Osteologie 2008; 17(02): 39-45
DOI: 10.1055/s-0037-1619847
Ernährung und Knochengesundheit
Schattauer GmbH

Zum Einfluss von Vitamin D und Kalzium auf die muskuloskelettale Gesundheit

The role of vitamin D in the treatment of osteoporosis in the elderly
M. Pfeifer
1   Institut für Klinische Osteologie Gustav Pommer und “MedWiss Bad Pyrmont”, Bad Pyrmont
,
H. W. Minne
1   Institut für Klinische Osteologie Gustav Pommer und “MedWiss Bad Pyrmont”, Bad Pyrmont
› Author Affiliations
Further Information

Publication History

Publication Date:
28 December 2017 (online)

Zusammenfassung

Bei älteren Menschen (etwa ab dem 65. Lebensjahr) kann eine Supplementation mit Vitamin D (800–1200 I.E. pro Tag) und Kalzium (800–1200 mg pro Tag) dazu beitragen, Stürze und sturzbedingte Knochenbrüche im Sinne einer Primärprävention zu verhindern. Inzwischen liegen hierzu zahlreiche randomisierte, placebokontrollierte und prospektive Doppelblindstudien vor, die zumindest für die Verminderung der Sturzrate eine Meta-Analyse erlauben, so dass nach den Kriterien einer auf Evidenz basierenden Medizin im Hinblick auf die Sturzprävention sowie für die Primärprävention von Schenkelhalsfrakturen von einer Evidenzstärke Grad Ia auszugehen ist, wobei die Wirkung bei Frauen mit einem 25-Hydroxy-Vitamin-D3-Serumspiegel unter 50 nmol/l besonders gut dokumentiert ist.

Summary

During the last five years several randomised, prospective, placebo-controlled clinical trials have been documented thata supplementation with vitamin D (800–1200 I.U. per day) together with calcium (800–1200 mg per day) may reduce the risk of falls and fall-related fractures in the elderly. This is especially the case in elderly women 65 years of age or older witha serum 25-hydroxy-vitamin D3 level below 50 nmol/l. Based on the results ofa recently published meta-analysis involving more than 10,000 participants the grade of evidence according to the Oxford centre of evidence-based medicine is Ia with respect to the primary prevention of falls in the elderly population.

