Effect of monthly high-dose vitamin D on bone density in community-dwelling older adults substudy of a randomized controlled trial
| Autor: | Robert Scragg, Lucie Taylor, Anne Horne, Manisha Singh, Sheryl Fenwick, Ian R. Reid, Borislav Mihov, Fadiya Al-Abuwsi, Gregory D. Gamble, Alistair W. Stewart, Carlos A. Camargo |
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| Rok vydání: | 2017 |
| Předmět: |
musculoskeletal diseases
Vitamin Male medicine.medical_specialty Bone density Osteoporosis Population 030209 endocrinology & metabolism vitamin D deficiency 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Bone Density Internal medicine Internal Medicine medicine Vitamin D and neurology Humans 030212 general & internal medicine Vitamin D education Femoral neck Aged Aged 80 and over Osteomalacia education.field_of_study business.industry Middle Aged medicine.disease medicine.anatomical_structure chemistry Physical therapy Female Independent Living business |
| Zdroj: | Journal of internal medicine. 282(5) |
| ISSN: | 1365-2796 |
| Popis: | Background Severe vitamin D deficiency causes osteomalacia, yet trials of vitamin D supplementation in the community have not on average demonstrated benefit to bone mineral density (BMD) or fracture risk in adults. Objective To determine whether monthly high-dose vitamin D supplementation influences BMD in the general population and in those with low 25-hydroxyvitamin D levels. Methods Two-year substudy of a trial in older community-resident adults. A total of 452 participants were randomized to receive monthly doses of vitamin D3 100 000 IU, or placebo. The primary end-point was change in lumbar spine BMD. Exploratory analyses to identify thresholds of baseline 25-hydroxyvitamin D for vitamin D effects on BMD were prespecified. Results Intention-to-treat analyses showed no significant treatment effect in the lumbar spine (between-groups difference 0.0071 g cm−2, 95%CI: −0.0012, 0.0154) or total body but BMD loss at both hip sites was significantly attenuated by ~1/2% over 2 years. There was a significant interaction between baseline 25-hydroxyvitamin D and treatment effect (P = 0.04). With baseline 25-hydroxyvitamin D ≤ 30 nmol L−1 (n = 46), there were between-groups BMD changes at the spine and femoral sites of ~2%, significant in the spine and femoral neck, but there was no effect on total body BMD. When baseline 25-hydroxyvitamin D was >30 nmol L−1, differences were ~1/2% and significant only at the total hip. Conclusions This substudy finds no clinically important benefit to BMD from untargeted vitamin D supplementation of older, community-dwelling adults. Exploratory analyses suggest meaningful benefit in those with baseline 25-hydroxyvitamin D ≤ 30 nmol L−1. This represents a significant step towards a trial-based definition of vitamin D deficiency for bone health in older adults. |
| Databáze: | OpenAIRE |
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