Effects of vitamin D and calcium supplementation on falls:: A randomized controlled trial
Effects of vitamin D and calcium supplementation on falls:: A randomized controlled trial
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DOI：
10.1359/jbmr.2003.18.2.343
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发表时间：
2003-02-01
影响因子：
6.2
通讯作者：
Conzelmann, M
中科院分区：
文献类型：
--
作者：
Bischoff, HA;Stähelin, HB;Conzelmann, M
维生素 D 的特异性受体已在人体肌肉组织中被发现。横断面研究表明，血清维生素 D 水平较高的老年人肌肉力量增强，跌倒次数较少。我们假设补充维生素 D 和钙可以改善肌肉骨骼功能并减少跌倒。在一项双盲随机对照试验中，我们研究了 122 名接受长期老年护理的老年妇女（平均年龄 85.3 岁；范围 63-99 岁）。在 12 周的治疗期内，参与者每天接受 1200 毫克钙加 800 IU 胆钙化醇（Cal+D 组；n = 62）或 1200 毫克钙（Cal 组；n = 60）。比较治疗组之间的每人跌倒次数（0、1、2-5、6-7、>7 次跌倒）。在意向治疗分析中，在控制年龄、6 周预处理期间的跌倒次数以及基线 25-羟基维生素 D 和 1,25-二羟基维生素 D 血清浓度后，使用泊松回归模型来比较跌倒情况。在治疗期间跌倒者中，比较治疗组之间的粗过度跌倒率（治疗-治疗前跌倒）。肌肉骨骼功能的变化（膝关节屈肌和伸肌力量、握力以及定时起立测试的总分）作为次要结果进行测量。在 Cal+D 组受试者中，血清 25-羟基维生素 D (+71%) 和 1,25-二羟基维生素 D (+8%) 中位数显着增加。治疗前，观察到的每人每周平均跌倒次数在 Cal+D 组中为 0.059 次，在 Cal-组中为 0.056 次。在 12 周的治疗期间，Cal+D 组每人每周平均跌倒次数为 0.034 次，Cal 组为 0.076 次。根据上述跌倒类别，调整后，Cal+D 治疗使跌倒次数减少了 49%（95% CI，14-71%；p < 0.01）。在治疗期间的跌倒者中，Cal 组的粗平均过度跌倒次数明显更高 (p = 0.045)。 Cal+D 组的肌肉骨骼功能显着改善 (p = 0.0094)。与单独使用钙剂相比，在 3 个月内使用维生素 D 加钙剂进行单次干预可将失败风险降低 49%。在这种短期干预中，经常跌倒的人似乎从治疗中受益最多。维生素 D 对跌倒的影响可能是通过观察到的肌肉骨骼功能的改善来解释的。
Specific receptors for vitamin D have been identified in human muscle tissue. Cross-sectional studies show that elderly persons with higher vitamin D serum levels have increased muscle strength and a lower number of falls. We hypothesized that vitamin D and calcium supplementation would improve musculoskeletal function and decrease falls. In a double-blind randomized controlled trial, we studied 122 elderly women (mean age, 85.3 years; range, 63-99 years) in long-stay geriatric care. Participants received 1200 mg calcium plus 800 IU cholecalciferol (Cal+D-group; n = 62) or 1200 mg calcium (Cal-group; n = 60) per day over a 12-week treatment period. The number of falls per person (0, 1, 2-5, 6-7, >7 falls) was compared between the treatment groups. In an intention to treat analysis, a Poisson regression model was used to compare falls after controlling for age, number of falls in a 6-week pretreatment period, and baseline 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D serum concentrations. Among fallers in the treatment period, crude excessive fall rate (treatment - pretreatment falls) was compared between treatment groups. Change in musculoskeletal function (summed score of knee flexor and extensor strength, grip strength, and the timed up&go test) was measured as a secondary outcome. Among subjects in the Cal+D-group, there were significant increases in median serum 25-hydroxyvitamin D (+71%) and 1,25-dihydroxyvitamin D (+8%). Before treatment, mean observed number of falls per person per week was 0.059 in the Cal+D-group and 0.056 in the Cal-group. In the 12-week treatment period, mean number of falls per person per week was 0.034 in the Cal+D-group and 0.076 in the Cal-group. After adjustment, Cal+D-treatment accounted for a 49% reduction of falls (95% CI, 14-71 %; p < 0.01) based on the fall categories stated above. Among fallers of the treatment period, the crude average number of excessive falls was significantly higher in the Cal-group (p = 0.045). Musculoskeletal function improved significantly in the Cal+D-group (p = 0.0094). A single intervention with vitamin D plus calcium over a 3-month period reduced the risk of failing by 49% compared with calcium alone. Over this short-term intervention, recurrent fallers seem to benefit most by the treatment. The impact of vitamin D on falls might be explained by the observed improvement in musculoskeletal function.