Edith Cowan University, School of Medical and Health Sciences, Joondalup.
University of Western Australia, Medical School, Perth, Western Australia.
Curr Opin Rheumatol. 2019 Mar;31(2):91-97. doi: 10.1097/BOR.0000000000000584.
Calcium and vitamin D supplementation is widely recommended for prevention of falls and fracture, particularly in the elderly where calcium intakes and vitamin D levels are often inadequate. A number of meta-analyses have questioned the benefits of untargeted or 'holistic' supplementation for falls and fracture, and raised the possibility of adverse cardiovascular effects. This review provides an update on these controversies.
Recent advances have largely centred around new trials of vitamin D and meta-analyses of published trials and observational studies. These articles have identified holistic vitamin D supplementation with or without calcium is unlikely to be an effective primary prevention strategy for falls or fracture. There has also been high-quality evidence that vitamin D, daily or as a bolus, does not reduce the risk of cardiovascular events.
The benefits of vitamin D and calcium supplements for holistic fall and fracture prevention remain uncertain. Recent evidence supports the concept that high-dose vitamin D has adverse musculoskeletal effects. Future studies should focus on moderate daily doses. Finally, there remain inconsistent findings for adverse cardiovascular effects of calcium supplements with or without vitamin D. This uncertainty should be taken into account when evaluating the risk/benefits of supplementation.
钙和维生素 D 补充剂广泛用于预防跌倒和骨折，特别是在老年人中，他们的钙摄入量和维生素 D 水平往往不足。一些荟萃分析对针对非特定目标或“整体”补充剂预防跌倒和骨折的益处提出了质疑，并提出了可能对心血管产生不利影响的可能性。本综述提供了这些争议的最新进展。
最近的进展主要集中在维生素 D 的新试验以及已发表试验和观察性研究的荟萃分析上。这些文章确定了补充维生素 D 和钙（单独或联合）不太可能是预防跌倒或骨折的有效初级预防策略。也有高质量的证据表明，维生素 D（每日或大剂量）并不能降低心血管事件的风险。
维生素 D 和钙补充剂对整体跌倒和骨折预防的益处仍不确定。最近的证据支持高剂量维生素 D 对肌肉骨骼有不良影响的观点。未来的研究应集中在适度的每日剂量上。最后，钙补充剂（单独或联合维生素 D）对心血管不良影响的结果不一致。在评估补充剂的风险/益处时，应考虑到这种不确定性。
