补充钙和维生素D预防骨质疏松性骨折疗效述评

骨质疏松性骨折是一项老年人常见的骨质疏松症的并发症，补充钙和维生素D已被认为是一种比较经济的防治骨质疏松性骨折的方法，但是有些多中心临床研究并未证实这一观点。因此，我们全面综述了临床进展，并分析了影响疗效的相关因素，结合国际权威学术机构的补充钙和维生素D预防骨质疏松症和骨质疏松性骨折的推荐和我国具体情况，提出：①补充钙和维生素D以及锻炼对骨质疏松症和骨质疏松性骨折的确有预防作用；②我国居民的平均钙摄入量低（389mg／d），所有年龄组的人都应该补充钙和维生素D，特别是中老年人；③预防骨质疏松性骨折的基础用药是补充钙和维生素D，但需要加用其他抗骨质疏松药物。     

维生素D3和维生素K3对实验性肾结石的影响

目的：探讨维生素C3和维生素K3与尿石症的关系。方法SD大鼠36只,随机分为对照组（A组）、成石组（B组）、维生D3组（C组）、成石＋维生素D3组（D组）、维生素K3组（E组）和成石＋维生素K3组（F组）,用免疫组化和原位杂交技术检测各组大鼠肾脏骨桥蛋白（OPN）及其mRNA的表达量,并测定尿晶体成分的浓度。结果：免疫组化结果显示,OPN主要表达于肾脏远曲小管和集合管,B、C、E组鼠肾和OPN的表达强度明显高于A组（P均＜0．05）;D、F组OPN的表达强度明显高于C、E组（P均＜0．05）,即维生素D3或维生素K3与诱石剂合用时呈相加效应。应用诱石剂后,D组尿钙排泄量明显增加,而F组草酸盐明显低于B组（P＜0．05）。维生素K3可减少尿划石剂后,D组尿排泄量明显增加,而组草酸盐明显低于B组（P＜0．05）。维生素K3可减少尿草酸盐的分泌和草酸钙晶体的沉积。结论：维生素D3可能通过多种机制种促进肾结石殂成,而维生素K3有抑制结石形成的作用。     

补充牛奶和维生素D对SD大鼠骨密度的影响

目的研究补充牛奶和维生素D对老龄大鼠骨密度(BMD)的影响。方法选取80只18月龄的SD大鼠,雌雄各半,作为骨质疏松模型。适应1周,随机分为两组,饮奶组按体重0.083ml·g-1·d-1灌胃并加维生素D36.6IU·kg-1·d-1,正常进食,自由饮水。不饮奶组普通饲料饲喂,自由饮水。灌胃前后使用双能X线骨密度仪测量双侧股骨骨密度(BMD)。结果4周后饮奶组较灌胃前骨密度(BMD)平均增加0.058gcm2,与灌胃前比较差别有统计学意义(P<0.05)。而不饮奶组灌胃后比灌胃前骨密度(BMD)减少0.007gcm2,灌胃前后差别无统计学意义。两组间比较灌胃前后骨密度(BMD)变化显著(P<0.05)。结论牛奶加低剂量维生素D有增加骨密度(BMD)作用。     

Fracture prevention with vitamin D supplementation: considering the inconsistent results

Background  

A meta-analysis found that high dose vitamin D, different from low dose, decreased fracture risk by 23% for any nonvertebral fracture and by 26% for hip fracture. Unfortunately, however, this effect was not confirmed by recent trials. The aim of this paper is to explore if this inconsistency can be attributed to publication bias or heterogeneity of the trials.     

Effect of vitamin D supplementation on bone health parameters of healthy young Indian women

Summary

There is a huge prevalence of hypovitaminosis D in the Indian population. We studied the efficacy and safety of oral vitamin D supplementation in apparently healthy adult women. Monthly cholecalciferol given orally, 60,000 IU/month during summers and 120,000 IU/month during winters, safely increases 25-hydroxyvitamin D (25(OH)D) levels to near normal levels.

Introduction

There is a huge burden of hypovitaminosis D in the Indian population. The current recommendation for vitamin D supplementation is not supported by sufficient evidence.

