Vitamin D: Trial-Sequential-Metaanalyse

Diese Metaanalyse zu „Vitamin D: Trial-Sequential-Metaanalyse“ bündelt Originalarbeiten und ordnet deren Aussagekraft sowie Grenzen ein.

Welche Frage wurde untersucht?

Die Arbeit „The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis“ prüft, wie Vitamin-D-Status oder Supplementierung mit dem im Titel bezeichneten Endpunkt zusammenhängen. Entscheidend ist die Ebene der Evidenz: Hier wird nicht eine einzelne Beobachtung, sondern eine systematisch zusammengeführte Studienlage betrachtet.

Wie wurde die Evidenz zusammengeführt?

Die Review- oder Metaanalyse bezieht 44 unmittelbar eingeschlossene Originalarbeiten ein. Diese Originalarbeiten stehen vollständig in der Quellenliste. Die Zusammenführung erhöht die Datenbasis, beseitigt aber Unterschiede bei Population, Ausgangsstatus, Vergleich, Dosisregime und Endpunktdefinition nicht.

Was zeigt der Gesamtbefund?

Die Trial-Sequential-Metaanalyse fand bei nicht ausgewählten, selbstständig lebenden Erwachsenen keinen Rückgang skelettaler oder nichtskelettaler Endpunkte um mindestens 15 %.

Der Befund beschreibt genau den untersuchten Vergleich. Er darf nicht als allgemeines Wirkversprechen für Vitamin D oder als Empfehlung für eine bestimmte Einnahmemenge gelesen werden.

Wie belastbar ist das Ergebnis?

Für institutionalisierte Menschen und Kombinationen mit Calcium gab es abweichende Signale; Population und Begleitintervention sind deshalb entscheidend. Metaanalysen übernehmen zudem die Grenzen ihrer eingeschlossenen Studien. Heterogenität, Bias und unterschiedliche Messweisen können einen gepoolten Wert beeinflussen.

Einordnung für Supplement Stack

Der Artikel dokumentiert die gemeinsam ausgewertete Studienlage samt Originalquellen. Die stoffweite Einordnung zu Versorgung, Referenzwerten und Sicherheit steht im Vitamin D: Warum Sonne, Knochen und Calcium zusammengehören.

Fazit

Die Trial-Sequential-Metaanalyse fand bei nicht ausgewählten, selbstständig lebenden Erwachsenen keinen Rückgang skelettaler oder nichtskelettaler Endpunkte um mindestens 15 %. Für die praktische Einordnung bleibt die genannte Grenze wesentlich: Für institutionalisierte Menschen und Kombinationen mit Calcium gab es abweichende Signale; Population und Begleitintervention sind deshalb entscheidend.

