补充维生素D3对骨密度的影响：一项系统评价与荟萃分析

Effect of supplemental vitamin D3 on bone mineral density: a systematic review and meta-analysis.

作者信息

Kazemian Elham, Pourali Ali, Sedaghat Fatemeh, Karimi Mehrdad, Basirat Vahid, Sajadi Hezaveh Zohreh, Davoodi Sayed Hossein, Holick Michael F

机构信息

Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.

Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

出版信息

Nutr Rev. 2023 Apr 11;81(5):511-530. doi: 10.1093/nutrit/nuac068.

DOI:10.1093/nutrit/nuac068

PMID:36308775

Abstract

CONTEXT

There is still controversy over the effect of vitamin D3 supplementation on bone health.

OBJECTIVE

The effects of vitamin D3 supplementation on bone mineral density (BMD) and markers of bone turnover, as well as the dose-response relationship between vitamin D3 and bone health in adults, were evaluated.

DATA SOURCES

The PubMed, Scopus, Cochrane, Web of Science, and AGRIS databases were searched for articles published through April 30, 2022. Thirty-nine of the 6409 records identified met the inclusion criteria.

DATA EXTRACTION

Data were extracted from articles by 2 authors, and data extraction was cross-checked independently. A random-effects model was used to estimate the pooled effect size and the associated 95%CI for the effect of vitamin D3 for each outcome. A one-stage random-effects dose-response model was used to estimate the dose-response relationship between vitamin D3 supplementation and BMD.

DATA ANALYSIS

Results of meta-analysis showed a beneficial effect of vitamin D3 at the lumbar spine (standardized mean difference [SMD] = 0.06; 95%CI, 0.01-0.12) and femoral neck (SMD = 0.25; 95%CI, 0.09-0.41). Dose-response analysis revealed a linear relationship between vitamin D3 supplementation doses and BMD at the femoral neck, lumbar spine, and total hip sites. No significant effect of vitamin D3 supplementation on whole-body or total hip BMD was observed (P > 0.05). Vitamin D3 supplementation significantly decreased BMD at both proximal and distal forearm (SMD = -0.16; 95%CI, -0.26 to -0.06). The variables of ethnicity, age, baseline 25-hydroxyvitamin D (25[OH]D), menopause status, vitamin D3 dosing frequency, and bone health status (P interaction = 0.02) altered the effect of vitamin D3 supplementation on BMD. Additionally, a nonlinear relationship between vitamin D3 supplement doses and markers of bone turnover was found.

CONCLUSION

A protective effect of vitamin D3 supplementation on BMD of the lumbar spine, femoral neck, and total hip is implicated.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42017054132.

摘要

背景

维生素D3补充剂对骨骼健康的影响仍存在争议。

目的

评估维生素D3补充剂对骨密度（BMD）和骨转换标志物的影响，以及成人中维生素D3与骨骼健康之间的剂量反应关系。

数据来源

检索了PubMed、Scopus、Cochrane、Web of Science和AGRIS数据库中截至2022年4月30日发表的文章。在识别出的6409条记录中，有39条符合纳入标准。

数据提取

由两名作者从文章中提取数据，并对数据提取进行独立交叉核对。采用随机效应模型估计维生素D3对每个结局的合并效应大小及相关的95%置信区间（CI）。采用单阶段随机效应剂量反应模型估计维生素D3补充剂与BMD之间的剂量反应关系。

数据分析

荟萃分析结果显示，维生素D3对腰椎（标准化均数差[SMD]=0.06；95%CI，0.01-0.12）和股骨颈（SMD=0.25；95%CI，0.09-0.41）有有益作用。剂量反应分析显示，维生素D3补充剂剂量与股骨颈、腰椎和全髋部位的BMD之间存在线性关系。未观察到维生素D3补充剂对全身或全髋BMD有显著影响（P>0.05）。维生素D3补充剂显著降低了前臂近端和远端的BMD（SMD=-0.16；95%CI，-0.26至-0.06）。种族、年龄、基线25-羟基维生素D（25[OH]D）、绝经状态、维生素D3给药频率和骨骼健康状况等变量（P交互作用=0.02）改变了维生素D3补充剂对BMD的影响。此外，还发现维生素D3补充剂剂量与骨转换标志物之间存在非线性关系。