Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials.
Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials.
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DOI：
10.1210/clinem/dgab742
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发表时间：
2022-02-17
期刊：
影响因子：
--
通讯作者：
El-Hajj Fuleihan G
中科院分区：
文献类型：
--
作者：
Chakhtoura M;Bacha DS;Gharios C;Ajjour S;Assaad M;Jabbour Y;Kahale F;Bassatne A;Antoun S;Akl EA;Bouillon R;Lips P;Ebeling PR;El-Hajj Fuleihan G
越来越多的关于维生素D（±钙）预防骨折的系统综述/荟萃分析（SR/MAs）导致了相互矛盾的指南。本综述旨在评估质量，并探讨补充维生素D降低成人骨折风险试验的SR/ ma差异的原因。我们检索了4个数据库（2010-2020）、Epistemonikos和收录的SRs/MAs的参考文献，并联系了该领域的专家。我们使用A MeaSurement Tool to evaluate systematic Reviews 2 （AMSTAR-2）进行质量评估。我们使用矩阵和亚组分析（PROSPERO注册号：CRD42019129540）比较了结果并调查了不一致的原因。与安慰剂/对照组相比，我们纳入了13名服用维生素D和钙（Ca/D）的SR/MAs和19名单独服用维生素D的SR/MAs。Ca/D上10个sr / ma中只有2个质量中等。Ca/D降低了12例SR/MAs中8例髋部骨折的风险（相对危险度[RR] 0.61-0.84）， 11例SR/MAs中7例髋部骨折（相对危险度[RR] 0.74-0.95）。与安慰剂/对照组相比，单独评估社区居民的SRs/MAs或单独服用维生素D的人没有发现骨折风险降低。SRs/MAs之间结果的不一致源于纳入了不同的试验，与检索期和资格标准有关，以及不同的方法（使用意向治疗、协议或单个试验的完整病例分析）。Ca/D可以降低髋部骨折和任何骨折的风险，这可能是由住院患者的研究结果推动的。有足够随访期的Ca/D患者的个体参与者数据荟萃分析和亚组分析将揭示补充剂有益反应的决定因素。
The growing number of systematic reviews/meta-analyses (SR/MAs) on vitamin D (± calcium) for fracture prevention has led to contradictory guidelines. This umbrella review aims to assess the quality and explore the reasons for the discrepancy of SR/MAs of trials on vitamin D supplementation for fracture risk reduction in adults. We searched 4 databases (2010-2020), Epistemonikos, and references of included SRs/MAs, and we contacted experts in the field. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) for quality assessment. We compared results and investigated reasons for discordance using matrices and subgroup analyses (PROSPERO registration: CRD42019129540). We included 13 SR/MAs on vitamin D and calcium (Ca/D) and 19 SR/MAs on vitamin D alone, compared to placebo/control. Only 2 from 10 SRs/MAs on Ca/D were of moderate quality. Ca/D reduced the risk of hip fractures in 8 of 12 SRs/MAs (relative risk [RR] 0.61-0.84), and any fractures in 7 of 11 SR/MAs (RR 0.74-0.95). No fracture risk reduction was noted in SRs/MAs exclusively evaluating community-dwelling individuals or in those on vitamin D alone compared to placebo/control. Discordance in results between SRs/MAs stems from inclusion of different trials, related to search periods and eligibility criteria, and varying methodology (using intention to treat, per-protocol, or complete case analysis from individual trials). Ca/D reduces the risk of hip and any fractures, possibly driven by findings from institutionalized individuals. Individual participant data meta-analyses of patients on Ca/D with sufficient follow-up periods, and subgroup analyses, would unravel determinants for a beneficial response to supplementation.
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影响因子：
3.3
作者：
Cesari M;Incalzi RA;Zamboni V;Pahor M
通讯作者：
Pahor M
影响因子：
2.3
作者：
Bergman, Gert J. D.;Fan, Tao;Sen, Shuvayu S.
通讯作者：
Sen, Shuvayu S.
影响因子：
105.7
作者：
Abrahamsen, B.;Masud, T.;Francis, R. M.
通讯作者：
Francis, R. M.
DOI：
10.1136/bmj.h4580
发表时间：
2015-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bolland MJ;Leung W;Tai V;Bastin S;Gamble GD;Grey A;Reid IR
通讯作者：
Reid IR
DOI：
10.1191/1740774504cn053oa
发表时间：
2004-01-01
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Avenell, Alison;Grant, Adrian M;McGee, Magnus A
通讯作者：
McGee, Magnus A