询问老年跌倒者和非跌倒者的维生素 D 状况：一个元分析以解决“被遗忘的步骤”。

Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a 'forgotten step'.

机构信息

Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, Angers University Hospital and UPRES EA 4638, University of Angers, UNAM, Angers, France; Robarts Research Institute, The University of Western Ontario, London, ON, Canada.

出版信息

J Intern Med. 2015 Jan;277(1):16-44. doi: 10.1111/joim.12250. Epub 2014 May 23.

DOI:10.1111/joim.12250

PMID:24697944

Abstract

BACKGROUND

Previous meta-analyses to determine the efficacy of vitamin D supplementation to prevent falls in the elderly have shown mixed results. Inconsistencies might depend on the dose of supplements, suggesting that serum 25-hydroxyvitamin D (25OHD) concentration could influence the risk of falling. Our objective was to systematically review and quantitatively analyse the relationship between serum 25OHD concentration and the occurrence of falls.

METHODS

A Medline search was conducted in December 2013, with no date limit, using the Medical Subject Heading terms 'Vitamin D' OR 'Ergocalciferols' OR 'Vitamin D deficiency' combined with 'Accidental Falls' OR 'Gait disorders, neurologic' OR 'Gait apraxia' OR 'Gait' OR 'Recurrent Falls' OR 'Falling'. Fixed and random-effects meta-analyses were performed to determine the following: (i) the effect size of the difference in 25OHD concentration between fallers and nonfallers and (ii) the risk of falling according to serum 25OHD concentration.

RESULTS

Of the 659 retrieved studies, 18 observational studies - including ten cross-sectional and eight cohort studies - met the selection criteria. All were of good quality. The number of participants ranged from 80 to 2957 (44-100% women); 11.0% to 69.3% were fallers. Serum 25OHD concentrations were 0.33 × SD lower in fallers compared to nonfallers [pooled effect size 0.33; 95% confidence interval (CI) 0.18-0.47]. The risk of falls was inversely associated with serum 25OHD concentration [summary odds ratio (OR) 0.97; 95% CI 0.96-0.99]. The association between falls and hypovitaminosis D varied according to the definition used; the summary OR for falls was 1.23 (95% CI 0.94-1.60) for 25OHD <10 ng mL(-1) , 1.44 (95% CI 1.17-1.76) for 25OHD <20 ng mL(-1) and 0.95 (95% CI 0.81-1.11) for 25OHD <30 ng mL(-1) .

CONCLUSIONS

Fallers have lower 25OHD concentrations, notably more often <20 ng mL(-1) , than nonfallers. These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls.

摘要

背景

先前的荟萃分析表明，维生素 D 补充剂对预防老年人跌倒的疗效存在差异。不一致的结果可能取决于补充剂的剂量，这表明血清 25-羟维生素 D（25OHD）浓度可能会影响跌倒的风险。我们的目的是系统地回顾和定量分析血清 25OHD 浓度与跌倒发生之间的关系。

方法

我们于 2013 年 12 月进行了一次 Medline 检索，没有时间限制，使用的医学主题词是“维生素 D”或“麦角钙化醇”或“维生素 D 缺乏”，并结合了“意外跌倒”或“步态障碍，神经病学”或“步态失调”或“步态”或“复发性跌倒”或“跌倒”。采用固定效应和随机效应荟萃分析来确定以下内容：（i）跌倒者和非跌倒者之间 25OHD 浓度差异的效应大小；（ii）根据血清 25OHD 浓度发生跌倒的风险。

结果

在 659 项检索到的研究中，有 18 项观察性研究符合选择标准，其中包括 10 项横断面研究和 8 项队列研究。所有研究的质量都很好。参与者的数量从 80 到 2957 人不等（44％-100％为女性）；11.0％至 69.3％为跌倒者。与非跌倒者相比，跌倒者的血清 25OHD 浓度低 0.33×SD[汇总效应量 0.33；95％置信区间（CI）0.18-0.47]。跌倒的风险与血清 25OHD 浓度呈负相关[汇总优势比（OR）0.97；95％CI 0.96-0.99]。跌倒与维生素 D 缺乏的关系因所使用的定义而异；对于血清 25OHD<10ng/mL，跌倒的汇总 OR 为 1.23（95％CI 0.94-1.60），对于血清 25OHD<20ng/mL，跌倒的汇总 OR 为 1.44（95％CI 1.17-1.76），而血清 25OHD<30ng/mL 时，跌倒的汇总 OR 为 0.95（95％CI 0.81-1.11）。