Kaiser Permanente Washington Health Research Institute, Seattle.
University of Iowa, Iowa City.
JAMA. 2018 Apr 17;319(15):1592-1599. doi: 10.1001/jama.2018.3185.
Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die.
To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on vitamin D supplementation, with or without calcium, to prevent fractures.
The USPSTF reviewed the evidence on vitamin D, calcium, and combined supplementation for the primary prevention of fractures in community-dwelling adults (defined as not living in a nursing home or other institutional care setting). The review excluded studies conducted in populations with a known disorder related to bone metabolism (eg, osteoporosis or vitamin D deficiency), taking medications known to be associated with osteoporosis (eg, long-term steroids), or with a previous fracture.
The USPSTF found inadequate evidence to estimate the benefits of vitamin D, calcium, or combined supplementation to prevent fractures in community-dwelling men and premenopausal women. The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women. The USPSTF found adequate evidence that supplementation with vitamin D and calcium increases the incidence of kidney stones.
The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (I statement) The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (D recommendation) These recommendations do not apply to persons with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.
由于人口老龄化，骨质疏松性骨折在美国已成为发病率和死亡率日益增高的重要原因。2005 年，美国约有 200 万例骨质疏松性骨折，预计到 2025 年，每年的发病率将增加到 300 多万例。髋部骨折发生后 1 年内，许多患者无法独立行走，超过一半的患者需要日常活动的帮助，20%至 30%的患者会死亡。
更新 2013 年美国预防服务工作组（USPSTF）关于维生素 D 补充剂（无论是否同时补充钙）用于预防骨折的建议。
USPSTF 回顾了关于维生素 D、钙和联合补充剂用于预防社区居住成年人（定义为不住在疗养院或其他机构护理环境中）骨折的主要证据。该综述排除了在已知与骨代谢相关疾病（如骨质疏松症或维生素 D 缺乏症）人群中进行的研究、已知与骨质疏松症相关的药物（如长期使用类固醇）或既往骨折的研究。
USPSTF 发现，没有足够的证据来估计维生素 D、钙或联合补充剂预防社区居住男性和绝经前女性骨折的益处。USPSTF 发现，每天补充 400IU 或以下的维生素 D 和 1000mg 或以下的钙对预防社区居住的绝经后妇女的骨折没有益处。USPSTF 发现，没有足够的证据来估计补充剂量大于 400IU 的维生素 D 或大于 1000mg 的钙对预防社区居住的绝经后妇女骨折的益处。USPSTF 发现，补充维生素 D 和钙会增加肾结石的发生率。
USPSTF 得出结论，目前的证据不足以评估维生素 D 和钙单独或联合补充用于预防无症状男性和绝经前女性社区居住者骨折的利弊。（I 级推荐）USPSTF 得出结论，目前的证据不足以评估每日补充剂量大于 400IU 的维生素 D 和大于 1000mg 的钙用于预防社区居住的绝经后妇女骨折的利弊。（I 级推荐）USPSTF 建议，不建议在社区居住的绝经后妇女中每天补充 400IU 或以下的维生素 D 和 1000mg 或以下的钙以预防骨折。（D 级推荐）这些建议不适用于有骨质疏松性骨折史、跌倒风险增加、骨质疏松症或维生素 D 缺乏症诊断的人群。
