National Osteoporosis Society Vitamin D Guideline Summary
National Osteoporosis Society Vitamin D Guideline Summary
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DOI：
10.1093/ageing/afu093
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发表时间：
2014-09-01
期刊：
影响因子：
6.7
通讯作者：
Francis, Roger M.
中科院分区：
文献类型：
--
作者：
Aspray, Terry J.;Bowring, Claire;Francis, Roger M.
国家骨质疏松症协会 (NOS) 于 2013 年发布了文件《维生素 D 和骨骼健康：患者管理实用临床指南》，作为治疗患有骨病或有患骨病风险的成年患者维生素 D 缺乏症的实用临床指南。英国对于维生素D缺乏症的评估和治疗尚未达成明确共识，临床实践也不一致。本指南针对临床医生，包括医生、护士和营养师。它建议在以下临床情况下测量血清 25 (OH) 维生素 D (25OHD) 来估计维生素 D 状态：可通过维生素 D 治疗改善的骨病；骨骼疾病，在进行特定治疗之前，纠正维生素 D 缺乏症是适当的；可能由维生素 D 缺乏引起的肌肉骨骼症状。该指南还指出，如果已经计划通过口服抗吸收治疗补充维生素 D，则无需进行常规维生素 D 检测，并设定了以下血清 25OHD 阈值：50 nmol/l 足以满足几乎所有人群的需要。对于治疗，建议口服维生素 D3，当需要快速纠正维生素 D 缺乏时，建议口服固定负荷剂量的口服维生素 D3，然后定期维持治疗，但在纠正缺乏症不太紧急或与口服抗吸收剂合用时，不需要负荷剂量。为了进行监测，应在完成负荷方案后 1 个月或开始补充维生素 D 后检查血清钙（根据白蛋白进行调整），以防原发性甲状旁腺功能亢进症被发现。然而，血清 25OHD 的常规监测通常是不必要的，但对于有症状的维生素 D 缺乏或吸收不良以及怀疑药物依从性差的患者可能是适当的。该指南重点关注骨骼健康，因为尽管维生素 D 对免疫调节、癌症预防以及心血管疾病和多发性硬化症风险有许多假定的影响，但在这些情况下对骨骼外因素和最佳维生素 D 状态的评估仍存在相当大的争议。
The National Osteoporosis Society (NOS) published its document, Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management, in 2013 as a practical clinical guideline on the management of vitamin D deficiency in adult patients with, or at risk of developing, bone disease. There has been no clear consensus in the UK on vitamin D deficiency its assessment and treatment, and clinical practice is inconsistent. This guideline is aimed at clinicians, including doctors, nurses and dieticians. It recommends the measurement of serum 25 (OH) vitamin D (25OHD) to estimate vitamin D status in the following clinical scenarios: bone diseases that may be improved with vitamin D treatment; bone diseases, prior to specific treatment where correcting vitamin D deficiency is appropriate; musculoskeletal symptoms that could be attributed to vitamin D deficiency. The guideline also states that routine vitamin D testing is unnecessary where vitamin D supplementation with an oral antiresorptive treatment is already planned and sets the following serum 25OHD thresholds: 50 nmol/l is sufficient for almost the whole population. For treatment, oral vitamin D3 is recommended with fixed loading doses of oral vitamin D3 followed by regular maintenance therapy when rapid correction of vitamin D deficiency is required, although loading doses are not necessary where correction of deficiency is less urgent or when co-prescribing with an oral antiresorptive agent. For monitoring, serum calcium (adjusted for albumin) should be checked 1 month after completing a loading regimen, or after starting vitamin D supplementation, in case primary hyperparathyroidism has been unmasked. However, routine monitoring of serum 25OHD is generally unnecessary but may be appropriate in patients with symptomatic vitamin D deficiency or malabsorption and where poor compliance with medication is suspected.The guideline focuses on bone health as, although there are numerous putative effects of vitamin D on immunity modulation, cancer prevention and the risks of cardiovascular disease and multiple sclerosis, there remains considerable debate about the evaluation of extraskeletal factors and optimal vitamin D status in these circumstances.