Methods

Study subjects included 100 healthy adult women of reproductive age group from hospital staff. They were randomized into group A (control) and group B (supplement) by simple randomization. Group B received 60,000 IU of cholecalciferol/month administered orally for 3 months, and then group A received 60,000 IU and group B 120,000 IU/month for 6 months.

Results

Mean baseline 25(OH)D level was 4.5?±?3.1 ng/ml and parathyroid hormone level was 50?±?25 pg/ml. In group B, 25(OH)D levels increased from 4.8?±?3.5 to 31.6?±?15.5 ng/ml (P?<?0.001) in 3 months. Interestingly, the increase, although of lower magnitude, was also observed in control group A, from 4.5?±?3.4 ng/ml (in spring) to 10.8?±?7.2 ng/ml (in summer; P?<?0.001). In group A (60,000 IU/month), mean 25(OH)D level had increased to 22.3?±?12.4 ng/ml (P?<?0.001) at 9 months (winter). In group B (120,000 IU/month), 25(OH)D levels were maintained at 30.7?±?12.8 ng/ml at 9 months (winter).

Conclusion

Our data show that monthly administration of 60,000 IU cholecalciferol in healthy subjects with hypovitaminosis D may suffice in summer months, but higher doses may be more appropriate during winter months.     

人参水煎剂防治去卵巢大鼠骨量丢失的骨形态计量学观察

目的 探讨人参水煎剂对去卵巢大鼠骨量丢失的骨形态学改变及其预防作用。方法4.5月龄SD雌性大鼠,按体重随机分为基础组、假手术组、去卵巢组、已烯雌酚阳性用药组、人参低剂量用药组、人参高剂量用药组,共给药10周,取胫骨上段骨组织包埋,不脱钙骨切片,用全自动图像分析仪及松质骨形态计量学软件进行测量和分析,观察人参对骨形态计量学参数的影响。结果 去卵巢10周后骨量丢失和破骨细胞活性、骨形成及骨转换率增加,差异有显著性(P<0.01)。低剂量的人参能使骨量增加26.6％,高剂量能使骨量增加35.1％,高低两剂量人参能使大鼠的骨吸收和骨转换率均下降,差异有显著性(P<0.01或0.05),不抑制藕联的骨形成。结论去卵巢大鼠骨量丢失,骨转换率增高,出现明显的骨质疏松;已烯雌酚(10μg·kg-1·d-1)能抑制骨吸收,也抑制骨形成。人参有增加骨量的趋势,增加骨形成,并对子宫无刺激作用,有弱的预防去卵巢大鼠的骨量丢失作用。     

钙剂、活性维生素D3对十堰地区低骨量人群的干预

目的 应用钙剂、活性维生素D3对低骨量人群进行干预治疗,观察其对BMD、BGP、DPD及预防骨质疏松的作用.方法 选取骨量减少患者100例,随机分成对照组和治疗组,每组50例,对照组服用乐力(2g/d),治疗组服用乐力(2g/d)和阿法迪三(0.5μg/d),连续治疗12个月.在治疗前、治疗后6月和12月检测BMD、BGP、DPD.结果 两组经治疗后BMD、BGP均较治疗前增加(P<0.05),DPD下降(P<0.05),以治疗组差异更为明显,组间比较有统计学意义(P<0.05).结论 骨量减少应早期干预治疗,钙剂与活性维生素D联合应用可以更有效地预防及延缓骨质疏松的发生.     

钙剂、活性维生素D3对十堰地区低骨量人群的干预

目的应用钙剂、活性维生素D3对低骨量人群进行干预治疗,观察其对BMD、BGP、DPD及预防骨质疏松的作用。方法选取骨量减少患者100例,随机分成对照组和治疗组,每组50例,对照组服用乐力(2g/d),治疗组服用乐力(2g/d)和阿法迪三(0.5μg/d),连续治疗12个月。在治疗前、治疗后6月和12月检测BMD、BGP、DPD。结果两组经治疗后BMD、BGP均较治疗前增加(P<0.05),DPD下降(P<0.05),以治疗组差异更为明显,组间比较有统计学意义(P<0.05)。结论骨量减少应早期干预治疗,钙剂与活性维生素D联合应用可以更有效地预防及延缓骨质疏松的发生。     

