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JAMA Intern Med:绝经后女性不要再妄想通过补充维生素D来提高骨骼健康了

2015-10-11 崔倩 译 MedSci原创

目前专家对于肌肉骨骼健康的最佳25-羟基维生素D(25[OH]D)的水平还不能确定。该研究的目的是比较维生素D缺乏的绝经后女性服用安慰剂,低剂量,和高剂量维生素D3后对于总体钙的吸收1年的变化,骨密度,计时起立-行走和5次坐立试验,以及肌肉质量的1年变化。这项随机,双盲,安慰剂对照的临床试验在威斯康星州麦迪逊市的一个单中心进行,从2010年5月1日开始,直到2013年7月31日,最后访问结束时间为

目前,对于肌肉骨骼健康,专家还不能确定最佳25-羟基维生素D(25[OH]D)的水平。该研究的目的是比较维生素D缺乏的绝经后女性服用安慰剂、低剂量和高剂量维生素D3后的对于总体钙的吸收的1年变化、骨密度、计时起立-行走和5次坐立试验、以及肌肉质量的1年变化。

这项随机、双盲、安慰剂对照的临床试验在威斯康星州麦迪逊市的一个单中心进行,从2010年5月1日开始,直到2013年7月31日,最后访问结束时间为2014年8月8日。共230名75岁及以下的绝经后女性参与了此研究,这些参与者基线25(OH)D水平为14至27ng/mL,均没有骨质疏松症。

3个研究组分别为服用每天一次白色安慰剂和每月两次黄色安慰剂的安慰剂组(n=76),每天800IU的维生素D3和每月两次的黄色安慰剂的低剂量组(n=75),以及每日一次白色安慰剂和每月两次50000 IU的维生素D3的高剂量组(n=79)。高剂量的维生素D方案达到并保持25(OH)D水平≥30ng/mL。

观察结果指标是研究人员使用2种稳定同位素、骨密度和肌肉质量(采用双能X线骨密度仪测定),计时起立-行走和5次坐立试验,功能状态(健康评估问卷),和身体活动(老年人身体活动量表)来检测总钙的吸收在1年的变化,并使用Benjamini-霍赫贝格校正的P值来控制的错误发现率。

在基线的钙吸收进行控制后,高剂量组的钙吸收增长了1%(10mg/d),但在低剂量组降低了2%(P=0.005 VS 高剂量组),安慰剂组下降了1.3%(P=0.03 VS 高剂量组)。研究人员在脊柱变化、平均总髋、平均股骨颈、或全身骨密度、骨小梁分数、肌肉质量、计时起立-行走和5次坐立测试成绩方面没有发现组间变化。同样地,研究人员在跌倒的次数、跌倒人数、体力活动、或功能状态方面也没有发现任何组间差异。

高剂量的维生素D3增加了钙的吸收,但效果不大,并没有转化为对骨密度、肌肉功能、肌肉质量、或跌倒有益的影响。研究人员发现没有数据可以支持专家们的建议,以维持绝经后女性的血清25(OH)D为30ng/mL的水平或更高。相反,研究人员发现,低剂量和高剂量的维生素D3对该队列研究中的绝经后女性(25(OH)D水平低于30ng/mL)的骨和肌肉的影响相当于安慰剂的作用是一样的。

原始出处:

Karen E. Hansen,R. Erin Johnson,Kaitlin R. Chambers,et al.Treatment of Vitamin D Insufficiency in Postmenopausal Women,JAMA Intern Med,2015.10.5

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  1. [GetPortalCommentsPageByObjectIdResponse(id=40225, encodeId=9283402251c, content=因为绝经后的骨质疏松根本机制在于骨量丢失,破骨细胞活性增加。所以这结果也没什么好惊讶的, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Thu Oct 22 10:51:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1257027, encodeId=64a2125e0276d, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1526611, encodeId=c25d1526611e8, content=<a href='/topic/show?id=2fe6e88863a' target=_blank style='color:#2F92EE;'>#绝经后女性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78886, encryptionId=2fe6e88863a, topicName=绝经后女性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b55511745984, createdName=chenhongpeng, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555700, encodeId=c6cf1555e00db, content=<a href='/topic/show?id=9cac10191188' target=_blank style='color:#2F92EE;'>#骨骼健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101911, encryptionId=9cac10191188, topicName=骨骼健康)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b9814658686, createdName=meichuangyi, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606651, encodeId=cacc160665183, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1631499, encodeId=9c1a163149983, content=<a href='/topic/show?id=6395e888343' target=_blank style='color:#2F92EE;'>#绝经后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78883, encryptionId=6395e888343, topicName=绝经后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b921798518, createdName=zxxiang, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=)]
    2015-10-22 cyzj007

    因为绝经后的骨质疏松根本机制在于骨量丢失,破骨细胞活性增加。所以这结果也没什么好惊讶的

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=40225, encodeId=9283402251c, content=因为绝经后的骨质疏松根本机制在于骨量丢失,破骨细胞活性增加。所以这结果也没什么好惊讶的, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Thu Oct 22 10:51:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1257027, encodeId=64a2125e0276d, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1526611, encodeId=c25d1526611e8, content=<a href='/topic/show?id=2fe6e88863a' target=_blank style='color:#2F92EE;'>#绝经后女性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78886, encryptionId=2fe6e88863a, topicName=绝经后女性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b55511745984, createdName=chenhongpeng, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555700, encodeId=c6cf1555e00db, content=<a href='/topic/show?id=9cac10191188' target=_blank style='color:#2F92EE;'>#骨骼健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101911, encryptionId=9cac10191188, topicName=骨骼健康)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b9814658686, createdName=meichuangyi, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1606651, encodeId=cacc160665183, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1631499, encodeId=9c1a163149983, content=<a href='/topic/show?id=6395e888343' target=_blank style='color:#2F92EE;'>#绝经后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78883, encryptionId=6395e888343, topicName=绝经后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b921798518, createdName=zxxiang, createdTime=Tue Oct 13 09:53:00 CST 2015, time=2015-10-13, status=1, ipAttribution=)]
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