钙剂和维生素 D 补充剂与创伤性 SCI 患者骨折的关联。
Association of Calcium and Vitamin D Supplements with Fractures in Persons with a Traumatic SCI.
机构信息
Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia.
Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia.
出版信息
Top Spinal Cord Inj Rehabil. 2024 Winter;30(1):98-112. doi: 10.46292/sci23-00057. Epub 2024 Feb 29.
BACKGROUND
Osteoporotic fractures occur in almost half of patients with a spinal cord injury (SCI) and are associated with significant morbidity and excess mortality. Paralyzed Veterans Administration (PVA) guidelines suggest that adequate calcium and vitamin D intake is important for skeletal health, however, the association of these supplements with osteoporotic fracture risk is unclear.
OBJECTIVES
To determine the association of filled prescriptions for calcium and vitamin D with fracture risk in Veterans with an SCI.
METHODS
The 5897 persons with a traumatic SCI of at least 2 years' duration (96% male; 4% female) included in the VSSC SCI/D Registry in FY2014 were followed from FY2014 to FY2020 for incident upper and lower extremity fractures. Filled daily prescriptions for calcium or vitamin D supplements for ≥6 months with an adherence ≥80% were examined.
RESULTS
Filled prescriptions for calcium (hazard ratio [HR] 0.65; 95% CI, 0.54-0.78) and vitamin D (HR 0.33; 95% CI, 0.29-0.38) supplements were associated with a significantly decreased risk for incident fractures.
CONCLUSION
Calcium and vitamin D supplements are associated with decreased risk of fracture, supporting PVA guidelines that calcium and vitamin D intake are important for skeletal health in persons with an SCI.
背景
骨质疏松性骨折几乎发生在一半以上的脊髓损伤（SCI）患者中，与显著的发病率和死亡率增加有关。瘫痪退伍军人管理局（PVA）指南表明，充足的钙和维生素 D 摄入对骨骼健康很重要，然而，这些补充剂与骨质疏松性骨折风险的关系尚不清楚。
目的
确定脊髓损伤退伍军人中钙和维生素 D 补充剂处方与骨折风险的相关性。
方法
在 FY2014 年 VSSC SCI/D 登记处纳入的 5897 名至少有 2 年病程的创伤性 SCI 患者（96%为男性；4%为女性），从 FY2014 年到 FY2020 年期间随访发生的上肢和下肢骨折事件。检查了钙或维生素 D 补充剂的每日处方，其服用时间≥6 个月且服用依从性≥80%。
结果
钙（危险比 [HR] 0.65；95%置信区间，0.54-0.78）和维生素 D（HR 0.33；95%置信区间，0.29-0.38）补充剂的处方与骨折事件风险显著降低相关。
结论
钙和维生素 D 补充剂与骨折风险降低相关，支持 PVA 指南，即钙和维生素 D 摄入对 SCI 患者的骨骼健康很重要。
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