Onion decreases the ovariectomy-induced osteopenia in young adult rats

It has been suggested that fruit and vegetable consumption are associated with good bone health. Onion, in particular, has been verified in its efficacy in bone resorption activity. In this study, we further investigated the effects of an onion-containing diet on ovariectomy-induced bone loss using methods of serum marker assay, histomorphometric analysis and biomechanical tests. Sixty-four female Wistar rats (14-week-old) with sham operations or ovariectomy were assigned to 6 groups: CON, sham-operated control group; OVX, ovariectomized group; ALN, ovariectomized rats treated with alendronate (1 mg/kg/day, p.o.); and 3% ON, 7% ON and 14% ON, ovariectomized rats fed with diets containing 3%, 7% and 14% (wt/wt) onion powder, respectively. Animals were sacrificed after a six-week treatment course. In the serum marker assay, alendronate and all three onion-enriched diets significantly decreased serum calcium level (p<0.05). Both 14% ON group and the ALN group even showed similarly lower level of serum osteocalcin (p<0.05), suggesting a down-regulation of bone turnover. The histomorphometric analysis showed that ovariectomy markedly decrease bone trabeculae. The ALN and 14% ON rats were 80% and 46% higher, respectively, in BV/TV than the OVX rats (p<0.05), and the rats fed with onion-enriched food showed a lesser ovariectomy-induced bone loss in a dose-dependent manner. Additionally, both ALN and 14% ON groups had significantly more trabecular number, less separated trabeculae, and fewer osteoclasts (p<0.05), but the protective efficacy from the 14% onion-enriched diet was slightly inferior to that of alendronate. Ovariectomy also significantly decreased tissue weight and biomechanical strength in the OVX group (p<0.05). The ALN and 14% ON groups equivalently showed a lesser decrease in tissue weight, though the difference was not significant. On the other hand, both the ALN and 14% ON groups represented similar biomaterial properties of femurs, and both reduced the ovariectomy-induced decrease in bending load and bending energy (p<0.05). The present study further verified that an onion-enriched diet could counteract ovariectomy-induced bone loss and deterioration of biomechanical properties.     

补充钙和维生素D防治骨质疏松症的全球临床指南进展

补充钙和维生素D防治骨质疏松症一直是全球权威学术机构临床指南的基本策略。然而,近来一些研究对过量补充钙和维生素D的健康骨骼益处提出不同的观点,从而干扰了国际公认的防治骨质疏松症的基本策略,混淆了临床医师的视听。因此,笔者综述近几年来中国、美国、加拿大、英国、波兰、日本、韩国等权威学术机构的临床指南的观点,重点介绍骨质疏松症的发病机制和病理生理学关注的骨重建的主要局部调节剂[受体激活剂核因子kb(RANK)及其配体RANKL和诱饵受体骨保护素(OPG);罗列各国为防治骨质疏松症推荐的钙和维生素D摄入量;联合补充钙和维生素D有利于防治骨质疏松症和骨质疏松性骨折;分析补充钙和维生素D的健康骨骼争议,一般健康人每天服用钙补充剂不应该超过1000 mg。特别是基于亚洲人(中国人、日本人、韩国人)的膳食钙摄入量、血脂水平、身体体重指数(BMI)和维生素D营养状况,参考中国、日本、韩国的补充钙和维生素D防治骨质疏松症的临床指南,提出钙和维生素D补充的方法:每日一次服用碳酸钙和维生素D3补充剂的剂量以元素钙500~600 mg和维生素D3200 IU为宜,比较适合中国成年人群预防骨质疏松症。如果需要补充更多剂量的钙和维生素D,必须分成多次服用。这些信息供我国临床医师参考使用。     

Differential effect of caffeine administration on calcium and vitamin D metabolism in young and adult rats

