Supplementation of Vitamin D3 and Calcium Carbonate to Improve Bone Density Development of Adolescent Living with HIV
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on April 3rd, 2026
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With the mass adoption of antiretroviral therapy in developing nations, the mortality rate in adolescents due to HIV infection had significantly decreased. However, adolescents affected HIV still experience detrimental suppression of musculoskeletal growth and development. A study, recently published in the Lancet, had examined the usage of calcium carbonate and vitamin D supplementation to enhance bone health in adolescents living with HIV.
Funding Source(s): European Developing Country Clinical Trials Partnership
The phase 3 clinical study was conducted in Zambia and Zimbabwe, and it included 842 participants with an average age of 15 years old who had been infected with HIV perinatally. All of the participants were treated with some form of antiretroviral therapy, with dolutegavir-based therapy being the most commonly used by around 80% of the patients. Protease inhibitor-based and NNRTI-based therapy was less commonly used by only around 10% of the cohort, respectively. These treatments were effective with the patients having an average CD4 cell count of around 568 cells per cubic millimeter, and around two-third of the patients have less than 60 HIV viral copies per mL of blood.
Bone density assessment of the participants with dual-energy X-ray absorptiometry showed a mean baseline TBLH-BMD Z score, which compared the total body bone mineral density - excluding the head - to the average population, to be around -1.64. The same method was used to determine the lumbar spine bone mineral density (LS-BMAD) Z score to be approximately -0.78. Physical assessment found that the maximal grip strength to be 29 kg, and maximal jump distance to be around 146 cm.
The patients were randomly assigned to be treated with either placebo or a combination of oral vitamin D3 and calcium carbonate. Vitamin D3 was given weekly at a dose of 20,000 IU, and calcium carbonate was given daily at a dose of 500 mg. After 48 weeks of treatment, the researchers found that there was no significant difference in bone mineral density or physical capabilities between patients supplemented with vitamin D3 plus calcium carbonate and patients treated with placebo. This lack of difference is consistent regardless of the participant’s sex, baseline 25(OH)D concentration, or dietary calcium intake. Since skeletal development is a long term process that happens between the age of 11 and 19 years old, the researchers noted that long term supplementation might lead to cumulative skeletal gains to improve peak bone mass.
Funding Source(s): European Developing Country Clinical Trials Partnership
The phase 3 clinical study was conducted in Zambia and Zimbabwe, and it included 842 participants with an average age of 15 years old who had been infected with HIV perinatally. All of the participants were treated with some form of antiretroviral therapy, with dolutegavir-based therapy being the most commonly used by around 80% of the patients. Protease inhibitor-based and NNRTI-based therapy was less commonly used by only around 10% of the cohort, respectively. These treatments were effective with the patients having an average CD4 cell count of around 568 cells per cubic millimeter, and around two-third of the patients have less than 60 HIV viral copies per mL of blood.
Bone density assessment of the participants with dual-energy X-ray absorptiometry showed a mean baseline TBLH-BMD Z score, which compared the total body bone mineral density - excluding the head - to the average population, to be around -1.64. The same method was used to determine the lumbar spine bone mineral density (LS-BMAD) Z score to be approximately -0.78. Physical assessment found that the maximal grip strength to be 29 kg, and maximal jump distance to be around 146 cm.
The patients were randomly assigned to be treated with either placebo or a combination of oral vitamin D3 and calcium carbonate. Vitamin D3 was given weekly at a dose of 20,000 IU, and calcium carbonate was given daily at a dose of 500 mg. After 48 weeks of treatment, the researchers found that there was no significant difference in bone mineral density or physical capabilities between patients supplemented with vitamin D3 plus calcium carbonate and patients treated with placebo. This lack of difference is consistent regardless of the participant’s sex, baseline 25(OH)D concentration, or dietary calcium intake. Since skeletal development is a long term process that happens between the age of 11 and 19 years old, the researchers noted that long term supplementation might lead to cumulative skeletal gains to improve peak bone mass.