Brincat Max, Gambin Jeannine, Brincat Mark, Calleja-Agius Jean
Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta.
Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta.
Maturitas. 2015 Mar;80(3):329-32. doi: 10.1016/j.maturitas.2014.12.018. Epub 2015 Jan 13.
It is known that circulating vitamin D predominantly originates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. There is limited research data on the management of vitamin D deficiency using therapeutic doses. The majority of studies focus on lower physiological doses rather than high pharmacological doses. In order to reach serum levels of 75nmol/L from a deficiency state, higher doses than 800-1000IU/day are required. Future focus should be on the implications of a rise in systemic 25(OH)D3 levels from a deficiency state to 75nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Vitamin D treatment and supplementation need to be re-evaluated in the light of new evidence suggesting that high pharmacological doses need to be used in order to obtain the desired effect in the prevention of osteoporosis and recurrence of osteoporotic fractures.
众所周知，循环中的维生素D主要来源于皮肤合成，因此应被视为一种激素而非维生素。维生素D缺乏（<50nmol/L）是一种全球性的流行病，因其在各种生理系统中的作用，对人类健康有多种影响。各种研究表明，随着血清25-羟维生素D水平升高，非椎骨和髋部骨折的发生率会降低。关于使用治疗剂量治疗维生素D缺乏症的研究数据有限。大多数研究集中在较低的生理剂量而非高药理剂量上。为了从缺乏状态达到75nmol/L的血清水平，所需剂量高于800 - 1000IU/天。未来的重点应放在从缺乏状态升至75nmol/L的全身25(OH)D3水平升高对骨密度和骨折风险的影响，以及在维生素D缺乏情况下使用高剂量治疗的问题上。鉴于新证据表明需要使用高药理剂量才能在预防骨质疏松症和骨质疏松性骨折复发方面获得理想效果，维生素D的治疗和补充需要重新评估。
