天津首次在頂級期刊JAMA發文：老年人補鈣和維生素D不能預防骨折
趙嘉國，男，1982年出生，博士，2015年破格晉升副主任醫師。從事足踝外科、創傷骨科和Cochrane循證醫學的工作。
JAMA，2017年12月26日318(24):2466-2482
補鈣或補充維生素D與社區居住的老年人骨折發生率的相關性——一項系統性評價和薈萃分析
Jia-Guo Zhao, MD1; Xian-Tie Zeng, MD1; Jia Wang, MD1; et al Lin Liu, MD2
·1Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
·2Department of Orthopaedic Surgery, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China
JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344
要點
問題：在社區居住的老年人中補鈣、補充維生素或者兩者聯合補充是否與較低的骨折發生率相關？
結果發現：在對共計納入了51145名參試者的33項隨機化臨床試驗的薈萃分析中發現，使用含鈣、維生素D或兩者都有的補充劑，與安慰劑或不治療相比，髖部骨折的風險並沒有顯著差異（風險比分別為1.53、1.21、1.09）。
意義：所發現的這些結果並不支持在社區居住的老年人中常規使用這類補充劑。
《壹篇》南南和北北
December 26, 2017
Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older AdultsA Systematic Review and Meta-analysis
Jia-Guo Zhao, MD1; Xian-Tie Zeng, MD1; Jia Wang, MD1; et al Lin Liu, MD2
·1Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
·2Department of Orthopaedic Surgery, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China
JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344
Key Points
Question Is supplementation with calcium, vitamin D, or combined calcium and vitamin D associated with a lower fracture incidence in community-dwelling older adults?
Findings In this meta-analysis of 33 randomized clinical trials that included 51 145 participants, the use of supplements that included calcium, vitamin D, or both was not associated with a significant difference in the risk of hip fractures compared with placebo or no treatment (risk ratio, 1.53, 1.21, and 1.09, respectively).
Meaning These findings do not support the routine use of these supplements in community-dwelling older adults.
Abstract
Importance The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.
Data Sources The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017.
Study Selection Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.
Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.
Main Outcomes and Measures Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture.
Results A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
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