Migliorini Filippo, Maffulli Nicola, Colarossi Giorgia, Filippelli Amelia, Memminger Michael, Conti Valeria
Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
Eur J Med Res. 2025 Mar 14;30(1):170. doi: 10.1186/s40001-025-02412-x.
The present systematic review investigates whether different doses of vitamin D and calcium supplementation in women with postmenopausal osteoporosis undergoing antiresorptive therapy have an association with BMD (spine, hip, femur neck), serum markers of osteoporosis (bone-ALP, NTX, CTX), the rate of pathological vertebral and non-vertebral fractures, adverse events, and mortality. This systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Scopus databases were accessed in September 2024. All randomised clinical trials (RCTs) comparing two or more treatments for postmenopausal osteoporosis supplemented with vitamin D and/or calcium were accessed. Only studies that indicated daily vitamin D and/or calcium supplementation doses were accessed. Data from 37 RCTs (43,397 patients) were retrieved. Patients received a mean of 833.6 ± 224.0 mg and 92.8 ± 228.7 UI of calcium and vitamin D supplementation, respectively. The mean length of the follow-up was 25.8 ± 13.3 months. The mean age of the patients was 66.4 ± 5.6 years, and the mean BMI was 25.2 ± 1.6 kg/m. There was evidence of a statistically significant negative association between daily vitamin D supplementation and gastrointestinal adverse events (r = - 0.5; P = 0.02) and mortality (r = - 0.7; P = 0.03). No additional statistically significant associations were evidenced. In postmenopausal women who undergo antiresorptive treatment for osteoporosis, vitamin D was associated with a lower frequency of gastrointestinal adverse events and mortality. Calcium supplementation did not evidence an association with any of the endpoints of interest.Level of evidence Level I, systematic review of RCTs.
本系统评价旨在研究接受抗吸收治疗的绝经后骨质疏松症女性补充不同剂量的维生素D和钙是否与骨密度（脊柱、髋部、股骨颈）、骨质疏松血清标志物（骨碱性磷酸酶、NTX、CTX）、病理性椎体和非椎体骨折发生率、不良事件及死亡率相关。本系统评价按照PRISMA 2020指南进行。于2024年9月检索了PubMed、谷歌学术、Embase和Scopus数据库。纳入了所有比较两种或更多种补充维生素D和/或钙治疗绝经后骨质疏松症的随机临床试验（RCT）。仅纳入了标明每日维生素D和/或钙补充剂量的研究。检索到来自37项RCT（43397例患者）的数据。患者钙补充剂和维生素D补充剂的平均摄入量分别为833.6±224.0mg和92.8±228.7IU。平均随访时间为25.8±13.3个月。患者的平均年龄为66.4±5.6岁，平均BMI为25.2±1.6kg/m²。有证据表明每日补充维生素D与胃肠道不良事件（r = -0.5；P = 0.02）及死亡率（r = -0.7；P = 0.03）之间存在统计学显著负相关。未发现其他具有统计学显著意义的相关性。在接受骨质疏松症抗吸收治疗的绝经后女性中，维生素D与较低的胃肠道不良事件发生率和死亡率相关。补充钙未显示与任何感兴趣的终点存在相关性。证据级别：I级，RCT的系统评价。
