{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:07:16Z","timestamp":1789168036161,"version":"build-2803163510"},"reference-count":67,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5\u00a0years after cancer therapy were assessed for the association between 25\u2010hydroxyvitamin D (25OHD) levels and BMD <jats:italic>Z<\/jats:italic>\u2010scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (\u226410\u00a0ng\/ml) found a significant association between 25OHD levels and BMD <jats:italic>Z<\/jats:italic>\u2010scores, while 25OHD as a continuous variable was not significantly associated with BMD <jats:italic>Z<\/jats:italic>\u2010scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2\u00a0studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3\u00a0studies) (very low quality evidence).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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 &lt;20\u00a0ng\/ml. Vitamin D\/calcium supplementation is recommended in children with low levels, to maintain levels \u226520\u00a0ng\/ml year\u2010long.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.4013","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T08:45:43Z","timestamp":1623228343000},"page":"4177-4194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4436-0089","authenticated-orcid":false,"given":"Jenneke E.","family":"van Atteveld","sequence":"first","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris E.","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Princess 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