Burden of vitamin d deficiency and bone health risk factors in persons with von Willebrand disease in Arkansas Free

Background: Vitamin D is an essential fat-soluble vitamin, and its deficiency can result in rickets in children and osteoporosis in adults. In the United States, vitamin D deficiency affects approximately 35% of adults and 15% of children. However, the prevalence of vitamin D deficiency (VDD) in persons with von Willebrand disease (PwVWD) in Arkansas is unknown and warrants investigation.

Objectives: This study aimed to determine the prevalence of VDD in PwVWD and identify additional risk factors for poor bone health in this population.

Methods: We conducted a retrospective chart review of PwVWD aged >5 years (both males and females) seen at the Arkansas Center for Bleeding Disorders between January 2021 and June 2025. Data were collected using a REDCap form and included demographic characteristics, vWD type, baseline vWD laboratory results, vitamin D levels, and prescriptions for vitamin D. Risk factors for osteoporosis included: HIV, hepatitis C, arthropathy, malignancy, endocrine or gastrointestinal disorders, early menopause, fracture history, chronic steroid or NSAID use, chemotherapy, immunosuppressant use, obesity, hypertension, diabetes mellitus, smoking, and heavy alcohol use. Vitamin D deficiency was defined as a 25-OH vitamin D level <20 ng/mL, and insufficiency (VDI) as 21–30 ng/mL.

Results: Among the 145 PwVWD included in the study, the median age was 18 years (range 5–69), with Type 3 participants being younger (median 11 years). The cohort was predominantly female (69.7%), particularly among those with Type 1 vWD. Vitamin D levels were between 0–10 ng/mL in 6.9% of participants, while 39.3% had levels between 11–20 ng/mL, and 35.2% between 21–30 ng/mL. The prevalence of VDD was 46.9% in Type 1 (including 1C), 30% in Type 2 (2A and 2B), and 60% in Type 3. Regarding risk factors for poor bone health, 31.7% had none, 39.3% had one, and 11.7% had three or more, with all individuals having four or more risk factors belonging to the Type 1 group. The small numbers in some vWD subtypes (e.g., Type 2B and 1C) limit interpretation of subgroup-specific trends.

Conclusion: This study highlights the high prevalence of VDD and the presence of multiple risk factors for poor bone health among PwVWD, regardless of disease severity. Given the well-documented high prevalence of osteoporosis and fractures in individuals with hemophilia, and recent reports indicating similar trends in PwVWD, addressing VDD in this population is essential. These findings underscore the importance of early bone health assessment and targeted interventions to mitigate long-term skeletal complications in individuals with vWD.