Since coffee drinking may lead to a worsening of calcium balance in humans, we studied the serial changes of serum calcium, PTH, 1,25-dihydroxyvitamin D (1,25(OH)2D) and calcium balance in young and adult rats after daily administration of caffeine for 4 weeks. In the young rats, there was an increase in urinary calcium and endogenous fecal calcium excretion after four days of caffeine administration that persisted for the duration of the experiment. Serum calcium decreased on the fourth day of caffeine administration and then returned to control levels. In contrast, the serum PTH and 1,25(OH)2D remained unchanged initially, but increased after 2 weeks of caffeine administration. The intestinal absorption coefficient of calcium remained unchanged, instead of declining gradually as observed in the young control group. This finding suggests that the intestinal absorption of calcium was stimulated by the increase in 1,25(OH)2D production after chronic administration of caffeine. In the adult rat group, an increase in the urinary calcium and endogenous fecal calcium excretion and serum levels of PTH was found after caffeine administration. However, the serum 1,25(OH)2D levels and intestinal absorption coefficient of calcium remained the same as in the adult control group. A decrease in the net balance of calcium occurred as a result of increased calcium excretion. The current study, using an animal model, supports the suggestion that chronic administration of caffeine could lead to negative calcium balance when there is an impaired ability to increase the efficiency of calcium absorption. Such a situation exists in elderly human subjects, since they have a reduced capacity to synthesize 1,25(OH)2D.     

Effects on bone mineral density of calcium and vitamin D supplementation in elderly women with vitamin D deficiency

OBJECTIVE: Calcium and vitamin D deficiency is common in older individuals, particularly those who live in nursing homes, and increases the risk of osteoporosis and fractures. METHODS: We conducted a randomized double-blind placebo-controlled study of combined supplementation with 500 mg of elemental calcium, as carbonate, and 400 IU of vitamin D bid for 12 months in women older than 65 years of age with vitamin D deficiency, defined as serum 25(OH)D concentrations 相似文献   

Vitamin D metabolites prevent vertebral osteopenia in ovariectomized rats

Summary The present study investigated the prophylactic effects of vitamin D metabolites and vitamin D metabolite combinations on static and dynamic, tetracycline-based, histomorphometric parameters in the axial skeleton of ovariectomized rats. Forty-three Fischer-344 rats (10 weeks old, 130 g each body weight, BW) were either bilaterally ovariectomized (OVX) or sham-operated (SHAM). The rats were allocated into the following groups: SHAM; OVX; OVX+7.5 ng 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃]/rat/day; OVX +15 ng 1,24R,25-trihydroxyvitamin D₃ [1,24,25-(OH)₃D₃]/rat/day; OVX+75 ng 24R,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃]/rat/day; OVX+7.5 ng 1,25(OH)₂D₃/rat/ day+15 ng 1,24,25(OH)₃D₃/rat/day; OVX+7.5 ng 1,25(OH)₂D₃/rat/day+75 ng 24,25(OH)₂D₃/rat/day. The vitamin D metabolites were fed orally starting 4 weeks after surgery. Urine and blood samples were collected 12 and 16 weeks postovariectomy, respectively. Sixteen weeks after surgery, all rats were sacrificed, and the first lumbar vertebrae were processed undecalcified for histomorphometric analysis. Ovariectomy induced a highly significant reduction (P<0.001) of cancellous bone mass in the secondary spongiosa of the lumbar vertebral body. The bone loss in OVX rats was accompanied by a distinct elevation of all histomorphometric parameters of bone formation and resorption. 1,25(OH)₂D₃ and both vitamin D metabolite combinations significantly raised serum calcium levels and prevented the bone loss by inhibiting the increased bone resorption in OVX rats. In the applied dosage, 1,24,25(OH)₃D₃ and 24,25(OH)₂D₃ alone were ineffective in preserving the cancellous bone of the lumbar vertebra in OVX rats. We conclude that the oral prophylactic application of low doses of active vitamin D metabolites can effectively prevent the osteopenia induced by ovariectomy in the axial skeleton of the rat.     

Differential effects of vitamin D receptor activators on vascular calcification in uremic rats

Vascular calcification is associated with cardiovascular disease, the most common cause of death in chronic kidney disease (CKD). Patients with CKD are treated with vitamin D receptor activators (VDRAs); therefore, we determined if this treatment affects vascular calcification. Uremic rats were given vehicle, calcitriol, paricalcitol, or doxercalciferol three times a week for 1 month. Calcitriol significantly increased the serum calcium-phosphate product and aortic calcium content. Paricalcitol had no effect but the same dose of doxercalciferol significantly increased the calcium-phosphate product and the aortic calcium content, the latter being confirmed by von Kossa staining. To see if the increased aortic calcium was due to an increased serum calcium-phosphate product or to a differential effect of the two VDRAs, we lowered the dose of doxercalciferol and increased the dose of paricalcitol. A lower doxercalciferol did not increase the calcium-phosphate product but increased the aortic calcium content. A higher dose of paricalcitol still had no effect. Doxercalciferol treatment increased the mRNA and protein expression of the bone-related markers Runx2 and osteocalcin in the aorta, whereas paricalcitol did not. Hence, different VDRAs have different effects on vascular calcification in uremic rats. The effects are independent of the serum calcium-phosphate product suggesting independent mechanisms.     

