Deroisy R, Collette J, Albert A, Jupsin I, Reginster J Y
Bone and Cartilage Metabolism Research Unit, WHO Collaborating Center for Public Health Aspects of Rheumatic Diseases, University of Liège, Belgium.
Aging Clin Exp Res. 2002 Feb;14(1):13-7. doi: 10.1007/BF03324412.
Supplementation of postmenopausal women with calcium alone or calcium-vitamin D association was suggested to have positive effects on bone turnover and bone density, as well as to lower fracture incidence. The beneficial effect appears to be mediated by a reduction in parathyroid hormone secretion. Our aim was to compare the respective efficacy of calcium and calcium-vitamin D supplements in reducing serum parathyroid hormone levels in postmenopausal women with prevalent low 25(OH)vitamin D levels.
One hundred consecutive ambulatory postmenopausal women with serum 25(OH)vitamin D levels below 18 ng/mL were included in a randomized, prospective, open label study. For a duration of 90 days, the women were randomly assigned to a daily supplementation of either one tablet of calcium gluconolactate and carbonate (500 mg calcium), or one powder-pack of an association of calcium carbonate (500 mg calcium), citric acid (2.175 gr) and cholecalciferol (200 IU). Changes observed during the 90 days of the study in circulating PTH levels were the primary endpoint, while changes in serum 25(OH)D levels were assessed as secondary endpoint.
A significant difference was observed between the calcium-vitamin D (CaD) and the calcium (Ca) only groups for changes occurring during the 90 days of the study in PTH (-14.5+/-40% and +2.5+/-46%) (p=0.009) and 25(OH)D (+67+/-77% and +18+/-55%) (p<0.001) circulating levels. PTH changes between baseline and day 90 were significant in the CaD group, but not in the Ca group. The odds ratio for a patient in group Ca to experience an absolute (<12 ng/mL) deficiency in circulating 25(OH)vitamin D levels, compared to a group CaD patient was statistically increased (OR: 3.22, 95% CI: 1.33-7.80).
Our results support the recommendation of supplementing postmenopausal women with low circulating levels of 25(OH)vitamin D with a combination of calcium and vitamin D, rather than with calcium alone.
有人提出，绝经后女性单独补充钙或补充钙与维生素D组合对骨转换和骨密度有积极影响，还能降低骨折发生率。这种有益作用似乎是通过甲状旁腺激素分泌减少来介导的。我们的目的是比较钙补充剂和钙 - 维生素D补充剂在降低25(OH)维生素D水平普遍较低的绝经后女性血清甲状旁腺激素水平方面的各自疗效。
100名连续门诊就诊的绝经后女性，其血清25(OH)维生素D水平低于18 ng/mL，被纳入一项随机、前瞻性、开放标签研究。在90天的时间里，这些女性被随机分配，每天补充一片葡萄糖酸钙和碳酸钙（含钙500毫克），或一包碳酸钙（含钙500毫克）、柠檬酸（2.175克）和胆钙化醇（200国际单位）的组合粉剂。研究90天期间观察到的循环中甲状旁腺激素（PTH）水平变化是主要终点，而血清25(OH)D水平变化作为次要终点进行评估。
在研究的90天期间，钙 - 维生素D（CaD）组和仅补钙（Ca）组在PTH（分别为-14.5±40%和+2.5±46%）（p = 0.009）和25(OH)D（分别为+67±77%和+18±55%）（p < 0.001）循环水平变化方面存在显著差异。CaD组基线至第90天的PTH变化显著，而Ca组则不显著。与CaD组患者相比，Ca组患者循环中25(OH)维生素D水平出现绝对（<12 ng/mL）缺乏的比值比在统计学上有所增加（比值比：3.22，95%置信区间：1.33 - 7.80）。
我们的结果支持建议25(OH)维生素D循环水平较低的绝经后女性补充钙和维生素D的组合，而不是单独补钙。
