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维生素D与肌肉骨骼健康:基于当前证据需考虑的突出方面。

Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence.

作者信息

Mendes Marcela Moraes, Botelho Patricia Borges, Ribeiro Helena

机构信息

Department of Nutrition, Faculty of Health Sciences, University of Brasília, Distrito Federal, Brazil.

Department of Nutrition, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.

出版信息

Endocr Connect. 2022 Sep 26;11(10). doi: 10.1530/EC-21-0596. Print 2022 Oct 1.

Abstract

Vitamin D enhances calcium absorption and bone mineralisation, promotes maintenance of muscle function, and is crucial for musculoskeletal health. Low vitamin D status triggers secondary hyperparathyroidism, increases bone loss, and leads to muscle weakness. The primary physiologic function of vitamin D and its metabolites is maintaining calcium homeostasis for metabolic functioning, signal transduction, and neuromuscular activity. A considerable amount of human evidence supports the well-recognised contribution of adequate serum 25-hydroxyvitamin D concentrations for bone homeostasis maintenance and prevention and treatment strategies for osteoporosis when combined with adequate calcium intake. This paper aimed to review the literature published, mainly in the last 20 years, on the effect of vitamin D and its supplementation for musculoskeletal health in order to identify the aspects that remain unclear or controversial and therefore require further investigation and debate. There is a clear need for consistent data to establish realistic and meaningful recommendations of vitamin D status that consider different population groups and locations. Moreover, there is still a lack of consensus on thresholds for vitamin D deficiency and optimal status as well as toxicity, optimal intake of vitamin D, vitamin D supplement alone as a strategy to prevent fractures and falls, recommended sun exposure at different latitudes and for different skin pigmentations, and the extra skeletal effects of vitamin D.

摘要

维生素D可增强钙的吸收和骨矿化,促进肌肉功能的维持,对肌肉骨骼健康至关重要。维生素D水平低会引发继发性甲状旁腺功能亢进,增加骨质流失,并导致肌肉无力。维生素D及其代谢产物的主要生理功能是维持钙稳态,以实现代谢功能、信号转导和神经肌肉活动。大量人体证据支持,当与充足的钙摄入相结合时,血清25-羟基维生素D浓度充足对维持骨稳态以及骨质疏松症的预防和治疗策略具有公认的作用。本文旨在综述主要在过去20年发表的关于维生素D及其补充剂对肌肉骨骼健康影响的文献,以确定仍不明确或有争议的方面,因此需要进一步研究和讨论。显然需要一致的数据来制定考虑不同人群和地点的关于维生素D状态的现实且有意义的建议。此外,在维生素D缺乏的阈值、最佳状态以及毒性、维生素D的最佳摄入量、单独使用维生素D补充剂作为预防骨折和跌倒的策略、不同纬度和不同皮肤色素沉着情况下建议的阳光照射量以及维生素D的骨骼外效应等方面仍缺乏共识。

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