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1.
Osteoporos Int ; 20(2): 315-22, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18629569

RESUMO

UNLABELLED: In 242 community-dwelling seniors, supplementation with either 1000 mg of calcium or 1000 mg of calcium plus vitamin D resulted in a decrease in the number of subjects with first falls of 27% at month 12 and 39% at month 20. Additionally, parameters of muscle function improved significantly. INTRODUCTION: The efficacy of vitamin D and calcium supplementation on risk of falling in the elderly is discussed controversially. Randomized controlled trials using falls as primary outcome are needed. We investigated long-term effects of calcium and vitamin D on falls and parameters of muscle function in community-dwelling elderly women and men. METHODS: Our study population consisted of 242 individuals recruited by advertisements and mailing lists (mean [ +/- SD] age, 77 +/- 4 years). All serum 25-hydroxyvitamin D (25[OH]D) levels were below 78 nmol/l. Individuals received in a double blinded fashion either 1000 mg of calcium or 1000 mg of calcium plus 800 IU of vitamin D per day over a treatment period of 12 months, which was followed by a treatment-free but still blinded observation period of 8 months. Falls were documented using diaries. The study took place in Bad Pyrmont, Germany (latitude 52 degrees ) and Graz, Austria (latitude 46 degrees ). RESULTS: Compared to calcium mono, supplementation with calcium plus vitamin D resulted in a significant decrease in the number of subjects with first falls of 27% at month 12 (RR = 0.73; CI = 0.54-0.96) and 39% at month 20 (RR = 0.61; CI = 0.34-0.76). Concerning secondary endpoints, we observed significant improvements in quadriceps strength of 8%, a decrease in body sway of 28%, and a decrease in time needed to perform the TUG test of 11%. DISCUSSION: Combined calcium and vitamin D supplementation proved superior to calcium alone in reducing the number of falls and improving muscle function in community-dwelling older individuals.


Assuntos
Acidentes por Quedas/prevenção & controle , Cálcio/administração & dosagem , Músculos/fisiologia , Vitamina D/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Áustria , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Seguimentos , Fraturas Ósseas/prevenção & controle , Alemanha , Humanos , Masculino , Modelos de Riscos Proporcionais , Meio Social , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
3.
MMW Fortschr Med ; 144(44): 41-4, 2002 Oct 31.
Artigo em Alemão | MEDLINE | ID: mdl-12494598

RESUMO

In terms of their clinical impact, bone fractures as late sequelae of osteoporosis are still largely ignored in Germany. Up to 80-90% of patients with treatment-requiring osteoporosis are not receiving specific treatment. The consequences for the patient are enormous: weeks of severe pain, subsequent fractures that occur for ever more banal reasons, increasing restriction of daily activities, invalidism and an increasing need for nursing care. All this despite the availability of powerful medications. In concert with an appropriate early diagnosis, not only could the majority of patients be spared such a fate, but also the costs incurred as a direct consequence of such fractures could be drastically lowered.


Assuntos
Pessoas com Deficiência/reabilitação , Ácido Etidrônico/análogos & derivados , Osteoporose/terapia , Dor/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Atividades Cotidianas , Fatores Etários , Alendronato/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Ácido Etidrônico/uso terapêutico , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/reabilitação , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/tratamento farmacológico , Dor/prevenção & controle , Cloridrato de Raloxifeno/uso terapêutico , Ácido Risedrônico , Fatores Sexuais , Fraturas da Coluna Vertebral/etiologia
5.
Osteoporos Int ; 13(3): 187-94, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11991436

