中国学者登上JAMA:补钙及维生素D未能预防老年人骨折

12月26日,世界顶级医学期刊《JAMA》刊登了天津医院骨科的系统综述文章,探究了补钙及维生素D是否有助于预防社区老年人骨折。目前中国学者以第一或通讯作者在JAMA上发表的论著仅20篇左右,使我国在该领域的研究向世界更推进了一步。下面来具体了解下这项研究。

研究意义:在全世界范围内,骨质疏松引起的骨折给社会经济造成了重大复旦,使得预防骨折损伤成为重要的公共卫生问题。前期研究在补钙、维生素D或同时补充两者对预防老年人骨折发生率方面存在争议。


研究目的:探究补充钙剂、维生素D或同时补充两者是否能降低社区老年人骨折发生率。


研究项目筛选:比较补充钙剂、维生素D或同时补充两者对比安慰剂或无治疗在50岁以上社区老年患者骨折发生率影响的随机临床试验。


数据提取与整合:两名研究者独立进行数据提取并检验研究质量。患病风险以随机模型中风险比(RRs)、绝对风险差异(ARDs)和95%置信区间(95% CIs)评估。


研究结果:总共33项临床试验,共51145名受试者被纳入本项研究。补充钙剂、维生素D对比安慰剂与髋关节骨折发生率无显著相关性(钙剂: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; 维生素D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01])。同时补充钙剂和维生素D对比安慰剂与髋关节骨折发生率也无显著相关性(RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00])。补充钙剂、维生素D或同时补充两者对比安慰剂与非椎骨、椎骨和总骨折发生率无显著相关性。亚组分析结果与该结论相同,与补钙和补维生素D剂量、性别、骨折病史、每日钙摄入、血浆25-羟维生素D浓度均无关。


研究结论:在这项对随机临床实验的meta分析中,补充钙剂、维生素D或同时补充两者对比安慰剂或未治疗组并无显著降低社区老年患者骨折发生率的作用。这一研究结论不能支持对社区老年患者常规使用这些营养补充剂的意义。


摘要原文:

Importance  The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.


Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.


Study Selection  Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.


Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.


Results  A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.


Conclusions and Relevance  In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.


Reference: Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older AdultsA Systematic Review and Meta-analysis


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