Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.
Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
Maturitas. 2020 Nov;141:63-70. doi: 10.1016/j.maturitas.2020.06.016. Epub 2020 Jun 22.
During the last decade, a cascade of evidence has questioned the anti-fracture efficacy of vitamin D supplementation. In general, vitamin D status, reflected by serum 25-hydroxy-vitamin D [25(OH)D] concentrations, seems to predict fracture risk and bone mineral density (BMD). Despite the well-documented detrimental effect of vitamin D deficiency on bones, vitamin D monotherapy does not seem to reduce the risk of fractures. On the other hand, high vitamin D doses, either at monthly (60,000-100,000 IU) or daily intervals (>4000 IU), appear to be harmful with regard to falls, fracture risk and BMD, especially for people without vitamin D deficiency and at low fracture risk. Therefore, a U-shaped effect of vitamin D on the musculoskeletal system may be supported by the current evidence. Vitamin D supplementation could be of value, at daily doses of at least 800 IU, co-supplemented with calcium (1000-1200 mg/day), in elderly populations, especially those with severe vitamin D deficiency [25(OH)D <25-30 nmol/L (<10-12 ng/mL)], although its anti-fracture and anti-fall efficacy is modest. Good compliance and at least 3-5 years of therapy are required.
在过去的十年中，大量证据质疑了维生素 D 补充剂的抗骨折功效。一般来说，血清 25-羟维生素 D [25(OH)D] 浓度反映的维生素 D 状态似乎可以预测骨折风险和骨密度 (BMD)。尽管维生素 D 缺乏对骨骼有明确的不利影响，但维生素 D 单一疗法似乎并不能降低骨折风险。另一方面，高剂量维生素 D，无论是每月（60,000-100,000 IU）还是每天（>4000 IU）给予，似乎与跌倒、骨折风险和 BMD 有关，特别是对于没有维生素 D 缺乏和低骨折风险的人。因此，目前的证据支持维生素 D 对骨骼肌肉系统的 U 形效应。维生素 D 补充剂可能具有一定的价值，尤其是对于老年人，特别是严重维生素 D 缺乏症患者（25(OH)D <25-30 nmol/L (<10-12 ng/mL)），建议每天至少补充 800 IU 维生素 D，同时补充钙（1000-1200 毫克/天），但抗骨折和抗跌倒效果并不显著。需要良好的依从性和至少 3-5 年的治疗。
