Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis

  • Review
  • Intervention

Authors


Abstract

Background

Vitamin D and related compounds have been used to prevent osteoporotic fractures in older people.

Objectives

To determine the effects of vitamin D or related compounds, with or without calcium, for preventing fractures in older people.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, CINAHL, and reference lists of articles. Most recent search: October 2007.

Selection criteria

Randomised or quasi-randomised trials comparing vitamin D or related compounds, alone or with calcium, against placebo, no intervention, or calcium alone, reporting fracture outcomes in older people.

Data collection and analysis

Two authors independently assessed trial quality, and extracted data. Data were pooled, where admissible, using the fixed-effect model, or random-effects model if heterogeneity between studies appeared high.

Main results

Forty-five trials were included.

Vitamin D alone appears unlikely to be effective in preventing hip fracture (nine trials, 24,749 participants, RR 1.15, 95% CI 0.99 to 1.33), vertebral fracture (five trials, 9138 participants, RR 0.90, 95% CI 0.42 to 1.92) or any new fracture (10 trials, 25,016 participants, RR 1.01, 95% CI 0.93 to 1.09).

Vitamin D with calcium reduces hip fractures (eight trials, 46,658 participants, RR 0.84, 95% CI 0.73 to 0.96). Although subgroup analysis by residential status showed a significant reduction in hip fractures in people in institutional care, the difference between this and the community-dwelling subgroup was not significant (P = 0.15).

Overall hypercalcaemia is significantly more common in people receiving vitamin D or an analogue, with or without calcium (18 trials, 11,346 participants, RR 2.35, 95% CI 1.59 to 3.47); this is especially true of calcitriol (four trials, 988 participants, RR 4.41, 95% CI 2.14 to 9.09). There is a modest increase in gastrointestinal symptoms (11 trials, 47,042 participants, RR 1.04, 95% CI 1.00 to 1.08, P = 0.04) and a small but significant increase in renal disease (11 trials, 46,537 participants, RR 1.16, 95% CI 1.02 to 1.33).

Authors' conclusions

Frail older people confined to institutions may sustain fewer hip fractures if given vitamin D with calcium. Vitamin D alone is unlikely to prevent fracture. Overall there is a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D or its analogues. Calcitriol is associated with an increased incidence of hypercalcaemia.

摘要

背景

維生素 D和維生素 D類似物預防與更年期和停經後骨質疏鬆症有關之骨折

維生素 D和相關化合物已被用來防止老年人骨質疏鬆性骨折。

目標

要確定維生素 D或相關的化合物,有或沒有鈣,在預防老年人骨折的功效。

搜尋策略

我們檢索了Cochrane骨,關節和肌肉創傷組專門登記冊,Cochrane中心對照試驗註冊庫(Cochrane圖書館 2007年第3期),MEDLINE,EMBASE,CINAHL,以及參考文獻目錄的文章。最近搜索:2007年10月。

選擇標準

老年人骨折的結果報告中,隨機或半隨機試驗比較維生素 D或相關的化合物,單獨或與鈣一起服用,對比安慰劑,不作為,或單獨使用鈣。

資料收集與分析

兩位作者獨立評估試驗質量,並提取數據。匯集可採納的數據,如果出現之間的異質性高即採用固定效應模型或隨機效應模型研究。

主要結論

45個試驗被納入。 單獨使用維生素 D似乎不太可能有效預防髖部骨折(9項試驗,24749參與者,RR 1.15,95%CI為 0.99至1.33),腰椎骨折(5項試驗,9138參與者,RR 0.90,95%CI為 0.42至1.92)或任何新的骨折(10次試驗,25016參與者,RR 1.01,95%CI為 0.93至1.09)。 維生素 D與鈣降低髖部骨折(8個試驗,46658參與者,RR 0.84,95%CI為 0.73至0.96)。儘管按居住形式的亞分組分析顯示,住在安養機構的人比住在社區的人顯著減少髖部骨折,但這差異不顯著(P = 0.15)。 總體來說高鈣血症明顯較常發生在服用維生素 D或類似物的人,不管有沒有服用鈣(18試驗,11346參與者,RR 2.35,95%CI為 1.59至3.47),這現象在使用鈣三醇的人尤其明顯(四項試驗,988參與者,RR 4.41,95%CI為2.14 至 9.09)。胃腸道症狀略為增加(11項試驗,47042參與者,RR 1.04,95%CI為 1.00至1.08,P = 0.04),小量卻明顯增加腎臟疾病(11項試驗,46537參與者,RR 1.16,95%CI為1.02至 1.33)。

作者結論

住在安養機構年老體弱的人如果服用維生素 D與鈣可以維持較少的髖部骨折。單是服用維生素 D不太可能預防骨折。整體而言,服用維生素 D或其類似物後,胃腸道症狀和腎臟疾病小幅卻症狀明顯地增加。鈣三醇與高鈣血症發病率上升相關聯。

翻譯人

本摘要由臺灣大學附設醫院何京澤翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

維生素 D對於生成骨頭是必要的。老年人因為缺乏暴露在陽光下和低膳食攝入量,往往維生素 D不足。因此有人提出,採取額外補充維生素 D可能有助於降低老年人常見的髖關節和其他骨折之風險。 這項審查包括45個試驗與 84585參與者。審查發現,單獨服用維生素 D不能防止骨折。服用維生素 D加上鈣補充劑確實降低安養機構住民髖部骨折的風險。雖然服用維生素 D和鈣出現不良反應的風險小,有些人,特別是腎結石,腎臟病或高血鈣的人,應尋求醫生意見才服用這些補充劑。

Plain language summary

Vitamin D and related vitamin D compounds for preventing fractures resulting from osteoporosis in older people.

Vitamin D is necessary for building bone. Older people often have low vitamin D levels through lack of exposure to sunlight and low dietary intake. Therefore, it has been suggested that taking additional vitamin D supplements may help to reduce the risk of hip and other fractures, which are very common in older people.

This review included 45 trials with 84,585 participants. The review found that taking vitamin D alone is unlikely to prevent fracture. Vitamin D taken with additional calcium supplements does appear to reduce risk of hip fractures in people living in institutional care. Although the risk of harmful effects from vitamin D and calcium is small, some people, particularly with kidney stones, kidney disease or high blood calcium, should seek medical advice before taking these supplements.

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