变量与BMDZ评分无显著相关。我们发现较低的25OHD水平与骨折之间没有显着关联（2项研究），维生素D（和钙）补充与BMD或骨折频率之间也没有（3项研究）（质量很低的证据）。
缺乏维生素D（和钙）补充剂对癌症儿童BMD或骨折的影响的证据。需要进一步的研究；在那之前，我们建议饮食中的维生素D/钙的摄入量符合国家标准，和定期25OHD监测以检测<20ng/ml的水平。维生素D/钙补充建议在低水平的儿童，保持≥20ng/ml的水平，持续一年。
我们使用PubMed进行了文献检索，Embase,和Cochrane数据库。包括癌症治疗后长达5年的儿童在内的研究评估了25-羟基维生素D（25OHD）水平与BMDZ评分或骨折之间的关系。以及补充维生素D对BMD或骨折的影响。使用GRADE方法评估证据质量。
19项研究(16项观察性研究和3项干预性研究，主要涉及血液系统恶性肿瘤儿童）。一项分析25OHD作为阈值变量（≤10ng/ml）的研究发现，25OHD水平与BMDZ评分之间存在显着关联。而在14项观察性研究中，25OHD作为连续变量与BMDZ评分无显著相关。我们发现较低的25OHD水平与骨折之间没有显着关联（2项研究），维生素D（和钙）补充与BMD或骨折频率之间也没有（3项研究）（质量很低的证据）。
缺乏维生素D（和钙）补充剂对癌症儿童BMD或骨折的影响的证据。需要进一步的研究；在那之前，我们建议饮食中的维生素D/钙的摄入量符合国家标准，和定期25OHD监测以检测<20ng/ml的水平。维生素D/钙补充建议在低水平的儿童，保持≥20ng/ml的水平，持续一年。
