Vitamin D and Calcium for the Prevention of Fracture A Systematic Review and Meta-analysis
文献类型：期刊论文
| 作者 | Yao, Pang3,5; Bennett, Derrick3,5; Mafham, Marion3,5; Chen, Zhengming3,5; Armitage, Jane3,5,6; Clarke, Robert3,5; Lin, Xu1,2,4; Chen, Zhengming6; , |
| 刊名 | JAMA NETWORK OPEN
 |
| 出版日期 | 2019 |
| 卷号 | 2期号:12页码:e1917789 |
| ISSN号 | 2574-3805 |
| DOI | 10.1001/jamanetworkopen.2019.17789 |
| 文献子类 | Review |
| 英文摘要 | IMPORTANCE Vitamin D and calcium supplements are recommended for the prevention of fracture, but previous randomized clinical trials (RCTs) have reported conflicting results, with uncertainty about optimal doses and regimens for supplementation and their overall effectiveness. OBJECTIVE To assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D (25[OH]D) in observational studies and the risks of fracture associated with supplementation with vitamin D alone or in combination with calcium in RCTs. DATA SOURCES PubMed, EMBASE, Cochrane Library, and other RCT databases were searched from database inception until December 31, 2018. Searches were performed between July 2018 and December 2018. STUDY SELECTION Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included. Randomized clinical trials compared vitamin D or vitamin D and calcium with control. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and assessed possible bias. Rate ratios (RRs) were estimated using fixed-effects meta-analysis. Data extraction and synthesis took place between July 2018 and June 2019. MAIN OUTCOMES AND MEASURES Any fracture and hip fracture. RESULTS In a meta-analysis of 11 observational studies (39 141 participants, 6278 fractures, 2367 hip fractures), each increase of 10.0 ng/mL (ie, 25 nmol/L) in 25 (OH)D concentration was associated with an adjusted RR for any fracture of 0.93 (95% CI, 0.89-0.96) and an adjusted RR for hip fracture of 0.80 (95% CI, 0.75-0.86). Ameta-analysis of 11 RCTs (34 243 participants, 2843 fractures, 740 hip fractures) of vitamin D supplementation alone (daily or intermittent dose of 400-30 000 IU, yielding a median difference in 25[OH]D concentration of 8.4 ng/mL) did not find a reduced risk of any fracture (RR, 1.06; 95% CI, 0.98-1.14) or hip fracture (RR, 1.14; 95% CI, 0.98-1.32), but these trials were constrained by infrequent intermittent dosing, low daily doses of vitamin D, or an inadequate number of participants. In contrast, a meta-analysis of 6 RCTs (49 282 participants, 5449 fractures, 730 hip fractures) of combined supplementation with vitamin D (daily doses of 400-800 IU, yielding a median difference in 25[OH]D concentration of 9.2 ng/mL) and calcium (daily doses of 1000-1200mg) found a 6% reduced risk of any fracture (RR, 0.94; 95% CI, 0.89-0.99) and a 16% reduced risk of hip fracture (RR, 0.84; 95% CI, 0.72-0.97). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D alone was associated with reduced risk of fracture, but daily supplementation with both vitamin D and calcium was a more promising strategy. |
| 学科主题 | Cell Biology |
| WOS关键词 | SERUM 25-HYDROXYVITAMIN D ; BONE-MINERAL DENSITY ; D SUPPLEMENTATION ; DOUBLE-BLIND ; CONTROLLED-TRIAL ; HIP FRACTURE ; OLDER-PEOPLE ; RANDOMIZED-TRIAL ; ELDERLY-PEOPLE ; DOSE-RESPONSE |
| 语种 | 英语 |
| CSCD记录号 | CSCD:31860103 |
| WOS记录号 | WOS:000512329100095 |
| 出版者 | AMER MEDICAL ASSOC |
| 版本 | 出版稿 |
| 源URL | [http://202.127.25.144/handle/331004/1134]  |
| 专题 | 中国科学院上海生命科学研究院营养科学研究所 |
| 作者单位 | 1.Chinese Acad Sci, Shanghai Inst Biol Sci, Shanghai, Peoples R China; 2.Univ Chinese Acad Sci, Shanghai, Peoples R China; 3.Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England; 4.Chinese Acad Sci, Key Lab Nutr Metab & Food Safety, Shanghai Inst Nutr & Hlth, Shanghai, Peoples R China; 5.Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England; 6.Univ Oxford, Med Res Council Populat Hlth Res Unit, Nuffield Dept Populat Hlth, Oxford, England, |
| 推荐引用方式 GB/T 7714 | Yao, Pang,Bennett, Derrick,Mafham, Marion,et al. Vitamin D and Calcium for the Prevention of Fracture A Systematic Review and Meta-analysis[J]. JAMA NETWORK OPEN,2019,2(12):e1917789. |
| APA | Yao, Pang.,Bennett, Derrick.,Mafham, Marion.,Chen, Zhengming.,Armitage, Jane.,...&,.(2019).Vitamin D and Calcium for the Prevention of Fracture A Systematic Review and Meta-analysis.JAMA NETWORK OPEN,2(12),e1917789. |
| MLA | Yao, Pang,et al."Vitamin D and Calcium for the Prevention of Fracture A Systematic Review and Meta-analysis".JAMA NETWORK OPEN 2.12(2019):e1917789. |
入库方式： OAI收割
来源：上海营养与健康研究所
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