Avenell Alison, Gillespie William J, Gillespie Lesley D, O'Connell Dianne
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK, AB25 2ZD.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD000227. doi: 10.1002/14651858.CD000227.pub3.
Vitamin D and related compounds have been used to prevent osteoporotic fractures in older people.
To determine the effects of vitamin D or related compounds, with or without calcium, for preventing fractures in older people.
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.
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.
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.
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.
维生素D及相关化合物已被用于预防老年人骨质疏松性骨折。
确定维生素D或相关化合物（无论是否联合钙剂）对预防老年人骨折的效果。
我们检索了Cochrane骨、关节与肌肉创伤组专业注册库、Cochrane对照试验中央注册库（2007年第3期《Cochrane图书馆》）、MEDLINE、EMBASE、CINAHL以及文章的参考文献列表。最近一次检索时间为2007年10月。
比较维生素D或相关化合物单独使用或联合钙剂与安慰剂、无干预措施或仅使用钙剂，报告老年人骨折结局的随机或半随机试验。
两位作者独立评估试验质量并提取数据。在可行的情况下，使用固定效应模型合并数据，若研究间异质性较高则使用随机效应模型。
纳入45项试验。单独使用维生素D似乎不太可能有效预防髋部骨折（9项试验，24749名参与者，RR=1.15，95%CI 0.99至1.33）、椎体骨折（5项试验，9138名参与者，RR=0.90，95%CI 0.42至1.92）或任何新发骨折（10项试验，25016名参与者，RR=1.01，95%CI 0.93至1.09）。维生素D联合钙剂可降低髋部骨折发生率（8项试验，46658名参与者，RR=0.84，95%CI 0.73至0.96）。尽管按居住状况进行的亚组分析显示，机构照护人群的髋部骨折显著减少，但与社区居住亚组之间的差异不显著（P=0.15）。总体而言，接受维生素D或其类似物（无论是否联合钙剂）的人群中高钙血症明显更为常见（18项试验，11346名参与者，RR=2.35，95%CI 1.59至3.47）；骨化三醇尤其如此（4项试验，988名参与者，RR=4.41，95%CI 2.14至9.09）。胃肠道症状有适度增加（11项试验，47042名参与者，RR=1.04，95%CI 1.00至1.08，P=0.04），肾脏疾病有小幅但显著的增加（11项试验，46537名参与者，RR=1.16，95%CI 1.02至1.33）。
对于居住在机构中的体弱老年人，给予维生素D联合钙剂可能会减少髋部骨折。单独使用维生素D不太可能预防骨折。总体而言，与维生素D或其类似物相关的胃肠道症状和肾脏疾病有小幅但显著的增加。骨化三醇与高钙血症发生率增加有关。
