Bischoff-Ferrari H A, Dawson-Hughes B, Staehelin H B, Orav J E, Stuck A E, Theiler R, Wong J B, Egli A, Kiel D P, Henschkowski J
Centre on Aging and Mobility, University of Zurich, Switzerland.
BMJ. 2009 Oct 1;339:b3692. doi: 10.1136/bmj.b3692.
To test the efficacy of supplemental vitamin D and active forms of vitamin D with or without calcium in preventing falls among older individuals.
We searched Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008 for relevant articles. Further studies were identified by consulting clinical experts, bibliographies, and abstracts. We contacted authors for additional data when necessary. Review methods Only double blind randomised controlled trials of older individuals (mean age 65 years or older) receiving a defined oral dose of supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1alpha-hydroxyvitamin D(3) (1alpha-hydroxycalciferol) or 1,25-dihydroxyvitamin D(3) (1,25-dihydroxycholecalciferol)) and with sufficiently specified fall assessment were considered for inclusion.
Eight randomised controlled trials (n=2426) of supplemental vitamin D met our inclusion criteria. Heterogeneity among trials was observed for dose of vitamin D (700-1000 IU/day v 200-600 IU/day; P=0.02) and achieved 25-hydroxyvitamin D(3) concentration (25(OH)D concentration: <60 nmol/l v >or=60 nmol/l; P=0.005). High dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/l or more resulted in a 23% fall reduction (pooled RR 0.77, 95% CI 0.65 to 0.90). Falls were not notably reduced by low dose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (pooled RR 1.35, 95% CI 0.98 to 1.84). Two randomised controlled trials (n=624) of active forms of vitamin D met our inclusion criteria. Active forms of vitamin D reduced fall risk by 22% (pooled RR 0.78, 95% CI 0.64 to 0.94).
Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.
测试补充维生素D及维生素D活性形式（无论是否补充钙）对预防老年人跌倒的效果。
检索截至2008年8月的Medline、Cochrane对照试验中心注册库、BIOSIS和Embase，查找相关文章。通过咨询临床专家、参考文献和摘要确定进一步的研究。必要时与作者联系获取更多数据。综述方法：仅纳入针对老年人（平均年龄65岁及以上）的双盲随机对照试验，这些试验给予确定口服剂量的补充维生素D（维生素D3（胆钙化醇）或维生素D2（麦角钙化醇））或维生素D活性形式（1α-羟维生素D3（1α-羟钙化醇）或1,25-二羟维生素D3（1,25-二羟胆钙化醇）），且有足够明确的跌倒评估方法。
八项补充维生素D的随机对照试验（n = 2426）符合纳入标准。试验间在维生素D剂量（700 - 1000 IU/天对200 - 600 IU/天；P = 0.02）和达到的25-羟维生素D3浓度（25(OH)D浓度：＜60 nmol/L对≥60 nmol/L；P = 0.005）方面存在异质性。高剂量补充维生素D使跌倒风险降低19%（合并相对风险（RR）0.81，95%可信区间0.71至0.92；来自七项试验的n = 1921），而血清25(OH)D浓度达到60 nmol/L或更高可使跌倒风险降低23%（合并RR 0.77，95%可信区间0.65至0.90）。低剂量补充维生素D（合并RR 1.10，95%可信区间0.89至1.35；来自两项试验的n = 505）或血清25-羟维生素D浓度低于60 nmol/L（合并RR 1.35，95%可信区间0.98至1.84）并未显著降低跌倒风险。两项维生素D活性形式的随机对照试验（n = 624）符合纳入标准。维生素D活性形式使跌倒风险降低22%（合并RR 0.78，95%可信区间0.64至0.94）。
每天700 - 1000 IU剂量的补充维生素D可使老年人跌倒风险降低19%，降低程度与维生素D活性形式相似。低于700 IU的补充维生素D剂量或血清25-羟维生素D浓度低于60 nmol/L可能无法降低老年人的跌倒风险。
