Where do we stand on vitamin D?
Where do we stand on vitamin D?
复制标题
DOI：
10.1016/j.bone.2007.03.010
复制
发表时间：
2007-07-01
期刊：
影响因子：
4.1
通讯作者：
Dawson-Hughes, Bess
中科院分区：
文献类型：
--
作者：
Bischoff-Ferrari, Heike Annette;Dawson-Hughes, Bess
2005年发表的一项对一级预防高质量试验的荟萃分析发现，与安慰剂相比，口服胆钙化醇（D3）每日剂量为700-800 IU或间歇性每4个月100，000 IU（含或不含钙）应显著降低髋部和非椎骨骨折风险。服用400 IU维生素D的试验没有达到骨折疗效。值得注意的是，治疗组中达到的较高25-羟基维生素D水平（25（OH）D）与骨折疗效之间存在显著相关性：观察到骨折疗效的最小平均水平为74 nmol/l（25（OH）D）。骨密度和下肢力量的流行病学数据支持这一阈值，使用700至800 IU D3的高质量试验表明，在机构和社区居住的老年人中，跌倒风险降低了35至65%，然而，自2005年荟萃分析以来，维生素D对骨折和跌倒减少的益处受到了最近几项试验结果的质疑。这篇综述提出，这些最近的试验的解释受到不同剂量的维生素D，不同类型的补充维生素D（D3或麦角钙化醇D2），低依从性，同时使用研究方案外的补充剂，开放性研究设计，短期随访和/或不同的患者风险特征（包括初级和二级骨折预防）的阻碍。在最近的试验中，低依从性、使用相对较弱的D2或剂量过低的D3（400 IU）可能会阻止治疗组中（25（OH）D）水平向至少75 nmol/l的理想范围的转变。总之，从最近的试验中，可以学到两个教训：（1）每日800 IU D3加钙的依从性低于60%不足以达到骨折疗效，（2）任何应用或任何先前研究的剂量的D2可能不会减少机构或社区居住的老年人的骨折。(C)2007年由Elsevier Inc.出版
A meta-analysis of primary prevention high-quality trials published in 2005 found that oral cholecalciferol (D3) in a daily dose of 700-800 IU or intermittently 100,000 IU every 4 months with or without calcium, should reduce both hip and non-vertebral fracture risk significantly compared to placebo. Trials that administered 400 IU vitamin D did not achieve fracture efficacy. Notably, there was a significant association between higher achieved 25-hydroxyvitamin D levels (25(OH)D) in the treatment groups and fracture efficacy: The minimal mean level where fracture efficacy was observed was 74 nmol/1 (25(OH)D). Epidemiological data for bone density and lower extremity strength support this threshold, and high-quality trials that used 700 to 800 IU D3 suggested fall risk reduction by 35 to 65% in institutionalized and community-dwelling older individuals.However, since the 2005 meta-analysis, benefits of vitamin D on fracture and fall reduction have been questioned by results from several recent trials. This review proposes that the interpretation of these recent trials is hindered by different doses of vitamin D, different types Of supplemental vitamin D (D3 or ergocalciferol D2), low adherence, concurrent use of supplements outside the study protocol, open study design, short follow-up, and/or different patient risk profiles including primary and secondary fracture prevention. In most recent trials, low adherence, the use of the relatively less potent D2, or a too low dose of D3 (400 IU) may have prohibited a shift of (25(OH)D) levels in the treatment groups to the desirable range of at least 75 nmol/l. In summary, from recent trials, two lesson may be learned: (1) Adherence less than 60% is insufficient to achieve fracture efficacy with daily 800 IU D3 plus calcium, (2) D2 in any application or any previously Studied dose may not reduce fractures in institutionalized or community-dwelling older individuals. (C) 2007 Published by Elsevier Inc.