ビタミンDの高齢者の転倒予防効果：メタ分析

ビタミンDの高齢者の転倒予防効果をみた系統的レビューとメタ分析の論文を紹介します。

Kalyani RR, Stein B, Valiyil R, Manno R, Maynard JW, Crews DC: Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc. 2010 Jul;58(7):1299-310.

結論としてはビタミンD投与群ではカルシウム投与群もしくはプラセボと比較して、14％転倒が少なくなり、統計学的有意差があります。

特に80歳未満の在宅高齢者、カルシウムとの併用療法、骨折・転倒の既往がない、6か月以上、コレカルシフェロール(ビタミンD3)、投与量が800IU以上の場合に、有意に転倒が少なかったという結果です。

ビタミンDは骨量だけでなく筋肉量の維持、改善に有効という報告が増えています。副作用と考えると安易に使用する気にはなりませんが、転倒リスクがありビタミンDが不足している高齢者に対しては投与が必要だと思います。

Abstract
OBJECTIVES: To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults.

DESIGN: Systematic review and meta-analysis.

SETTING: MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies.

PARTICIPANTS: Older adults (aged > or = 60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition.

MEASUREMENTS: Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I(2) statistic was used to assess heterogeneity in a random-effects model.

RESULTS: Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200-1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79-0.93; I(2)=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community-dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta-regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87-0.98) and more heterogeneity (I(2)=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001).

CONCLUSION: Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.