Vitamin D: Update Bone and Muscle Effects

Zusammenfassung

Vitamin D verändert das Frakturrisiko auf 2-fache Weise: über Sturzreduktion und über eine Verbesserung der Knochendichte. Zwei aktuelle Metaanalysen hochqualitativer Doppelblindstudien kamen zu dem Ergebnis, dass Vitamin D das Sturzrisiko um 19 %, das Hüftbruchrisiko um 18 % reduziert, und dass Vitamin D das Risiko für jegliche nicht vertebrale Frakturen um 20 % heruntersetzt. Allerdings war dieser Vorteil von der Dosierung abhängig: Sturzprävention setzte eine minimale Dosis von 700 Einheiten Vitamin D pro Tag voraus, und die Frakturprävention setzte eine erhaltene Dosis (Behandlungsdosis × Adherenz) von über 400 Einheiten Vitamin D pro Tag voraus. Sturzprävention fand entsprechend ab erreichtem 25-Hydroxyvitamin-D-Blutspiegel von mindestens 60 nmol / l (24 ng / ml), Frakturprävention ab mindestens 75 nmol / l (30 ng / ml) statt. Beide Endpunkte verbesserten sich weiter mit höheren 25-Hydroxyvitamin-D-Spiegeln. Evidenzbasiert sollten ältere Personen ab 60 und postmenopausale Frauen generell 700–1000 IU Vitamin D pro Tag einnehmen als effiziente, günstige und gut verträgliche Prävention gegen Stürze und Frakturen. Ältere Personen mit einem schweren Vitamin-D-Mangel oder übergewichtige Personen brauchen möglicherweise eine höhere Dosierung.

Abstract

Vitamin D modulates fracture risk in 2 ways: by decreasing falls and increasing bone density. Two most recent meta-analyses of double-blind randomized controlled trials came to the conclusion that vitamin D reduces the risk of falls by 19 %, the risk of hip fracture by 18 % and the risk of any non-vertebral fracture by 20 %, however this benefit was dose-dependent. Fall prevention was only observed in trial of at least 700 IU vitamin D per day, and fracture prevention required a received dose (treatment dose × adherence) of more than 400 IU vitamin D per day. Anti-fall efficacy started with achieved 25-hydroxyvitamin D levels of at least 60 nmol / l (24 ng / ml) and anti-fracture efficacy started with achieved 25-hydroxyvitamin D levels of at least 75 nmol / l (30 ng / ml) and both endpoints improved further with higher achieved 25-hydroxyvitamin D levels. Based on these evidence-based data derived from the general older population, vitamin D supplementation should be at least 700–1000 IU per day and taken with good adherence to cover the needs for both fall and fracture prevention. Ideally, the target range for 25-hydroxyvitamin D should be at least 75 nmol / l, which may need more than 700–1000 IU per day vitamin D in older individuals with severe vitamin D deficiency or those overweight.

Schlüsselwörter

Vitamin D - Stürze - Knochendichte - Frakturen - Supplementierung - 25-Hydroxyvitamin D

Keywords

vitamin D - falls - bone density - fractures - supplementation - 25-hydroxyvitamin D

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