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Prevención de fracturas con la suplementación de vitamina D: un metanálisis de ensayos controlados aleatorios
Heike A Bischoff-Ferrari1, Walter C Willett, John B Wong
1Department of Nutrition, Harvard School of Public Health, Boston, Mass 02115, USA. hbischof@hsph.harvard.edu
JAMA
|May 12, 2005
Resumen
Las dosis más altas de vitamina D oral (700-800 UI/día) previenen eficazmente las fracturas de cadera y no vertebrales en los ancianos. Las dosis más bajas (400 UI/d) de vitamina D no proporcionan suficientes beneficios de prevención de fracturas.
Área de la Ciencia:
- Gerontología Gerontología.
- Ciencias de la Nutrición Ciencias de la Nutrición
- Salud ósea Salud ósea.
Sus antecedentes:
- La dosis óptima de vitamina D oral para la prevención de fracturas en adultos mayores sigue sin estar clara.
- La investigación existente no ha establecido definitivamente el papel de la suplementación con vitamina D en la prevención de fracturas no vertebrales.
Objetivo del estudio:
- Determinar la efectividad de la suplementación de vitamina D en la prevención de fracturas de cadera y no vertebrales entre personas mayores.
- Para comparar la eficacia de diferentes dosis orales de vitamina D para la prevención de fracturas en personas mayores.
Principales métodos:
- Se llevó a cabo una revisión sistemática y un metanálisis de ensayos controlados aleatorios doble ciego (ECA).
- Los estudios publicados entre 1960 y 2005 fueron identificados utilizando MEDLINE, el Registro de Ensayos Controlados Cochrane y EMBASE.
- Los criterios de inclusión se centraron en ECA con personas mayores (≥60 años) que recibieron vitamina D oral (colecalciferol o ergocalciferol) con o sin calcio, en comparación con placebo o calcio solo, examinando fracturas de cadera o no vertebrales.
Principales resultados:
- Se realizaron análisis combinados de 5 ECA (n=9294) para fracturas de cadera y 7 ECA (n=9820) para fracturas no vertebrales utilizando modelos de efectos aleatorios.
- Una dosis diaria de 700-800 UI de vitamina D redujo significativamente el riesgo relativo (RR) de fracturas de cadera en un 26% (RR, 0,74; IC del 95%, 0,61-0,88) y cualquier fractura no vertebral en un 23% (RR, 0,77; IC del 95%, 0,68-0,87).
- Una dosis diaria de 400 UI de vitamina D no mostró ningún beneficio significativo en la prevención de las fracturas de cadera (RR, 1.15; IC del 95%, 0.88-1.50) o cualquier fractura no vertebral (RR, 1.03; IC del 95%, 0.86-1.24).
Conclusiones:
- La suplementación oral de vitamina D en dosis de 700-800 UI/día es efectiva para reducir los riesgos de fractura de cadera y no vertebral en personas mayores.
- Una dosis diaria de vitamina D oral de 400 UI es insuficiente para una prevención efectiva de las fracturas en la población anciana.
- Estos hallazgos apoyan la suplementación con dosis más altas de vitamina D para la salud ósea y la prevención de fracturas en adultos mayores.
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