Quellen

  1. Lips et al. (1996). Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med. DOI: 10.7326/0003-4819-124-4-199602150-00003. PMID: 8554248.
  2. Flicker et al. (2005). Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc. DOI: 10.1111/j.1532-5415.2005.00468.x. PMID: 16274368.
  3. Komulainen et al. (1998). HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas. DOI: 10.1016/s0378-5122(98)00085-1. PMID: 10091204.
  4. Bolton-Smith et al. (2007). Two-year randomized controlled trial of vitamin K1 (phylloquinone) and vitamin D3 plus calcium on the bone health of older women. J Bone Miner Res. DOI: 10.1359/jbmr.070116. PMID: 17243866.
  5. Lappe et al. (2007). Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. DOI: 10.1093/ajcn/85.6.1586. PMID: 17556697.
  6. Chapuy et al. (2002). Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int. DOI: 10.1007/s001980200023. PMID: 11991447.
  7. Wactawski-Wende et al. (2006). Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med. DOI: 10.1056/nejmoa055222. PMID: 16481636.
  8. Björkman et al. (2008). Vitamin D supplementation has minor effects on parathyroid hormone and bone turnover markers in vitamin D-deficient bedridden older patients. Age Ageing. DOI: 10.1093/ageing/afm141. PMID: 17965037.
  9. Dawson-Hughes et al. (1997). Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. DOI: 10.1056/nejm199709043371003. PMID: 9278463.
  10. Chapuy et al. (1994). Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ. DOI: 10.1136/bmj.308.6936.1081. PMID: 8173430.
  11. Jackson et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. DOI: 10.1056/nejmoa055218. PMID: 16481635.
  12. Porthouse et al. (2005). Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ. DOI: 10.1136/bmj.330.7498.1003. PMID: 15860827.
  13. Bolland et al. (2014). The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. The Lancet Diabetes & Endocrinology. DOI: 10.1016/s2213-8587(13)70212-2. PMID: 24703049.
  14. Latham et al. (2003). A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc. DOI: 10.1046/j.1532-5415.2003.51101.x. PMID: 12588571.
  15. Harwood et al. (2004). A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NoNOF) Study. Age Ageing. DOI: 10.1093/ageing/afh002. PMID: 14695863.
  16. Baeksgaard et al. (1998). Calcium and vitamin D supplementation increases spinal BMD in healthy, postmenopausal women. Osteoporos Int. DOI: 10.1007/s001980050062. PMID: 9797910.
  17. Sanders et al. (2010). Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. DOI: 10.1001/jama.2010.594. PMID: 20460620.
  18. Pfeifer et al. (2009). Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. DOI: 10.1007/s00198-008-0662-7. PMID: 18629569.
  19. Inkovaara et al. (1983). Calcium, vitamin D and anabolic steroid in treatment of aged bones: double-blind placebo-controlled long-term clinical trial. Age Ageing. DOI: 10.1093/ageing/12.2.124. PMID: 6346829.
  20. Bischoff et al. (2003). Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. DOI: 10.1359/jbmr.2003.18.2.343. PMID: 12568412.
  21. Chapuy et al. (1992). Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. DOI: 10.1056/nejm199212033272305. PMID: 1331788.
  22. Krieg et al. (1999). Effect of supplementation with vitamin D3 and calcium on quantitative ultrasound of bone in elderly institutionalized women: a longitudinal study. Osteoporos Int. DOI: 10.1007/s001980050265. PMID: 10624454.
  23. Corless et al. (1985). Do vitamin D supplements improve the physical capabilities of elderly hospital patients?. Age Ageing. DOI: 10.1093/ageing/14.2.76. PMID: 4003187.
  24. Burleigh et al. (2007). Does vitamin D stop inpatients falling? A randomised controlled trial. Age Ageing. DOI: 10.1093/ageing/afm087. PMID: 17656420.
  25. Grant et al. (2005). Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. DOI: 10.1016/s0140-6736(05)63013-9. PMID: 15885294.
  26. Bolland et al. (2010). Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. DOI: 10.1136/bmj.c3691. PMID: 20671013.
  27. Trivedi et al. (2003). Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. DOI: 10.1136/bmj.326.7387.469. PMID: 12609940.
  28. Avenell et al. (2004). The effects of an open design on trial participant recruitment, compliance and retention—a randomized controlled trial comparison with a blinded, placebo-controlled design. Clin Trials. DOI: 10.1191/1740774504cn053oa. PMID: 16279289.
  29. Lyons et al. (2007). Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporos Int. DOI: 10.1007/s00198-006-0309-5. PMID: 17473911.
  30. Brazier et al. (2005). Clinical and laboratory safety of one year's use of a combination calcium + vitamin D tablet in ambulatory elderly women with vitamin D insufficiency: results of a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. DOI: 10.1016/j.clinthera.2005.12.010. PMID: 16507374.
  31. Salovaara et al. (2010). Effect of vitamin D(3) and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial—the OSTPRE-FPS. J Bone Miner Res. DOI: 10.1002/jbmr.48. PMID: 20200964.
  32. Aloia et al. (2005). A randomized controlled trial of vitamin D-3 supplementation in African American women. Arch Intern Med. DOI: 10.1001/archinte.165.14.1618. PMID: 16043680.
  33. Chel et al. (2008). Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. Osteoporos Int. DOI: 10.1007/s00198-007-0465-2. PMID: 17874029.
  34. Smith et al. (2007). Effect of annual intramuscular vitamin D on fracture risk in elderly men and women--a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). DOI: 10.1093/rheumatology/kem240. PMID: 17998225.
  35. Cooper et al. (2003). Vitamin D supplementation and bone mineral density in early postmenopausal women. Am J Clin Nutr. DOI: 10.1093/ajcn/77.5.1324. PMID: 12716689.
  36. Pfeifer et al. (2000). Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res. DOI: 10.1359/jbmr.2000.15.6.1113. PMID: 10841179.
  37. Broe et al. (2007). A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc. DOI: 10.1111/j.1532-5415.2007.01048.x. PMID: 17302660.
  38. Glendenning et al. (2012). Effects of three-monthly oral 150,000 IU cholecalciferol supplementation on falls, mobility, and muscle strength in older postmenopausal women: a randomized controlled trial. J Bone Miner Res. DOI: 10.1002/jbmr.524. PMID: 21956713.
  39. Meyer et al. (2002). Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res. DOI: 10.1359/jbmr.2002.17.4.709. PMID: 11918228.
  40. Komulainen M, Kr?ger H, Tuppurainen MT, Heikkinen AM, Alhava E, Honkanen R, Jurvelin J, Saarikoski S (1999). Prevention of femoral and lumbar bone loss with hormone replacement therapy and vitamin D3 in early postmenopausal women: a population-based 5-year randomized trial.. Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/jcem.84.2.5496. PMID: 10022414.
  41. Prince et al. (2008). Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Arch Intern Med. DOI: 10.1001/archinternmed.2007.31. PMID: 18195202.
  42. Lips et al. (2010). Once-weekly dose of 8400 IU vitamin D(3) compared with placebo: effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. Am J Clin Nutr. DOI: 10.3945/ajcn.2009.28113. PMID: 20130093.
  43. Zhu et al. (2008). Effects of calcium and vitamin D supplementation on hip bone mineral density and calcium-related analytes in elderly ambulatory Australian women: a five-year randomized controlled trial. J Clin Endocrinol Metab. DOI: 10.1210/jc.2007-1466. PMID: 18089701.
  44. Meier et al. (2004). Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res. DOI: 10.1359/jbmr.040511. PMID: 15231008.
  45. Hsia et al. (2007). Calcium/vitamin D supplementation and cardiovascular events. Circulation. DOI: 10.1161/circulationaha.106.673491. PMID: 17309935.