Vitamin D therapy in patients with sickle cell disease (SCD)

Intervention with vitamin D therapy, which should be a maximum for three months, was introduced based on VD serum levels and BMD as described below. The patients were divided into three groups; A (Arm 1), B (Arm 2) and C (Arm 3). BMD measurement was done using Dual Energy X-ray Absorbtiometry (DEXA) at upper/neck femur, forearm and lumbar spine, osteopenia (T score between -1 to -2.5) and osteoporosis (A bone mineral density (BMD) greater than 2.5 standard deviations from the normal with T score less than or equal to -2.5) will be diagnosed as per the WHO criteria. BMD were requested for all patients as base line. BMD will be done twice, before the therapy as base line and later three months after the last dose of VD. Group A (Arm 1): Patients with VD deficiency (< 30nmol/l), and low BMD for osteoporosis or osteopenia according to WHO criteria: first dose therapeutic intervention was introduced with intramuscular vitamin D (IM VD), (Cholecalciferol (Arachitol-6L) 600,000 IU/month), but, the second dose will be decided after the second run of their serum VD levels one month later, if VD levels become normal no more therapy will be given and the patient will be out of the study, if the levels are still insufficient/deficient then a second IM injection dose will be given, again after one month the VD serum levels will be checked and a third dose will be decided accordingly. Group B (Arm 2): Patients with insufficient VD levels (30-50nmol/l), BMD score for osteoporosis/osteopenia according to WHO criteria: first dose therapeutic intervention was introduced with IM VD injection, Cholecalciferol 600,000 IU/month, unless the patient preferred tablets. For Group B the second and third doses will be decided as for Group A. Group C (Arm 3): Patients with insufficient VD levels, and normal BMD according to WHO criteria: intervention was introduced with oral vitamin D supplements (Cholecalciferol tablet 50.000 IU/week for 3 months) and should come back after three months to check their VD serum levels. However, patients with optimal VD serum levels (>50 nmol/l), irrespective of their BMD, were not given any therapy. For recording pain scores, crisis or utilization of care a daily dairy for a whole month was designed with four different colors indicating; no pain, mild, moderate and severe pain. Four dairies were provided for each patient, one should be filled before therapy start and the rests during the therapy. Further evaluation of vitamin D status and chronic musculoskeletal pain in SCD patients is being evaluated