Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies.
Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies.
复制标题
DOI：
10.1186/1471-2458-10-331
复制
发表时间：
2010-06-11
影响因子：
4.5
通讯作者：
Banks E
中科院分区：
文献类型：
--
作者：
Lai JK;Lucas RM;Clements MS;Roddam AW;Banks E
尽管相关随机对照试验（RCT）证据的解释相互矛盾，但补充维生素D预防骨折是普遍的。本研究定量总结了来自RCT和观察性研究的关于维生素D、甲状旁腺激素（PTH）和髋部骨折风险的现有证据。我们对检查维生素D补充和髋部骨折的RCT进行了单独的荟萃分析，并对血清维生素D状态（25-羟基维生素D（25（OH）D）水平），PTH和髋部骨折进行了观察性研究。使用报告的风险比/相对风险（RR）合并RCT结果。使用髋部骨折病例与对照组相比的25（OH）D和PTH测量值的比值，将病例对照研究的结果结合起来。通过PubMed和Web of Science数据库，检索参考文献列表和关键论文的转发引用，确定了维生素D，PTH和髋部骨折的原始发表研究。7项符合条件的随机对照试验显示，随机接受胆钙化醇或麦角钙化醇补充治疗的患者与安慰剂/对照组相比，髋部骨折风险无显著差异（RR = 1.13[95%CI 0.98-1.29]; 801例病例），<800 IU/d和≥800 IU/d的试验之间无显著差异。基于1903例病例，17项确定的病例对照研究发现，与对照组相比，病例组血清25（OH）D水平降低33%。与基于医院的对照相比，基于人群的研究中的这种差异显著更大（χ21（异质性）= 51.02，p < 0.001），总体上存在显著异质性（χ216（异质性）= 137.9，p < 0.001）。基于10项病例对照研究（905例），髋部骨折患者血清PTH水平与对照组无显著差异（χ29（异质性）= 149.68，p < 0.001）。补充较高或较低剂量的维生素D都不能预防髋部骨折。关于维生素D和髋部骨折的随机和观察数据似乎有所不同。其原因尚不清楚;一种可能的解释是观察性研究中的非受控混杂。骨折后PTH水平与髋部骨折风险无关。
Vitamin D supplementation for fracture prevention is widespread despite conflicting interpretation of relevant randomised controlled trial (RCT) evidence. This study summarises quantitatively the current evidence from RCTs and observational studies regarding vitamin D, parathyroid hormone (PTH) and hip fracture risk. We undertook separate meta-analyses of RCTs examining vitamin D supplementation and hip fracture, and observational studies of serum vitamin D status (25-hydroxyvitamin D (25(OH)D) level), PTH and hip fracture. Results from RCTs were combined using the reported hazard ratios/relative risks (RR). Results from case-control studies were combined using the ratio of 25(OH)D and PTH measurements of hip fracture cases compared with controls. Original published studies of vitamin D, PTH and hip fracture were identified through PubMed and Web of Science databases, searches of reference lists and forward citations of key papers. The seven eligible RCTs identified showed no significant difference in hip fracture risk in those randomised to cholecalciferol or ergocalciferol supplementation versus placebo/control (RR = 1.13[95%CI 0.98-1.29]; 801 cases), with no significant difference between trials of <800 IU/day and ≥800 IU/day. The 17 identified case-control studies found 33% lower serum 25(OH)D levels in cases compared to controls, based on 1903 cases. This difference was significantly greater in studies with population-based compared to hospital-based controls (χ21 (heterogeneity) = 51.02, p < 0.001) and significant heterogeneity was present overall (χ216 (heterogeneity) = 137.9, p < 0.001). Serum PTH levels in hip fracture cases did not differ significantly from controls, based on ten case-control studies with 905 cases (χ29 (heterogeneity) = 149.68, p < 0.001). Neither higher nor lower dose vitamin D supplementation prevented hip fracture. Randomised and observational data on vitamin D and hip fracture appear to differ. The reason for this is unclear; one possible explanation is uncontrolled confounding in observational studies. Post-fracture PTH levels are unrelated to hip fracture risk.
登录
查看更多内容
DOI：
10.1093/jnci/dji019
发表时间：
2005-02-02
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Berwick, M;Armstrong, BK;Barnhill, R
通讯作者：
Barnhill, R
影响因子：
158.5
作者：
Cummings, SR;Browner, WS;Ettinger, B
通讯作者：
Ettinger, B
DOI：
10.1093/gerona/54.9.m467
发表时间：
1999-09-01
影响因子：
5.1
作者：
Dubin, NH;Monahan, LK;Magaziner, J
通讯作者：
Magaziner, J
影响因子：
105.7
作者：
Abrahamsen, B.;Masud, T.;Francis, R. M.
通讯作者：
Francis, R. M.
影响因子：
4
作者：
COOPER, C;CAMPION, G;MELTON, LJ
通讯作者：
MELTON, LJ