RESUMO

The aim of this review is to summarize current knowledge on the relation between vitamin D and muscle function. Molecular mechanisms of vitamin D action on muscle tissue have been known for many years and include genomic and non-genomic effects. Genomic effects are initiated by binding of 1,25-dihydroxyvitamin D3 (1,25(OH)2D) to its nuclear receptor, which results in changes in gene transcription of messenger RNA and subsequent protein synthesis. Non-genomic effects of vitamin D are rapid and mediated through a membrane-bound vitamin D receptor (VDR). Genetic variations in the VDR and the importance of VDR polymorphisms in the development of osteoporosis are still a matter of controversy and debate. Most recently, VDR polymorphisms have been described to affect muscle function. The skin has an enormous capacity for vitamin D production and supplies the body with 80-100% of its requirements of vitamin D. Age, latitude, time of day, season of the year and pigmentation can dramatically affect the production of vitamin D in the skin. Hypovitaminosis D is a common feature in elderly people living in northern latitudes and skin coverage has been established as an important factor leading to vitamin D deficiency. A serum 25-hydroxyvitamin D level below 50 nmol/l has been associated with increased body sway and a level below 30 nmol/l with decreased muscle strength. Changes in gait, difficulties in rising from a chair, inability to ascend stairs and diffuse muscle pain are the main clinical symptoms in osteomalacic myopathy. Calcium and vitamin D supplements together might improve neuromuscular function in elderly persons who are deficient in calcium and vitamin D. Thus 800 IU of cholecalciferol in combination with mg of elemental calcium reduces hip fractures and other non-vertebral fractures and should generally be recommended in individuals who are deficient in calcium and vitamin D. Given the strong interdependency of vitamin D deficiency, low serum calcium and high levels of parathyroid hormone, however, it is difficult to identify exact mechanisms of action.


Assuntos
Músculo Esquelético/fisiologia , Vitamina D/fisiologia , 25-Hidroxivitamina D 2/sangue , Idoso , Pressão Sanguínea/fisiologia , Cálcio/deficiência , Cálcio/uso terapêutico , Feminino , Fraturas do Quadril/prevenção & controle , Humanos , Masculino , Debilidade Muscular/sangue , Músculo Esquelético/fisiopatologia , Músculo Liso Vascular/metabolismo , Hormônio Paratireóideo/fisiologia , Receptores de Calcitriol/metabolismo , Vitamina D/uso terapêutico , Deficiência de Vitamina D/fisiopatologia
6.
Z Gastroenterol ; 40 Suppl 1: S57-S61, 2002 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-11930292

RESUMO

Osteoporosis therapy has been controversially discussed in the past. In the meantime, several therapeutic options to prevent fractures are available for this disease. With respect to proven fracture benefit, however, the quality of evidence from randomised and controlled clinical trials varies substantially among therapies. From systematic research the best external evidence is available for a supplementation with calcium and vitamin D and a therapy with the bisphosphonates alendronate or risedronate, as well as the SERM raloxifene. For other therapeutic agents like fluorides, vitamin D metabolites, calcitonin and etidronate the quality of evidence is much lower. So far, there is no evidence for other pharmaceutical therapies. Hip protectors are effective in the prevention of hip fractures.


Assuntos
Osteoporose/tratamento farmacológico , Calcitonina/uso terapêutico , Cálcio/uso terapêutico , Difosfonatos/uso terapêutico , Medicina Baseada em Evidências , Fluoretos/uso terapêutico , Fraturas Espontâneas/prevenção & controle , Fraturas do Quadril/prevenção & controle , Humanos , Osteoporose/diagnóstico , Osteoporose/etiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Fraturas da Coluna Vertebral/prevenção & controle , Vitamina D/uso terapêutico
8.
Exp Clin Endocrinol Diabetes ; 109(2): 87-92, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11341304