 
  • Literatur

  • 1 Jackson RD, LaCroix AZ, Gass M. et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354: 669-683.
  • 2 http://www.aerzteblatt.de/v4/news.asp?id=23147
  • 3 Melton III LJ. Epidemiology of spinal osteoporosis. Spine 1997; 22 (Suppl. 01) S2-S11.
  • 4 Pfeifer M, Wittenberg R, Würtz R, Minne HW. Schenkelhalsfrakturen in Deutschland. Dt Ärztebl 2001; 98: A1751-A1757.
  • 5 Avenell A, Gillespie WJ, Gillespie LD, O`Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. The Cochrane Database of Systematic Reviews. 2005 Issue 3. Art. No.: CD000227.pub2. DOI: 10.1002/14651858.CD000227.pub2.
  • 6 Pfeifer M, Minne HW. Editorial: Prävention von Stürzen und Frakturen bei älteren Menschen. Dtsch Ärztebl. 2006 103. A116-A117.
  • 7 Chapuy MC, Arlot ME, Duboeuf F. et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637-1642.
  • 8 Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in elderly men and women. N Engl J Med 1997; 337: 670-676.
  • 9 Pfeifer M, Begerow B, Minne HW. et al. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 2000; 15: 1113-1118.
  • 10 Bischoff HA, Stähelin HB, Dick W. et al. Effects of vitamin D and calcium supplementation on falls: a randomized trial. J Bone Miner Res 2003; 18: 343-351.
  • 11 Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 2004; 19: 370-378.
  • 12 Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study. Aging Clin Exp Res 2005; 17: 125-132.
  • 13 Grant AM, Avenell A, Campbell MK. et al. 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 trail. Lancet 2005; 365: 1621-1628.
  • 14 Porthouse J, Cockayne S, King C. et al. Randomised controlled trail of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. Br Med J 2005; 330: 1003-1009.
  • 15 Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC. et al. Effect of vitamin D on falls. A meta-analysis. J Am Med Assoc 2004; 291: 1999-2006.
  • 16 Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of longterm vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2008 (in print)
  • 17 Schacht E, Richy F, Reginster JY. The therapeutic effects of alfacalcidol on bone strength, muscle metabolism and prevention of falls and fractures. J Musculoskeletal Neuronal Interaction 2005; 05: 273-284.
  • 18 Henderson RG, Ledingham JGG, Oliver DO. et al. Effects of 1,25-dihydroxy-cholecalciferol on calcium absorption, muscle weakness and bone disease in chronic renal failure. Lancet 1974; I: 379-384.
  • 19 Dukas L, Schacht E, Mazor Z, Stähelin HB. Treatment with alfacalcidol in elderly people decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min. Osteoporos Int 2005; 16: 198-203.
  • 20 Dukas L, Bischoff HA, Lindpaintner LS. et al. Alfacalcidol reduces the number of fallers in a community-dwelling elderly population with a minimum calcium intake of more than 500 mg daily. J Am Geriatr Soc 2004; 52: 230-236.
  • 21 Gallagher JC. The effects of calcitriol on falls and fractures and physical performance tests. J Steroid Biochem Mol Biol 2004; 89: 497-501.
  • 22 Pfeifer M, Begerow B, Minne HW. Vitamin D and muscle function. Osteoporos Int 2002; 13: 187-194.
  • 23 Holick MF. Non-calcemic actions of dihydroxyvitamin D3 and clinical applications Bone. 1995; 17: S107-S111.
  • 24 Walters MR. Newly identified actions of the vitamin D endocrine system. Endocr Rev 1992; 13: 719-764.
  • 25 Morrison N. Vitamin D receptor gene variants and osteoporosis: a contributor to the polygenetic control of bone density. In: Feldman B, Glorieux FH, Pike JW. Vitamin D. San Diego: Academic Press; 1997: 713-731.
  • 26 Geusens P, Vandevyver C, Vanhoof J. et al. Quadriceps and grip strength are related to vitamin D receptor genotype in elderly non-obese women. J Bone Miner Res 1997; 12: 2082-2088.
  • 27 Norman AW, Nemere I, Zhou LX. et al. 1,25(OH)2D, a steroid hormone that produces biologic effects via both genomic and nongenomic pathways. J Steroid Biochem Mol Biol 1992; 41: 231-240.
  • 28 Peacock M, Selby PL, Francis RM. eds. et al. Sixth Workshop on Vitamin D. Berlin: de Gruyter; 1985: 569-570.
  • 29 Prineas W, Stuart-Mason A, Henson RA. Myopathy and neuropathy associated with osteomalacia. Br Med J 1965; I: 1034-1036.
  • 30 Schott GD, Wills MR. Muscle weakness in osteomalacia. Lancet 1976; I: 626-629.
  • 31 Chalmers J, Conacher WDH, Gardner DL, Scott PJ. Osteomalacia – a common disease in elderly women. J Bone Joint Surg Br 1967; 49: 403-423.
  • 32 Gloth FM, Lindsay JM, Zelesnick LB, Greenough WB. Can vitaminD deficiency produce an unusual pain syndrome?. Arch Intern Med 1991; 151: 1662-1664.
  • 33 Skaria J, Katiyar BC, Srivastava TP, Dube B. Myopathy and neuropathy associated with osteomalacia. Acta Neurol Scand 1975; 51: 37-58.
  • 34 Ronin DI, Wu Y, Sahgal V, MacLean IC. Intractable muscle pain syndrome, osteomalacia, and axonopathy in long-term use of phenytoin. Arch Phys Med Rehabil 1991; 72: 755-758.
  • 35 Mallette LE, Patten BM, Engel WK. Neuromuscular disease in secondary hyperparathyroidism. Ann Intern Med 1975; 82: 474-483.
  • 36 Yoshikawa S, Nakamura T, Tanabe H, Imamura T. Osteomalacicmyopathy. EndocrinolJpn 1979; 26: 65-72.
  • 37 Jones DA, Round JM. Skeletal muscle in health and disease. Manchester: Manchester University Press; 1992: 52-60.
  • 38 McConas AJ. Skeletal muscle: form and function. Champaign: Human Kinetics; 1996: 62-65.
  • 39 Pfeifer M, Minne HW. Vitamin D and hip fracture. Trends Endocrinol Metab 1999; 10: 417-420.
  • 40 Stein MS, Wark JD, Scherer SC. et al. Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 1999; 47: 1195-1201.
  • 41 Dhesi JK, Bearne LM, Moniz C. et al. Neuromuscular and psychomotor function in elderly people who fall and the relationship with vitamin D status. J Bone Miner Res 2002; 17: 891-897.
  • 42 Bischoff-Ferrari HA, Borchers M, Gudat F. et al. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res 2004; 19 (02) 265-269.
  • 43 Curry OB, Basten JF, Francis MJ, Smith R. Calcium uptake by sarcoplasmatic reticulum of muscle from vitamin D deficient rabbits. Nature 1974; 249: 83-84.
  • 44 Birge SJ, Haddad JG. 25-Hydroxycholecalciferol stimulation of muscle metabolism. J Clin Invest 1975; 56: 1100-1107.
  • 45 Boland R. Role of vitamin D in skeletal muscle function. Endocr Rev 1986; 07: 434-448.
  • 46 Boland R, deBoland AR, Ritz E, Hasselbach W. Effect of 1,25-dihydroxycholecalciferol on sarcoplasmatic reticulum calcium transport in strontium fed rats. Calcif Tiss Int 1983; 35: 190-194.
  • 47 Pointon JJ, Francis MJ, Smith R. Effect of vitamin D deficiency on sarcoplasmatic reticulum function and troponin C concentration of rabbit skeletal muscle. Clin Sci 1979; 57: 257-263.
  • 48 Pleasure D, Wyszynski B, Summer A. et al. Skeletal muscle calcium metabolism and contractile force in vitamin D-deficient chicks. J Clin Invest 1979; 64: 1157-1167.
  • 49 Simpson R, Thomas G, Arnold A. Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle. J Biol Chem 1985; 260: 8882-8891.
  • 50 Boonen S, Lips P, Bouillon R. et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanlysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92: 1415-1423.
  • 51 Bischof-Ferrari HA. How to select the doses of vitamin D in the management of osteoporosis. Osteoporos Int. 2007
  • 52 Bolland MJ, Barber PA, Doughty RN. et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Br Med J 2008; 336: 262-266.
  • 53 Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 2006; 166: 424-430.
  • 54 Dawson-Hughes B, Heaney RP, Holick MF. et al. Estimates of optimal vitamin D status. Osteoporos Int 2005; 16: 713-716.
  • 55 Resch H, Walliser J, Phillips S. et al. Physician and patient perceptions on the use of vitamin D and calcium in osteoporosis treatment: a European and Latin American perspective. Curr Med Res Opin 2007; 23: 1227-1237.
  • 56 Roux C, Bischoff-Ferrari HA, Papapoulos SE. et al. New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion. Curr Med Res Opin 2008; 24: 1363-1370.