Reis Aline Rocha, Santos Ramara Kadija Fonseca, Dos Santos Cynthia Batista, Santos Beatriz da Cruz, de Carvalho Gabrielli Barbosa, Brandão-Lima Paula Nascimento, de Oliveira E Silva Ana Mara, Pires Liliane Viana
Postgraduate Program in Nutrition Sciences, Department of Nutrition, Federal University of Sergipe, São Cristóvão, Brazil; Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil.
Nutritional Biochemistry Laboratory, Department of Nutrition, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.
Nutrition. 2023 Dec;116:112151. doi: 10.1016/j.nut.2023.112151. Epub 2023 Jul 6.
Menopause and vitamin D deficiency increase bone reabsorption and bone fracture risk in women in postmenopause, and vitamin D supplementation may improve bone health and decrease bone fracture risk. This study aims to discuss the effect of vitamin D supplementation, isolated or calcium-associated, on remodeling and fracture risk bone in women in postmenopause without osteoporosis. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO database registration: CRD42022359796). A search was conducted in four databases and gray literature using MeSH and similar terms related to supplements, vitamin D, calcium, remodeling, and fracture bone, without the restriction of language and year of publication. A total of 3460 studies were identified, and nine were selected. Vitamin D supplementation increased 25-hydroxyvitamin D levels ≥10 ng/mL and decreased parathyroid hormone secretion dependent on baseline levels. The doses of 400 IU of vitamin D improved the percentage of carboxylated osteocalcin, whereas 800 to 1000 IU combined with calcium resulted in reduced, improved, or maintained bone mineral density and reduced alkaline phosphatase levels. However, 4000 IU alone or combined with calcium for 6 mo did not improve C-telopeptide and procollagen type 1 peptide levels. Additionally, 15 000 IU/wk increased the cortical area of metacarpal bone, whereas 500 000 IU of vitamin D annually for 5 y did not contribute to reducing the fracture risk and falls. Only one study found a reduction in fracture risk (dose of 800 IU of vitamin D plus 1200 mg of calcium). Thus, the vitamin D supplementation, alone or calcium-associated, improved the status of 25-hydroxyvitamin D and bone remodeling, but it was not possible to assert that it reduced fracture bone risk in postmenopausal women.
绝经和维生素D缺乏会增加绝经后女性的骨吸收和骨折风险，补充维生素D可能改善骨骼健康并降低骨折风险。本研究旨在探讨单独补充维生素D或与钙联合补充对无骨质疏松症的绝经后女性骨重塑和骨折风险的影响。本研究按照系统评价和Meta分析的首选报告项目指南（PROSPERO数据库注册号：CRD42022359796）进行。使用医学主题词（MeSH）以及与补充剂、维生素D、钙、重塑和骨折骨相关的类似术语，在四个数据库和灰色文献中进行检索，不受语言和出版年份限制。共识别出3460项研究，筛选出9项。补充维生素D可使25-羟维生素D水平升高≥10 ng/mL，并根据基线水平降低甲状旁腺激素分泌。400 IU的维生素D剂量可提高羧化骨钙素的百分比，而800至1000 IU与钙联合使用可降低、改善或维持骨密度并降低碱性磷酸酶水平。然而，单独4000 IU或与钙联合使用6个月并未改善Ⅰ型胶原C端肽和前胶原肽水平。此外，每周15000 IU可增加掌骨皮质面积，而每年500000 IU的维生素D连续使用5年对降低骨折风险和跌倒并无作用。仅有一项研究发现骨折风险降低（800 IU维生素D加1200 mg钙的剂量）。因此，单独补充维生素D或与钙联合补充可改善25-羟维生素D状态和骨重塑，但无法确定其能降低绝经后女性的骨折风险。
