Efficacy of vitamin D3 supplementation in preventing fractures in elderly women: A meta-analysis
Efficacy of vitamin D3 supplementation in preventing fractures in elderly women: A meta-analysis
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DOI：
10.1185/03007991003659814
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发表时间：
2010-05-01
影响因子：
2.3
通讯作者：
Sen, Shuvayu S.
中科院分区：
文献类型：
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作者：
Bergman, Gert J. D.;Fan, Tao;Sen, Shuvayu S.
背景：维生素 D-3 在预防骨折和跌倒方面的功效已在多项临床试验中得到探索。然而，最近的证据揭示了关于补充维生素 D-3 的足够剂量及其在独立于钙补充剂的各种类型骨折预防骨折方面的功效的新问题。目的：进行荟萃分析，估计每天补充 800 IU 维生素 D-3 对增加绝经后妇女骨密度 (BMD) 和预防骨折的有效性。方法：检索 Medline 和 EMBASE 比较胆钙化醇（维生素）有效性的对照试验D-3) 与安慰剂对照，在治疗绝经后妇女时补充或不补充钙。 结果：评估了 8 项对照试验，评估补充或不补充钙的维生素 D-3 的效果。贝叶斯荟萃分析纳入了 12658 名女性，其中 6089 名女性接受了维生素 D-3（含或不含钙），6569 名女性接受了安慰剂（含或不含钙）。与安慰剂相比，补充钙的维生素 D3 对非脊椎骨折（比值比 [OR] 0.77，95% 可信限 [CL] 0.6-0.93）和髋部骨折（OR 0.70，95% CL 0.53-0.90）的发生率显示出有益的作用，同时对非脊椎非髋部骨折（OR 0.84，95% CL）也有影响。 0.67-1.04)% 点增加) 与更多的不确定性相关。在预防非椎体骨折、髋部骨折和非椎体、非髋部骨折方面，补充维生素 D-3 有 70% 的可能性比安慰剂更好。与补充钙相比，维生素 D-3 加钙可减少非椎骨骨折（OR 0.68，95% CL 0.43-1.01）和非椎骨、非髋部骨折（OR 0.64，95% CL 0.38-0.99），但不能减少髋部骨折（OR 1.03，95% CL 0.39-2.25）。该分析的主要局限性包括研究数量较少和研究人群的异质性。结论：该荟萃分析支持每天使用 800 IU 维生素 D3 来降低老年女性骨质疏松性非椎骨、髋部和非椎骨-非髋部骨折的发生率。对于非椎骨和非椎骨非髋部骨折，维生素 D-3 与钙的结合似乎比单独补充钙所获得的效果要好。
Background:The efficacy of vitamin D-3 in preventing fractures and falls has been explored in a number of clinical trials. However, recent evidence revealed new questions about the adequate doses of vitamin D-3 supplementation and its efficacy in fracture prevention independent of calcium supplements for various types of fractures.Objective:To conduct a meta-analysis to estimate the effectiveness of 800 IU daily vitamin D-3 supplementation for increasing bone mineral density (BMD) and preventing fractures in postmenopausal women.Methods:Medline and EMBASE were searched for controlled trials comparing the effectiveness of cholecalciferol (vitamin D-3) against placebo with or without background calcium supplementation in the treatment of postmenopausal women.Results:Eight controlled trials evaluating the effect of vitamin D-3 supplementation with or without calcium were assessed. Of 12 658 women included in a Bayesian meta-analysis, 6089 received vitamin D-3 (with or without calcium) and 6569 received placebo (with or without calcium). Compared to placebo, vitamin D3 with calcium supplementation showed beneficial effects on the incidence of non-vertebral (odds ratio [OR] 0.77, 95% credibility limit [CL] 0.6-0.93) and hip (OR 0.70, 95% CL 0.53-0.90) fractures, while the effects on non-vertebral-non-hip fractures (OR 0.84, 95% CL 0.67-1.04) % point increase) were associated with more uncertainty. Vitamin D-3 supplementation showed a 70% probability of being a better treatment than placebo for the prevention of non-vertebral fractures, hip fractures, and non-vertebral, non-hip fractures. Compared to calcium supplementation, vitamin D-3 plus calcium reduced non-vertebral fractures (OR 0.68, 95% CL 0.43-1.01) and non-vertebral, non-hip fractures (OR 0.64, 95% CL 0.38-0.99), but did not reduce hip fractures (OR 1.03, 95% CL 0.39-2.25). Key limitations to this analysis include a small number of studies and heterogeneity in the study populations.Conclusions:This meta-analysis supports the use of vitamin D3 of 800 IU daily to reduce the incidence of osteoporotic non-vertebral, hip, and non-vertebral-non-hip fractures in elderly women. Vitamin D-3 with calcium appears to achieve benefits above those attained with calcium supplementation alone for non-vertebral and non-vertebral-non-hip fractures.