Effect of vitamin D supplementation in the institutionalized elderly

An intervention study with vitamin D supplementation was conducted in order to study the amount of vitamin D required in the elderly. Sixty-four institutionalized elderly were randomly assigned to two groups: group (A) to take a beverage containing 200 mg calcium daily, and group (B) to take a beverage containing 200 mg calcium and 5 μg vitamin D daily for 30 days. Prior to the study, the subjects' average vitamin D intake was 7.3 μg/day, which is approximately 150% of the current adequate intake (AI), however their mean plasma 25OH-D level at baseline was only 12 ng/mL, strongly indicating hypovitaminosis D. During the study, average plasma 25OH-D concentration significantly increased to 14.7 ng/mL in group (B), but not in group (A). However, group (B) was still in the hypovitaminosis range. Thus, daily intake exceeding the current AI of 5 μg is required for the institutionalized elderly.     

Effects of vitamin K2, vitamin D, and calcium on the bone metabolism of rats in the growth phase

 Using 168 female Sprague-Dawley rats, we determined whether the peak bone mass could be increased, and which drugs would be effective in suppressing the rate of decrease in bone mass by continuous administration from childhood. At the age of 3 months, these 168 rats were divided into five groups depending on the type of diet that they were fed (control, regular; group A, vitamin K₂; group B, vitamin D; group C, high calcium; group D, vitamins D and K₂ and high calcium) and kept to the age of 16 months. Dual-energy X-ray absorptiometry (DXA) was used to measure the bone mineral density of the femoral epiphysis and microcomputed tomography (CT) to analyze its fine structure. The average bone mass increased rapidly with age and reached a peak at the age of 8 months. Peak bone mass for the four drug administration groups was higher than that for the control group. Among these four groups, the peak bone mass was the highest in group C and the rate of decrease the smallest in group D. The results of the present animal study suggest that the peak bone mass of humans can be raised by consuming sufficient amounts of vitamins K₂ and D and calcium continuously from childhood, and that this diet will suppress the rate of decrease in bone mass, thus ultimately preventing bone fractures caused by osteoporosis. Received: June 12, 2001 / Accepted: January 22, 2002     

Beneficial effects of vitamin E isomer supplementation on static and dynamic bone histomorphometry parameters in normal male rats

Bone is a specialized connective tissue that functions as the load-bearing structure of the body. Free radicals may affect bone remodeling by regulating osteoclast activity in either the physiological or pathological condition. Vitamin E, a lipid-soluble antioxidant, has been demonstrated to offer protection against osteoporosis and to improve the bone material and structure of animal models. The aim of this study was to observe and compare the effects of alpha-tocopherol (α-tocopherol), delta-tocotrienol (δ-tocotrienol), and gamma-tocotrienol (γ-tocotrienol) on the static and dynamic bone histomorphometric parameters in normal male rats. Thirty-two normal Sprague–Dawley male rats aged 3 months and weighing 200–250 g were randomly divided into four groups. The control group was supplemented with oral gavages of olive oil (vehicle), whereas the α-tocopherol, δ-tocotrienol, and γ-tocotrienol groups were given oral gavages of 60 mg/kg α-tocopherol, δ-tocotrienol, and γ-tocotrienol, respectively. The rats were injected twice with calcein to fluorochrome-label the bones. After 4 months of treatment, the rats were killed, and the left femurs were dissected out and prepared for bone histomorphometry. Both the static and dynamic parameters of the vitamin E-treated groups were better than those of the normal control group. Among the vitamin E-treated groups, the tocotrienol groups showed better histomorphometry results compared to the α-tocopherol group, with the γ-tocotrienol group demonstrating the best effects on both sets of parameters. We concluded that vitamin E can promote bone formation in normal rats, with γ-tocotrienol being the most potent form of vitamin E.