Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis
Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis
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DOI：
10.1016/s0140-6736(07)61342-7
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发表时间：
2007-08-25
期刊：
影响因子：
168.9
通讯作者：
Bensoussan, Alan
中科院分区：
文献类型：
--
作者：
Tang, Benjamin M. P.;Eslick, Guy D.;Bensoussan, Alan
背景补充钙是否能减少骨质疏松性骨折尚不确定。我们做了一项荟萃分析，包括所有使用钙或钙与维生素D联合预防骨折和骨质疏松性骨丢失的随机试验。方法：我们使用电子数据库识别了29项随机试验（n=63897），并辅以手工检索参考文献列表、综述文章和会议摘要。所有招募50岁或以上人群的随机试验都符合条件。主要结果是所有类型的骨折和骨矿物质密度相对于基线的百分比变化。使用随机效应模型汇总数据。结果在报告骨折作为结局的试验中（17项试验，n=52625），治疗与所有类型骨折的风险降低12%相关（风险比0中心点88，95%CI 0中心点83中心点0中心点95; p=O中心点0004）。在报告骨矿物质密度作为结果的试验中，（23项试验，n= 41419），治疗与0中心点54%的骨丢失率降低相关（0个中心点35 -0个中心点73; p <0个中心点0001），1个中心点19%（0中心点76-1中心点61%; p <0中心点0001）。在依从率高的试验中，骨折风险降低显著（24%）（p <0. 0001）。钙剂量为1200 mg或更多时的治疗效果优于剂量小于1200 mg时的治疗效果（0中心点80对0中心点94; p= 0.006），维生素D剂量为800 IU或更多时的治疗效果优于剂量小于800 IU时的治疗效果（0中心点84对0中心点87; p= 0.03）。解释有证据支持在50岁或以上人群中使用钙或钙与维生素D补充剂联合用于预防性治疗骨质疏松症。为了获得最佳治疗效果，我们建议最低剂量为1200 mg钙和800 IU维生素D（用于联合钙和维生素D补充剂）。
Background Whether calcium supplementation can reduce osteoporotic fractures is uncertain. We did a meta-analysis to include all the randomised trials in which calcium, or calcium in combination with vitamin D, was used to prevent fracture and osteoporotic bone loss. Methods We identified 29 randomised trials (n=63897) using electronic databases, supplemented by a hand-search of reference lists, review articles, and conference abstracts. All randomised trials that recruited people aged 50 years or older were eligible. The main outcomes were fractures of all types and percentage change of bone-mineral density from baseline. Data were pooled by use of a random-effect model. Findings In trials that reported fracture as an outcome (17 trials, n=52625), treatment was associated with a 12% risk reduction in fractures of all types (risk ratio 0 center dot 88, 95% CI 0 center dot 83 center dot 0 center dot 95; p=O center dot 0004). In trials that reported bone-mineral density as an outcome (23 trials, n=41 419), the treatment was associated with a reduced rate of bone loss of 0 center dot 54% (0 center dot 3 5-0 center dot 73; p < O center dot 0001) at the hip and 1 center dot 19% (0 center dot 76-1 center dot 61%; p < O center dot 0001) in the spine. The fracture risk reduction was significantly greater (24%) in trials in which the compliance rate was high (p < O center dot 0001). The treatment effect was better with calcium doses of 1200 mg or more than with doses less than 1200 mg (0 center dot 80 vs 0 center dot 94; p=O.006), and with vitamin D doses of 800 IU or more than with doses less than 800 IU (0 center dot 84 vs 0 center dot 87; p=O.03). Interpretation Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation).