A new study suggests that giving adolescents living with HIV high-dose vitamin D and calcium supplements can significantly improve bone density and lower the risk of fractures. The findings highlight a low-cost, practical intervention to address an often-overlooked complication of HIV in young people.
Large Trial Conducted in Southern Africa
Researchers enrolled 842 adolescents aged 11 to 19 years from HIV clinics in Harare, Zimbabwe, and Lusaka, Zambia. All participants were aware of their HIV status and were receiving antiretroviral therapy. The trial focused on adolescents, a critical period for bone development and long-term skeletal health.
Among participants with insufficient vitamin D levels, the study found that bone mineral apparent density in the spine increased by 41% more over one year in those who received supplements compared with those who did not. Importantly, researchers estimated that supplementation reduced fracture risk by around 10% within one year, with the potential for greater benefits over time.
International Collaboration and Publication
An international research consortium led the trial, including the London School of Hygiene & Tropical Medicine, the Biomedical Research and Training Institute in Zimbabwe, University Teaching Hospital Lusaka in Zambia, and universities in Bristol and Oxford, along with Research Centre Borstel in Germany. The team published the findings in The Lancet Child & Adolescent Health.
Why Bone Health Matters in Adolescents with HIV
HIV can negatively affect physical development in children and adolescents. It can stunt growth, delay puberty, reduce muscle mass, and lower bone density, all of which increase the risk of fractures. Consequently, protecting bone health during adolescence is essential to prevent long-term complications.
Testing a Practical, Low-Cost Intervention
Building on evidence from high- and middle-income countries, the researchers tested whether supplementation could work in African settings, where dietary vitamin D intake is often lower and nearly 90% of children living with HIV reside. Participants received a weekly high dose of vitamin D (20,000 international units) along with a daily dose of calcium carbonate (500 mg).
The team administered the supplements as chewable tablets over 48 weeks as part of a randomized, double-blind, placebo-controlled trial. Using dual-energy X-ray absorptiometry scans, researchers measured changes in spinal bone density with precision.
Experts Highlight Long-Term Benefits
Professor Rashida Ferrand, chief investigator of the VITALITY trial, emphasized that this is the first African study to demonstrate a safe, affordable, and feasible approach to reducing HIV-related bone damage during adolescence. She noted that improvements at this stage could deliver lifelong benefits.
Dr. Vicky Simms, a co-author, added that people reach peak bone mass in their early twenties. Therefore, adolescence offers a vital window to strengthen bones. This is especially important for young people living with HIV, whose vitamin D needs may be higher than those of their peers.
Implications for Public Health Practice
Overall, the study underscores the value of targeted nutritional supplementation as part of comprehensive HIV care for adolescents. By integrating vitamin D and calcium into routine treatment, health systems may reduce fracture risk. This approach can also improve the long-term quality of life for young people living with HIV.