RESUMO

The aim of this study was to identify factors associated with fractures in patients with postmenopausal osteoporosis. The overall hypothesis was that trunk muscle strength, body sway and hypovitaminosis D would influence daily activities and the likelihood of falls and fractures. - In 237 women (mean age 62.9+/-7.4 years) osteoporosis was defined by a T-score at the femoral neck below -2.5 SD. Trunk muscle strength was determined using isokinetic dynamometry and body sway was measured according to Lord et al. Limitations in everyday life were assessed and the history of falls was documented. A fracture was defined as a vertebral height reduction of more than 20% or at least 4 mm. The assessment was carried out using the Spine Deformity Index (SDI) and was confirmed by an experienced radiologist. Pearson coefficients of correlation were calculated. - After correction for age, significant associations were found for body sway and 25-hydroxyvitamin D (p<0.001), body sway and falls (p<0.001), body sway and rib fractures (p<0.01), trunk muscle strength and limitations in everyday life (p<0.001), trunk muscle strength and SDI (p<0.001), trunk muscle strength and bone density (p<0.001), and bone density and 25-hydroxyvitamin D (p<0.001). No significant correlation was found for trunk muscle strength and 25-hydroxyvitamin D (p=0.712). - Findings suggest that hypovitaminosis D is associated with increased body sway and an elevated risk for falls and falls-related fractures. Musculoskeletal rehabilitation should include strengthening exercises for the trunk muscles and training of neuromuscular co-ordination and balance.


Assuntos
Acidentes por Quedas , Fraturas Ósseas/etiologia , Músculo Esquelético/fisiologia , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/fisiopatologia , Equilíbrio Postural/fisiologia , Vitamina D/análogos & derivados , Vitamina D/metabolismo , Idoso , Densidade Óssea , Feminino , Humanos , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fatores de Risco , Vitamina D/sangue
9.
J Clin Endocrinol Metab ; 86(4): 1633-7, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11297596

RESUMO

Calcium supplementation is effective in reducing blood pressure in various states of hypertension, including pregnancy-induced hypertension and preeclampsia. In addition, calcitropic hormones are associated with blood pressure. The hypothesis is that short-term therapy with calcium and vitamin D(3) may improve blood pressure as well as secondary hyperparathyroidism more effectively than calcium monotherapy. The effects of 8 weeks of supplementation with vitamin D(3) (cholecalciferol) and calcium on blood pressure and biochemical measures of bone metabolism were studied. The sample consisted of 148 women (mean +/- SD age, 74 +/- 1 yr) with a 25-hydroxycholecalciferol (25OHD(3)) level below 50 nmol/L. They received either 1200 mg calcium plus 800 IU vitamin D(3) or 1200 mg calcium/day. We measured intact PTH, 25OHD(3), 1,25-dihydroxyvitamin D(3), blood pressure, and heart rate before and after treatment. Compared with calcium, supplementation with vitamin D(3) and calcium resulted in an increase in serum 25OHD(3) of 72% (P < 0.01), a decrease in serum PTH of 17% (P = 0.04), a decrease in systolic blood pressure (SBP) of 9.3% (P = 0.02), and a decrease in heart rate of 5.4% (P = 0.02). Sixty subjects (81%) in the vitamin D(3) and calcium group compared with 35 (47%) subjects in the calcium group showed a decrease in SBP of 5 mm Hg or more (P = 0.04). No statistically significant difference was observed in the diastolic blood pressures of the calcium-treated and calcium- plus vitamin D(3)-treated groups (P = 0.10). Pearson coefficients of correlation between the change in PTH and the change in SBP were 0.49 (P < 0.01) for the vitamin D(3) plus calcium group and 0.23 (P < 0.01) for the calcium group. A short-term supplementation with vitamin D(3) and calcium is more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women.


