维生素 D 补充剂改善维生素 D 缺乏儿童和青少年骨密度：随机对照试验的系统评价和个体参与者数据荟萃分析。

Vitamin D supplementation for improving bone density in vitamin D-deficient children and adolescents: systematic review and individual participant data meta-analysis of randomized controlled trials.

机构信息

Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Calcium Metabolism & Osteoporosis Program, WHO CC in Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon.

出版信息

Am J Clin Nutr. 2023 Sep;118(3):498-506. doi: 10.1016/j.ajcnut.2023.05.028. Epub 2023 Aug 8.

DOI:10.1016/j.ajcnut.2023.05.028

PMID:37661104

Abstract

BACKGROUND

Vitamin D supplements are widely used for improving bone health in children and adolescents, but their effects in vitamin D-deficient children are unclear.

OBJECTIVES

This study aimed to examine whether the effect of vitamin D supplementation on bone mineral density (BMD) in children and adolescents differs by baseline vitamin D status and estimate the effect in vitamin D-deficient individuals.

METHODS

This is a systematic review and individual participant data (IPD) meta-analysis. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, MBASE, CINAHL, AMED, and ISI Web of Science (until May 27, 2020) for randomized controlled trials (RCTs) of vitamin D supplementation reporting bone density outcomes after ≥6 mo in healthy individuals aged 1-19 y. We used two-stage IPD meta-analysis to determine treatment effects on total body bone mineral content and BMD at the hip, femoral neck, lumbar spine, and proximal and distal forearm after 1 y; examine whether effects varied by baseline serum 25-hydroxyvitamin D [25(OH)D] concentration, and estimate treatment effects for each 25(OH)D subgroup.

RESULTS

Eleven RCTs were included. Nine comprising 1439 participants provided IPD (86% females, mean baseline 25(OH)D = 36.3 nmol/L). Vitamin D supplementation had a small overall effect on total hip areal BMD (weighted mean difference = 6.8; 95% confidence interval: 0.7, 12.9 mg/cm; I = 7.2%), but no effects on other outcomes. There was no clear evidence of linear or nonlinear interactions between baseline 25(OH)D and treatment; effects were similar in baseline 25(OH)D subgroups (cutoff of 35 or 50 nmol/L). The evidence was of high certainty.

CONCLUSIONS

Clinically important benefits for bone density from 1-y vitamin D supplementation in healthy children and adolescents, regardless of baseline vitamin D status, are unlikely. However, our findings are mostly generalizable to White postpubertal girls and do not apply to those with baseline 25(OH)D outside the studied range or with symptomatic vitamin D deficiency (e.g., rickets). This study was preregistered at PROSPERO as CRD42017068772. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017068772.

摘要

背景

维生素 D 补充剂被广泛用于改善儿童和青少年的骨骼健康，但它们对维生素 D 缺乏儿童的影响尚不清楚。

目的

本研究旨在检验维生素 D 补充剂对儿童和青少年骨密度（BMD）的影响是否因基线维生素 D 状态而异，并估计维生素 D 缺乏个体的影响。

方法

这是一项系统评价和个体参与者数据（IPD）荟萃分析。我们检索了 Cochrane 对照试验中心注册库、MEDLINE、MBASE、CINAHL、AMED 和 ISI Web of Science（截至 2020 年 5 月 27 日），以寻找维生素 D 补充剂治疗≥6 个月后健康 1-19 岁个体的骨密度结局的随机对照试验（RCT）。我们使用两阶段 IPD 荟萃分析来确定治疗对 1 年后全身骨矿物质含量和髋部、股骨颈、腰椎、近端和远端前臂 BMD 的影响；检验治疗效果是否因基线血清 25-羟维生素 D [25(OH)D]浓度而异，并估计每个 25(OH)D 亚组的治疗效果。

结果

纳入了 11 项 RCT。其中 9 项包含 1439 名参与者提供了 IPD（86%为女性，平均基线 25(OH)D=36.3 nmol/L）。维生素 D 补充对全髋面积 BMD 有轻微的总体影响（加权均数差=6.8；95%置信区间：0.7，12.9 mg/cm；I=7.2%），但对其他结果没有影响。基线 25(OH)D 与治疗之间没有明显的线性或非线性相互作用；在基线 25(OH)D 亚组中（35 或 50 nmol/L 为界），作用相似。证据质量为高。

结论

1 年的维生素 D 补充对健康儿童和青少年的骨密度没有明显的临床获益，无论基线维生素 D 状态如何。然而，我们的发现主要适用于白人青春期后女孩，不适用于基线 25(OH)D 处于研究范围之外或有症状性维生素 D 缺乏（如佝偻病）的个体。本研究在 PROSPERO 上预先注册，注册号为 CRD42017068772。https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017068772。