Bischoff-Ferrari Heike A, Orav E John, Dawson-Hughes Bess
Department of Rheumatology and Institute for Physical Medicine, University Hospital Zurich, Zurich, Switzerland.
Arch Intern Med. 2006 Feb 27;166(4):424-30. doi: 10.1001/archinte.166.4.424.
A recent meta-analysis found that cholecalciferol (vitamin D) should reduce falls by more than 20%. However, little is known about whether supplemental cholecalciferol plus calcium citrate malate will lower the long-term risk of falling in men, active older individuals, and older individuals with higher 25-hydroxyvitamin D levels.
We studied the effect of 3-year supplementation with cholecalciferol-calcium on the risk of falling at least once in 199 men and 246 women 65 years or older and living at home. Individuals received 700 IU of cholecalciferol plus 500 mg of calcium citrate malate per day or placebo in a randomized double-blind manner. Subjects were classified as less physically active if physical activity was below the median level. Low 25-hydroxyvitamin D levels were classified as those below 32 ng/mL (<80 nmol/L).
In 3 years, 55% of women and 45% of men reported at least 1 fall. Mean +/- SD baseline 25-hydroxyvitamin D levels were 26.6 +/- 12.7 ng/mL (66.4 +/- 31.7 nmol/L) in women and 33.2 +/- 14.2 ng/mL (82.9 +/- 34.9) in men. Cholecalciferol-calcium significantly reduced the odds of falling in women (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.30-0.97), but not in men (OR, 0.93; 95% CI, 0.50-1.72). Fall reduction was most pronounced in less active women (OR, 0.35; 95% CI, 0.15-0.81). Baseline 25-hydroxyvitamin D level did not modulate the treatment effect.
Long-term dietary cholecalciferol-calcium supplementation reduces the odds of falling in ambulatory older women by 46%, and especially in less active women by 65%. Supplementation had a neutral effect in men independent of their physical activity level.
最近的一项荟萃分析发现，胆钙化醇（维生素D）可使跌倒风险降低20%以上。然而，对于补充胆钙化醇加苹果酸钙是否会降低男性、活跃的老年人以及25-羟基维生素D水平较高的老年人的长期跌倒风险，人们知之甚少。
我们研究了胆钙化醇-钙补充3年对199名65岁及以上居家男性和246名65岁及以上居家女性至少跌倒一次的风险的影响。参与者以随机双盲方式每天接受700国际单位胆钙化醇加500毫克苹果酸钙或安慰剂。如果身体活动低于中位数水平，则将受试者分类为身体活动较少。25-羟基维生素D水平低被分类为低于32纳克/毫升（<80纳摩尔/升）。
在3年中，55%的女性和45%的男性报告至少跌倒过1次。女性的平均±标准差基线25-羟基维生素D水平为26.6±12.7纳克/毫升（66.4±31.7纳摩尔/升），男性为33.2±14.2纳克/毫升（82.9±34.9）。胆钙化醇-钙显著降低了女性跌倒的几率（优势比[OR]，0.54；95%置信区间[CI]，0.30-0.97），但对男性没有影响（OR，0.93；95%CI，0.50-1.72）。跌倒减少在活动较少的女性中最为明显（OR，0.35；95%CI，0.15-0.81）。基线25-羟基维生素D水平未调节治疗效果。
长期饮食补充胆钙化醇-钙可使非卧床老年女性跌倒几率降低46%，特别是活动较少的女性降低65%。补充剂对男性有中性作用，与他们的身体活动水平无关。
