综合干预措施（包括维生素 D）可有效降低老年骨质疏松症患者跌倒的风险。
Comprehensive Interventions Including Vitamin D Effectively Reduce the Risk of Falls in Elderly Osteoporotic Patients.
机构信息
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
出版信息
Orthop Surg. 2021 Jun;13(4):1262-1268. doi: 10.1111/os.13009. Epub 2021 May 5.
OBJECTIVE
To evaluate the effects of different intervention measures to prevent falls in elderly osteoporotic patients.
METHODS
A randomized controlled trial was conducted in our outpatient ward from August 2014 to September 2015. A total of 420 patients over 60 years of age were assigned to four groups. NA VitD group took 800 mg calcium and 800 IU non-active vitamin D. P-NA VitD group took 800 mg calcium, 800 IU non-active vitamin D, and received physical exercise. A VitD group took 800 mg calcium and 0.5 μg active vitamin D. P-A VitD took 800 mg calcium, 0.5 μg active vitamin D, and received physical exercise. Physical exercise includes guidance in improving muscle strength and balance ability. Short physical performance battery (SPPB), grip strength, modified falls efficacy scale (MFES), blood calcium, and 25-hydroxyl vitamin D were measured before interventions and at 3, 6, and 12 months after interventions. Bone mineral density (BMD) was detected before interventions and at 12 months after interventions. The incidence of falls and fractures, adverse events, and drug reactions were recorded for 12 months.
RESULTS
A total of 420 patients were allocated in the four groups: 98 cases into the NA VitD group (11 males, 87 females), 97 cases into the P-NA VitD group (13 males, 84 females), 99 cases in the A VitD group (15 males, 84 females), and 98 cases into the P-A VitD group (11 males, 87 females). At 6 months after interventions, the SPPB of A VitD group significantly increased from 6.9 ± 1.9 to 8.0 ± 2.4 (P < 0.05), and the SPPB of A VitD group significantly increased from 7.2 ± 2.1 to 8.6 ± 1.7 (P < 0.05). At 6 months after interventions, MFES of P-NA VitD group 7.0 ± 1.6 to 7.6 ± 1.6 (P < 0.05), and MFES of P-A VitD group significantly increased from 6.7 ± 1.6 to 7.5 ± 1.6 (P < 0.05). At 12 months after interventions, SPPB of all groups, grip strength, and MFES of P-NA VitD group, A VitD group, P-A VitD group were significantly improved (P < 0.05). The BMD of lumbar vertebrae of A VitD group significantly increased from 0.742 ± 0.042 to 0.776 ± 0.039, and P-A VitD group significantly increased from 0.743 ± 0.048 to 0.783 ± 0.042 (P < 0.05). No serious adverse events occurred during the 12 months of follow-up.
CONCLUSION
Active vitamin D is better than non-active vitamin D to improve physical ability and the BMD of lumbar vertebrae and reduce the risk of falls.
目的
评估不同干预措施预防老年骨质疏松症患者跌倒的效果。
方法
本随机对照试验于 2014 年 8 月至 2015 年 9 月在我院门诊病房进行。共纳入 420 名 60 岁以上的患者，将其分为四组。NA VitD 组服用 800mg 钙和 800IU 非活性维生素 D。P-NA VitD 组服用 800mg 钙、800IU 非活性维生素 D，并接受体育锻炼。A VitD 组服用 800mg 钙和 0.5μg 活性维生素 D。P-A VitD 组服用 800mg 钙、0.5μg 活性维生素 D，并接受体育锻炼。体育锻炼包括改善肌肉力量和平衡能力的指导。在干预前和干预后 3、6 和 12 个月测量短体表现电池（SPPB）、握力、改良跌倒效能量表（MFES）、血钙和 25-羟维生素 D。在干预前和干预后 12 个月检测骨密度（BMD）。记录 12 个月内跌倒和骨折的发生率、不良事件和药物反应。
结果
共有 420 名患者被分配到四组：NA VitD 组 98 例（男 11 例，女 87 例），P-NA VitD 组 97 例（男 13 例，女 84 例），A VitD 组 99 例（男 15 例，女 84 例），P-A VitD 组 98 例（男 11 例，女 87 例）。干预后 6 个月，A VitD 组 SPPB 从 6.9±1.9 显著增加到 8.0±2.4（P<0.05），A VitD 组 SPPB 从 7.2±2.1 显著增加到 8.6±1.7（P<0.05）。干预后 6 个月，P-NA VitD 组 MFES 从 7.0±1.6 增加到 7.6±1.6（P<0.05），P-A VitD 组 MFES 从 6.7±1.6 显著增加到 7.5±1.6（P<0.05）。干预后 12 个月，所有组的 SPPB、握力和 P-NA VitD 组、A VitD 组、P-A VitD 组的 MFES 均显著改善（P<0.05）。A VitD 组腰椎 BMD 从 0.742±0.042 显著增加到 0.776±0.039，P-A VitD 组从 0.743±0.048 增加到 0.783±0.042（P<0.05）。随访 12 个月内无严重不良事件发生。
结论
活性维生素 D 比非活性维生素 D 更能改善身体能力和腰椎骨密度，降低跌倒风险。
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