Quantitative analysis of efficacy and associated factors of calcium intake on bone mineral density in postmenopausal women
Quantitative analysis of efficacy and associated factors of calcium intake on bone mineral density in postmenopausal women
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DOI：
10.1007/s00198-017-3993-4
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发表时间：
2017-06-01
影响因子：
4
通讯作者：
Li, L.
中科院分区：
文献类型：
--
作者：
Wu, J.;Xu, L.;Li, L.
采用基于模型的荟萃分析方法定量分析钙摄入对绝经后妇女骨密度增加的疗效特征。我们发现年龄和钙摄入剂量是影响BMD改变效率和开始的关键因素，建议每日1200mg钙是有益的剂量。本文旨在量化钙摄入对绝经后妇女骨密度（BMD）下降的预防作用，并探讨可能影响其疗效的因素。从2016年1月开始在PubMed和EMBASE进行了全面的文献检索。本研究纳入了绝经后妇女骨质疏松症治疗中钙摄入的安慰剂对照或无治疗对照随机试验。从研究中提取受试者的临床和人口学特征以及疗效数据，定义为每个观察时间点与基线相比脊柱骨密度（L2-L4）的平均百分比变化。采用基于模型的meta分析（MBMA）描述钙摄入对骨密度变化的时间过程，并确定相关因素。本研究包括17项试验，涉及2537名受试者。结果表明，经典的药效学最大效应（E (max)）模型可以描述钙摄入对骨密度变化的时间过程。使用该模型，我们发现年龄和钙摄入剂量是影响BMD改变效率和开始的关键因素。一名60岁的女性服用800 mg/天的钙可达到最大骨密度增加率2.38%，达到该最大值50%的时间（称为发病时间）为9.44个月。50岁至83岁妇女的最大效应值每年增加0.0817%。钙剂量间隔为250 ~ 2000 mg/天，起效时间为9.44 ×（剂量/800）（-1.33）个月。两年的钙摄入量为700、1200和2000毫克/天，BMD的最大功效分别为68.0、81.3和89.6%。这表明在1200 mg/d剂量下，最终疗效已经达到平台期（> 80% E (max)）。钙的摄入可以有效延缓绝经后妇女骨密度下降的趋势。钙剂量的增加有助于缩短发病时间。考虑到药物作用率和安全性，绝经期妇女可合理用药1200mg /天，以减少骨质流失。
A model-based meta-analysis method was performed to quantitatively analyze the efficacy characteristics of calcium intake in BMD increase among postmenopausal women. We found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change, and daily 1200 mg calcium was suggested to be a beneficial dosage.This paper aims to quantify the efficacy of calcium intake in preventing bone mineral density (BMD) decrease among postmenopausal women and to investigate the factors that may affect the efficacy.Comprehensive literature search was conducted in PubMed and EMBASE from January 2016. Placebo-controlled or no-treatment controlled randomized trials focused on calcium intake for the management of osteoporosis in postmenopausal women were included. The clinical and demographic characteristics of participants and efficacy data, defined as the mean percentage change of spine BMD (L2-L4) at each observation time point compared with that of baseline, were extracted from the studies. Model-based meta-analysis (MBMA) was used to describe the time course of BMD change by calcium intake and identify the related factors.This study includes 17 trials involving 2537 subjects. The results showed that a classic pharmacodynamic maximal effect (E (max)) model could describe the time course of BMD change by calcium intake. Using this model, we found that age and calcium intake dose were key factors affecting the efficiency and onset of BMD change. A 60-year-old woman administered with 800 mg/day calcium can achieve a maximum BMD increasing rate of 2.38%, and the time to reach 50% of this maximum (known as onset time) was 9.44 months. An increase of 0.0817% per year was noted in the maximal effect value for women aged between 50 and 83 years. For calcium dose interval from 250 to 2000 mg/day, the onset time was expressed as 9.44 x (dose/800)(-1.33) months. Two-year calcium intake of 700, 1200, and 2000 mg/day resulted in a maximum efficacy of BMD of 68.0, 81.3, and 89.6%, respectively. This indicates that the final efficacy had already reached the plateau (> 80% E (max)) under the 1200-mg/day dose.Calcium intake can effectively postpone the tendency of BMD decrease in postmenopausal women. An increased calcium dose contributes to the shortening of the onset time. Considering the drug-acting rate and safety into account, menopausal women can be administered with a rational dose of 1200 mg/day to reduce bone loss.