Vitamin D: What is an adequate vitamin D level and how much supplementation is necessary?
Vitamin D: What is an adequate vitamin D level and how much supplementation is necessary?
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DOI：
10.1016/j.berh.2009.09.005
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发表时间：
2009-12-01
影响因子：
5.2
通讯作者：
Bischoff-Ferrari, Heike
中科院分区：
文献类型：
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作者：
Bischoff-Ferrari, Heike
强有力的证据表明，美国和欧洲的许多或大多数成年人将受益于维生素D补充剂，以预防骨折和跌倒，并可能达到其他公共卫生目标，如心血管健康，糖尿病和癌症。本文综述了维生素D补充剂的需要量和理想的25-羟基维生素D水平达到最佳的肌肉骨骼health.Vitamin D调制骨折风险在两个方面：通过减少福尔斯和增加骨密度。最近两项双盲随机对照试验的荟萃分析得出结论，维生素D可降低福尔斯风险19%，髋部骨折风险18%，任何非椎骨骨折风险20%;然而，这种益处是剂量依赖性的。跌倒预防仅在每天至少700 IU维生素D的试验中观察到，骨折预防需要每天超过400 IU维生素D的接受剂量（治疗剂量 * 依从性）。抗跌倒功效始于达到至少60 nmol l（-1）的25-羟基维生素D水平（24 ng ml（-1））和抗骨折疗效开始与实现至少75 nmol l（-1）的25-羟基维生素D水平（30 ng ml-1），两个终点随着25-羟基维生素D水平的提高而进一步改善。根据来自一般老年人群的数据，维生素D补充剂应每天至少700-1000 IU，并保持良好的依从性，以满足预防跌倒和骨折的需要。理想情况下，25-羟基维生素D的目标范围应至少为75 nmol l（-1），这可能需要超过700-1000 IU的维生素D严重缺乏或超重的个体。(C)2009爱思唯尔有限公司版权所有。
Strong evidence indicates that many or most adults in the United States and Europe Would benefit from vitamin D supplements with respect to fracture and fall prevention, and possibly other public health targets, Such as cardiovascular health, diabetes and cancer. This review discusses the amount of vitamin D Supplementation needed and a desirable 25-hydroxyvitamin D level to be achieved for optimal musculoskeletal health.Vitamin D modulates fracture risk in two ways: by decreasing falls and increasing bone density. Two most recent meta-analyses of double-blind randomised controlled trials came to the Conclusion that vitamin D reduces the risk of falls by 19%, the risk of hip fracture by 18% and the risk of any non-vertebral fracture by 20%; however, this benefit was dose dependent. Fall prevention was only observed in a trial of at-least 700 IU vitamin D per day, and fracture prevention required a received dose (treatment dose*adherence) of more than 400 IU vitamin D per day. Anti-fall efficacy started with achieved 25-hydroxyvitamin D levels of at least 60 nmol l(-1) (24 ng ml(-1)) and anti-fracture efficacy started with achieved 25-hydroxyvitamin D levels of at least 75 nmol l(-1) (30 ng ml-1) and both endpoints improved further with higher achieved 25-hydroxyvitamin D levels.Founded on these evidence-based data derived from the general older population, vitamin D supplementation should be at least 700-1000 IU per day and taken with good adherence to cover the needs for both fall and fracture prevention. Ideally, the target range for 25-hydroxyvitamin D should be at least 75 nmol l(-1), which may need more than 700-1000 IU vitamin D in individuals with severe vitamin D deficiency or those overweight. (C) 2009 Elsevier Ltd. All rights reserved.