PDF(Pubmed)
Abstract：
Three recently-completed, large clinical trials in the U.S, New Zealand, and Australia, referred to herein as the \'mega-trials\', were conducted to determine the impact of supplemental vitamin D on a variety of outcomes including falls and fractures. The trials were similar in design and collectively included over 50,000 generally vitamin D replete, older men and women. The mega-trials established that vitamin D supplementation with the equivalent of 2000 to 3300 IU/d of vitamin D3 had no favorable effect on risk of falls or fractures. This review focuses on specific design elements of the trials and how they likely influenced these trial findings. While these trials were in progress, evidence emerged that circulating 25-hydroxyvitamin D levels have a U-shaped association with risk of falling, raising concern about a potential untoward effect of high dose supplementation. There is compelling evidence that in older, vitamin D- and calcium-insufficient nursing home residents, the combination of vitamin D and calcium in modest replacement doses dramatically reduces the risk of hip and other fractures. Community-dwelling older adults in many populous countries around the globe have widespread vitamin D and calcium insufficiency. It is time to follow the evidence trail and determine the effect of vitamin D and calcium replacement on their risk of falls and fractures.
摘要：
最近完成的三个，美国的大型临床试验,新西兰,澳大利亚,在此称为“大型试验”，我们的目的是确定补充维生素D对包括跌倒和骨折在内的各种结局的影响。这些试验的设计相似，总共包括超过50,000个维生素D充足，年长的男人和女人。大型试验确定，补充维生素D相当于2000至3300IU/d的维生素D3对跌倒或骨折的风险没有有利影响。这篇综述集中在试验的具体设计元素以及它们如何可能影响这些试验结果。虽然这些试验正在进行中，有证据表明，循环中的25-羟维生素D水平与下降的风险呈U型关系，引起人们对大剂量补充的潜在不利影响的关注。有令人信服的证据表明，在老年人中，维生素D和钙不足的养老院居民，维生素D和钙以适度的替代剂量联合使用可显著降低髋部和其他骨折的风险.全球许多人口众多国家的社区居住老年人普遍存在维生素D和钙不足。现在是时候追踪证据并确定维生素D和钙替代对跌倒和骨折风险的影响。
