Falls are associated with decreased renal function and insufficient calcitriol production by the kidney
Falls are associated with decreased renal function and insufficient calcitriol production by the kidney
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DOI：
10.1016/j.jsbmb.2006.12.082
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发表时间：
2007-03-01
影响因子：
4.1
通讯作者：
Smith, Lynette
中科院分区：
文献类型：
--
作者：
Gallagher, J. C.;Rapuri, Prema;Smith, Lynette
在一项为期3年的老年女性骨质疏松症双盲安慰剂对照研究中，我们收集了有关跌倒的前瞻性数据。研究人群包括489名65-77岁的正常老年妇女，随机分为四组：安慰剂组、骨化三醇0.25 mcg b.i.d组、结合马雌激素（0.625 mg/d）组和骨化三醇+雌激素组。57%的女性发生过跌倒。使用泊松回归模型，低gfr -肌酐清除率（CrCl < 60 ml/min）的安慰剂组比CrCl >= 60 ml/min的组多60%的跌倒。进一步的亚组分析显示，当CrCl浓度为60- 70,70 - 80,> - 90ml /min时，跌倒的风险没有增加。与低CrCl组的安慰剂相比，骨化三醇治疗显著减少了50%的跌倒次数（OR = 0.5, 95% CI: 0.4-0.9, p = 0.0 10）。CrCl降低组钙吸收降低（p < 0.001），血清1,25-二羟基维生素D (1,25（OH)(2)D）降低（p < 0.001），血清25OHD正常，提示衰老肾脏25OHD向1,25(OH)(2)D的转化减少。虽然不能排除骨化三醇对中枢神经系统的影响，但据推测，骨化三醇治疗的下降与血清1,25(OH)(2)D的增加、VDR的上调和肌肉力量的改善有关。(c) 2006 Elsevier Ltd.版权所有。
In a double blind placebo controlled 3-year osteoporosis study in elderly women, we collected prospective data on falls. The study population comprised 489 normal elderly women aged 65-77 years randomized to four groups: placebo, calcitriol 0.25 mcg b.i.d., conjugated equine estrogens (0.625 mg/day) and calcitriol + estrogen. Falls occurred in 57% of all women.Using a Poisson regression model, the placebo group with low GFR-creatinine clearance (CrCl < 60 ml/min) had 60% more falls compared to the group with CrCl >= 60 ml/min. Further sub group analyses showed that there is no increased risk of falls with CrCl 60-70, 70-80 and > 90 ml/min. Calcitriol treatment significantly reduced the number of falls by 50% (OR = 0.5, 95% CI: 0.4-0.9, p = 0.0 10) compared to placebo in the low CrCl group.The group with lower CrCl had lower calcium absorption (p < 0.001), lower serum 1,25-dihydroxyvitamin D (1,25(OH)(2)D) (P < 0.001) and normal serum 25OHD suggesting that there is decreased conversion of 25OHD to 1,25(OH)(2)D by the aging kidney. It is postulated that the decrease in falls on calcitriol therapy is related to an increase in serum 1,25(OH)(2)D, upregulation of VDR and improvement in muscle strength although one cannot exclude an effect on the central nervous system. (c) 2006 Elsevier Ltd. All rights reserved.