Graduation Date

Spring 5-6-2017

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Corrine Hanson, Ph.D, RD, LMNT

Second Advisor

Ann Anderson-Berry, M.D., Ph.D.

Third Advisor

Nicole Spurgeon, RD, LMNT

Abstract

BACKGROUND: Bone health is a serious concern for long-term survivors of Allo-HSCT due to multiple risk factors including steroids, chemotherapy, immunosuppressive drugs, and poor nutrition status1. Steroids have been long proven to have negative impact on bone health and the National Osteoporosis Foundation (NOF) lists steroids as a contributing factor to osteoporosis and fractures. NOF guidelines recommend providing adequate daily vitamin D as a safe and inexpensive way to help reduce fracture risk1. Therefore, proper supplementation of vitamin D may increase the quality of life for patients post Allo-HSCT.

PURPOSE: The purpose of this study is to determine if Allo-HSCT patients who receive steroids as part of their treatment at Nebraska Medicine are being supplemented with vitamin D.

METHODS: A retrospective review of electronic medical records was used to determine if vitamin D supplementation was prescribed to patients who received steroids after undergoing Allo-HSCT and whether this had an impact on their bone health, including serum 25(OH)D levels, incidence of fractures/falls, DEXA scan results, and GVHD diagnosis. Inclusion criteria included adults who received Allo-HSCT from January 1, 2013 to December 31, 2014.

RESULTS: Out of 99 patients who underwent Allo-HSCT, 59 percent were prescribed steroids of > 5 mg/day of prednisone or equivalent for > 3 months, compared to 41 percent who were not. Vitamin D supplementation was significantly different between the two groups with 71 percent of the steroid group receiving vitamin D supplementation compared to 40 percent of the non-steroid group (p=0.004). Diagnosis of GVHD was also found to be statistically significant between groups with 90 percent of the steroid group compared to 71 percent of the non-steroid group (p=0.016). Mortality was found to be significantly higher in the non-steroid group compared to the steroid group (p=0.005).

CONCLUSION: This study found 71 percent of patients who received steroids of > 5 mg/day of prednisone or equivalent for > 3 months, received vitamin D supplementation. However, adequacy of vitamin D supplementation is still uncertain in this patient population.

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