Assuntos
Envelhecimento/sangue , Pressão Sanguínea/efeitos dos fármacos , Cálcio/uso terapêutico , Colecalciferol/uso terapêutico , Hormônio Paratireóideo/sangue , Idoso , Idoso de 80 Anos ou mais , Calcifediol/sangue , Calcitriol/sangue , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Fatores de Tempo
10.
J Bone Miner Res ; 15(6): 1113-8, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10841179

RESUMO

Long-term vitamin D and calcium supplementation is effective in reducing nonvertebral fractures in elderly people. Increased bone fragility caused by secondary hyperparathyroidism (sHPT) and impaired balance are known risk factors for hip fractures. The hypothesis is that short-term therapy with calcium and vitamin D may improve body sway as well as sHPT more effectively than calcium monotherapy. The effects of 8 weeks of supplementation with vitamin D (cholecalciferol) and calcium on body sway and biochemical measures of bone metabolism were measured. The sample consisted of 148 women (mean [+/-SD] age, 74 +/- 1 years) with a 25-hydroxycholecalciferol level below 50 nmol/liter. They received either 1200 mg of calcium plus 800 IU of vitamin D or 1200 mg of calcium per day. We measured intact parathyroid hormone (PTH), markers of bone turnover, and body sway before and after treatment. Falls and fractures among the participants were followed over a 1-year period. Compared with calcium mono, supplementation with vitamin D and calcium resulted in an increase in serum 25-hydroxyvitamin D of 72% (p < 0.0001), a decrease in the serum PTH of 18% ( p = 0.0432), and a decrease in body sway of 9% (p = 0.0435). The mean number of falls per subject during a 1-year follow-up period was 0.45 for the calcium mono group and 0.24 for the calcium and vitamin D group (p = 0.0346). Short-term supplementation with vitamin D and calcium improves sHPT and body sway and therefore may prevent falls and subsequent nonvertebral fractures in elderly women.


Assuntos
Cálcio/farmacologia , Colecalciferol/farmacologia , Hiperparatireoidismo Secundário/tratamento farmacológico , Idoso , Cálcio/sangue , Cálcio/metabolismo , Cálcio/urina , Suplementos Nutricionais , Feminino , Marcha , Humanos , Hiperparatireoidismo Secundário/metabolismo , Hiperparatireoidismo Secundário/fisiopatologia , Hormônio Paratireóideo/sangue , Fatores de Tempo , Vitamina D/análogos & derivados , Vitamina D/sangue
11.
Osteoporos Int ; 10(1): 26-33, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10501776

RESUMO

The aim of the study was to identify factors affecting patients with postmenopausal osteoporosis who had experienced one or more vertebral fractures. The overall hypothesis was that time after fracture would influence patients' perception of pain and well-being. The sample (50 patients) was split into two groups (group A, time after fracture < or > 24 months; group B, time after fracture >24 months). A fracture was defined as a vertebral height reduction of more than 20% or at least 4 mm. The assessment was carried out using the Spine Deformity Index and was confirmed by an experienced radiologist. To assess quality of life (QoL) the following measures were used: 'well-being scale' including social extroversion as a subscale, pain scale, and limitations in everyday life. The Sense of Coherence questionnaire developed by Antonovsky measures the ability of a person to see life meaningful, manageable and explicable. This questionnaire may reflect patients' coping abilities and was introduced to establish whether these influence the perception of pain and well-being after vertebral fracture. Variance and covariance analysis was carried out using SPSS (version 6.1). Differences between groups A and B were found for perception of average pain (p = 0.017), social extroversion (p = 0.003) and well-being (p = 0.024). No differences were found for limitations in everyday life (p = 0.607), Sense of Coherence (p = 0.638), the Spine Deformity Index (p = 0.171) and loss of height (p = 0.619). All analyses were corrected for age. Concurrent medication was not found to influence the results. Findings suggest that time after fracture is an important variable when considering QoL and well-being after vertebral fracture and should, therefore, be considered in future studies.


Assuntos
Osteoporose Pós-Menopausa/complicações , Limiar da Dor , Qualidade de Vida , Fraturas da Coluna Vertebral/etiologia , Idoso , Análise de Variância , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/psicologia , Osteoporose Pós-Menopausa/reabilitação , Fraturas da Coluna Vertebral/psicologia , Fraturas da Coluna Vertebral/reabilitação , Inquéritos e Questionários , Fatores de Tempo
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