Can Vitamin D Supplementation Reduce the Risk of Fracture in the Elderly? A Randomized Controlled Trial
作者:Haakon E. Meyer、Guro B. Smedshaug、Elisabeth Kvaavik、Jan A. Falch、Aage Tverdal、Jan I. Pedersen
DOI:10.1359/jbmr.2002.17.4.709
日期:——
Randomized controlled trials have shown that a combination of vitamin D and calcium can prevent fragility fractures in the elderly. Whether this effect is attributed to the combination of vitamin D and calcium or to one of these nutrients alone is not known. We studied if an intervention with 10 μg of vitamin D3 per day could prevent hip fracture and other osteoporotic fractures in a double‐blinded randomized controlled trial. Residents from 51 nursing homes were allocated randomly to receive 5 ml of ordinary cod liver oil (n = 569) or 5 ml of cod liver oil where vitamin D was removed (n = 575). During the study period of 2 years, fractures and deaths were registered, and the principal analysis was performed on the intention‐to‐treat basis. Biochemical markers were measured at baseline and after 1 year in a subsample. Forty‐seven persons in the control group and 50 persons in the vitamin D group suffered a hip fracture. The corresponding figures for all nonvertebral fractures were 76 persons (control group) and 69 persons (vitamin D group). There was no difference in the incidence of hip fracture (p = 0.66, log‐rank test), or in the incidence of all nonvertebral fractures (p = 0.60, log‐rank test) in the vitamin D group compared with the control group. Compared with the control group, persons in the vitamin D group increased their serum 25‐hydroxyvitamin D concentration with 22 nmol/liter (p = 0.001). In conclusion, we found that an intervention with 10 μg of vitamin D3 alone produced no fracture‐preventing effect in a nursing home population of frail elderly people.
随机对照试验表明,维生素 D 和钙的结合可以预防老年人脆性骨折。至于这种效果是归功于维生素 D 和钙的结合,还是单独归功于其中一种营养素,目前尚不清楚。我们在一项双盲随机对照试验中研究了每天摄入 10 μg 维生素 D3 的干预措施能否预防髋部骨折和其他骨质疏松性骨折。来自 51 家养老院的居民被随机分配到 5 毫升普通鱼肝油(569 人)或 5 毫升去除了维生素 D 的鱼肝油(575 人)中。在为期两年的研究期间,对骨折和死亡病例进行了登记,并在意向治疗的基础上进行了主要分析。在基线和一年后,对一个子样本的生化指标进行了测量。对照组中有 47 人髋部骨折,维生素 D 组中有 50 人髋部骨折。所有非椎体骨折的相应数字分别为 76 人(对照组)和 69 人(维生素 D 组)。与对照组相比,维生素 D 组的髋部骨折发生率(p = 0.66,对数秩检验)和所有非椎体骨折发生率(p = 0.60,对数秩检验)均无差异。与对照组相比,维生素 D 组患者的血清 25- 羟维生素 D 浓度增加了 22 毫摩尔/升(p = 0.001)。总之,我们发现,在疗养院的体弱老人中,仅使用 10 微克维生素 D3 的干预措施不会产生预防骨折的效果。