Calcium and vitamin D status in Lupus children in Jakarta, Indonesia

Background and Aims: Osteopenia and subsequent osteoporosis are complications faced by children living with lupus on steroid therapy. Calcium and vitamin D have been embedded in the management protocol early in therapy. Aim To evaluate calcium and vitamin D level in children with lupus. Methods Lupus patient recruited if their age 5–18 years old, on steroid therapy at least 5 month. Lupus diagnosis, follow up record and SLEDAI score were retrieved from medical record. Subjects have DXA-scanning to determine bone density and plasma level for 25-hydroxyvitamin D and calcium at the latest visit. Daily intake of calcium and vitamin D was determined from 3 day food diary.Results There were 16 patient included, 14 were girls and average age 13.3 years. Duration of steroid use was 27.75+17.4 month with the last SLEDAI score of mild and moderate flare on 9 subjects. Subjects received 400 mg calcium and vitamin D3 200 IU (5 mcg) daily. Average Calcium intake was 587.58+213.29 mg (RDA 1300 mg/day) and vitamin D 2.9 mcg daily(RDA 15 mcg/day). Plasma level of 25-OHD was 19.3+5.4 ng/ml (normal level 36–108) and calcium was 8.69+0.5 mg/dl (normal level 8.5–10.2). DXA results showed 7 subjects with Z-score lumbal <−2.0 and mean Z-score −1.75+1.24. Conclusions Our paediatric Lupus patient showed low plasma level of calcium and vitamin D. Current supplementation should be increased 2 times to achieve relevant RDA and maintaining normal bone density.