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胆钙化醇补充剂可促进中国维生素 D 缺乏症成年人的骨代谢。

Cholecalciferol Supplementation Promotes Bone Turnover in Chinese Adults with Vitamin D Deficiency.

机构信息

Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and University of the Chinese Academy of Sciences, Shanghai, China.

Key Laboratory of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, China.

出版信息

J Nutr. 2018 May 1;148(5):746-751. doi: 10.1093/jn/nxy032.

DOI:10.1093/jn/nxy032

PMID:29897564

Abstract

BACKGROUND

Bone turnover markers (BTMs) are proposed as alternative indicators for bone mineral density in diagnosis and management of osteoporosis. However, little is known about the effects of vitamin D supplementation on BTMs in nonwhite populations.

OBJECTIVE

We aimed to investigate the responses in BTMs after vitamin D supplementation in Asians.

METHODS

In this secondary data analysis of a randomized, double-blind, placebo-controlled trial, 448 Chinese adults [mean ± SD age: 31.9 ± 8.0 y; mean ± SD body mass index (kg/m2): 22.1 ± 2.6; 69% were women] with vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] <50 nmol/L) received 2000 IU/d cholecalciferol or placebo for 20 wk. Serum concentrations of 25(OH)D, parathyroid hormone (PTH), calcium, and markers of bone formation and resorption were measured at weeks 0 and 20. Intention-to-treat analysis was applied, and between-group differences were compared by general linear models with adjustments.

RESULTS

Cholecalciferol supplementation increased the serum bone alkaline phosphatase (BALP) concentration (+1.7 ± 1.9 µg/L) significantly more than placebo (+1.1 ± 1.7 µg/L; P = 0.004), but not circulating concentrations of procollagen type I N-terminal propeptide (PINP), β-isomerized C-terminal telopeptide of type I collagen (β-CTX), or tartrate-resistant acid phosphatase 5b (TRAP5b) (P ≥ 0.53). Notably, a pooled analysis indicated that changes in serum 25(OH)D were positively associated with changes in serum BALP, PINP, and TRAP5b (r = 0.07-0.16, P ≤ 0.02), but inversely with changes in PTH (r = -0.15, P < 0.001). Among cholecalciferol-treated participants, individuals who achieved serum 25(OH)D ≥75 nmol/L had greater increases in serum β-CTX (224% compared with 146%; P = 0.02) and TRAP5b (22.2% compared with 9.1%; P = 0.007), but smaller decreases in serum calcium (-1.3% compared with -1.9%; P = 0.005) and calcium-phosphorus product (-2.6% compared with -3.3%; P = 0.02) compared with those with serum 25(OH)D <75 nmol/L.

CONCLUSIONS

Daily supplementation with 2000 IU cholecalciferol for 20 wk may promote bone formation in Chinese adults with vitamin D deficiency. More studies are needed to elucidate the potential clinical implications of BTMs.This trial was registered at clinicaltrials.gov as NCT01998763.

摘要

背景

骨转换标志物（BTM）被提议作为诊断和治疗骨质疏松症时骨密度的替代指标。然而，对于维生素 D 补充对非白色人群 BTM 的影响知之甚少。

目的

我们旨在研究亚洲人补充维生素 D 后 BTM 的反应。

方法

在这项随机、双盲、安慰剂对照试验的二次数据分析中，448 名中国成年人[平均年龄 ± 标准差：31.9 ± 8.0 岁；平均体重指数 ± 标准差：22.1 ± 2.6；69%为女性]存在维生素 D 缺乏（血清 25-羟维生素 D [25(OH)D] <50 nmol/L），接受 2000 IU/d 胆钙化醇或安慰剂治疗 20 周。在第 0 周和第 20 周时测量血清 25(OH)D、甲状旁腺激素 (PTH)、钙和骨形成和骨吸收标志物的浓度。采用意向治疗分析，并通过调整后的一般线性模型比较组间差异。

结果

胆钙化醇补充剂使血清骨碱性磷酸酶 (BALP) 浓度（+1.7 ± 1.9 µg/L）显著增加（与安慰剂相比，增加了 1.1 ± 1.7 µg/L；P = 0.004），但不增加前胶原 I N 端前肽（PINP）、I 型胶原 β 异构体 C 端肽（β-CTX）或抗酒石酸酸性磷酸酶 5b（TRAP5b）的循环浓度（P ≥ 0.53）。值得注意的是，一项汇总分析表明，血清 25(OH)D 的变化与血清 BALP、PINP 和 TRAP5b 的变化呈正相关（r = 0.07-0.16，P ≤ 0.02），与 PTH 的变化呈负相关（r = -0.15，P <0.001）。在接受胆钙化醇治疗的参与者中，血清 25(OH)D 达到≥75 nmol/L 的个体，血清 β-CTX（增加 224%比增加 146%；P = 0.02）和 TRAP5b（增加 22.2%比增加 9.1%；P = 0.007）的增加幅度更大，而血清钙（减少 1.3%比减少 1.9%；P = 0.005）和钙磷乘积（减少 2.6%比减少 3.3%；P = 0.02）的减少幅度更小与血清 25(OH)D <75 nmol/L 的个体相比。