| Trials | |
| Vitamin D supplementation in older people (VDOP): Study protocol for a randomised controlled intervention trial with monthly oral dosing with 12,000 IU, 24,000 IU or 48,000 IU of vitamin D3 | |
| Terence Aspray3  Ann Prentice5  Jennie Parker4  Jennifer Wilkinson4  Alison Yarnall3  Christine Harle4  Gail R Goldberg5  Thomas Chadwick1  Elaine McColl4  Roger M Francis2  Inez Schoenmakers5  | |
| [1] Institute of Health and Society, Newcastle University, Baddiley-Clark Building Richardson Road, Newcastle upon Tyne NE2 4 AX, UK;Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality Nuns Moor, Newcastle upon Tyne NE4 5PL, UK;Bone Clinic Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK;Newcastle Clinical Trials Unit, The Medical School, 4th Floor, William Leech Building Framlington Place, Newcastle upon Tyne NE2 4HH, UK;MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK | |
| 关键词: Older people; Bone markers; Parathyroid hormone; 25 hydroxy vitamin D; Bone mineral density; Vitamin D supplementation trial; | |
| Others : 1093050 DOI : 10.1186/1745-6215-14-299 |
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| received in 2013-06-07, accepted in 2013-09-06, 发布年份 2013 | |
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【 摘 要 】
The randomised, double blind intervention trial ‘Optimising Vitamin D Status in Older People’ (VDOP) will test the effect of three oral dosages of vitamin D given for one year on bone mineral density (BMD) and biochemical markers of vitamin D metabolism, bone turnover and safety in older people. VDOP is funded by Arthritis Research UK, supported through Newcastle University and MRC Human Nutrition Research and sponsored by the Newcastle upon Tyne Hospitals NHS Foundation Trust.a
Background
Vitamin D insufficiency is common in older people and may lead to secondary hyperparathyroidism, bone loss, impairment of muscle function and increased risk of falls and fractures. Vitamin D supplementation trials have yielded conflicting results with regard to decreasing rates of bone loss, falls and fractures and the optimal plasma concentration of 25 hydroxy vitamin D (25OHD) for skeletal health remains unclear.
Method/design
Older (≥70 years) community dwelling men and women are recruited through General Practices in Northern England and 375 participants are randomised to take 12,000 international units (IU), 24,000 IU or 48,000 IU of vitamin D3 orally each month for one year starting in the winter or early spring. Hip BMD and anthropometry are measured at baseline and 12 months. Fasting blood samples are collected at baseline and three-month intervals for the measurement of plasma 25OHD, parathyroid hormone (PTH), biochemical markers of bone turnover and biochemistry to assess the dose–response and safety of supplementation. Questionnaire data include falls, fractures, quality of life, adverse events and outcomes, compliance, dietary calcium intake and sunshine exposure.
Discussion
This is the first integrated vitamin D supplementation trial in older men and women using a range of doses given at monthly intervals to assess BMD, plasma 25OHD, PTH and biochemical markers of bone turnover and safety, quality of life and physical performance. We aim to investigate the vitamin D supplementation and plasma 25OHD concentration required to maintain bone health and to develop a set of biochemical markers that reflects the effect of vitamin D on bone. This will aid future studies investigating the effect of vitamin D supplementation on fracture risk.
#ISRCTN 35648481 (assigned 16 August 2012), EudraCT 2011-004890-10.
【 授权许可】
2013 Schoenmakers et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20150130155938849.pdf | 297KB |
【 参考文献 】
- [1]Francis RM: What do we currently know about nutrition and bone health in relation to United Kingdom public health policy with particular reference to calcium and vitamin D? Br J Nutr 2008, 99:155-159.
- [2]Nutrition TSACo: Update on Vitamin D. London: The Stationery Office; 2007.
- [3]Prentice A: Vitamin D deficiency: a global perspective. Nutr Rev 2008, 66:S153-S164.
- [4]Bischoff-Ferrari HA, Conzelmann M, Stahelin HB, Dick W, Carpenter MG, Adkin AL, Theiler R, Pfeifer M, Allum JH: Is fall prevention by vitamin D mediated by a change in postural or dynamic balance? Osteoporos Int 2006, 17:656-663.
- [5]Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B: Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women. Osteoporos Int 2008, 19:1307-1314.
- [6]Sahota O, Gaynor K, Harwood RH, Hosking DJ: Hypovitaminosis D and ‘functional hypoparathyroidism’-the NoNoF (Nottingham Neck of Femur) study. Age Ageing 2001, 30:467-472.
- [7]Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ: The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004, 35:312-319.
- [8]Rejnmark L, Vestergaard P, Brot C, Mosekilde L: Increased fracture risk in normocalcemic postmenopausal women with high parathyroid hormone levels: a 16-year follow-up study. Calcif Tissue Int 2011, 88:238-245.
- [9]Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001, 22:477-501.
- [10]Boonen S, Rizzoli R, Meunier PJ, Stone M, Nuki G, Syversen U, Lehtonen-Veromaa M, Lips P, Johnell O, Reginster JY: The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report. Osteoporos Int 2004, 15:511-519.
- [11]IoMotN A: Dietary Reference Intakes for Calcium and Vitamin D. Washington D.C: The National Academies Press; 2011.
- [12]Holick MF: Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging 2007, 24:1017-1029.
- [13]Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B: Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006, 84:18-28.
- [14]Vieth R, Ladak Y, Walfish PG: Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 2003, 88:185-191.
- [15]Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R: Estimates of optimal vitamin D status. Osteoporos Int 2005, 16:713-716.
- [16]Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A: The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007, 85:649-650.
- [17]Grant WB, Cross HS, Garland CF, Gorham ED, Moan J, Peterlik M, Porojnicu AC, Reichrath J, Zittermann A: Estimated benefit of increased vitamin D status in reducing the economic burden of disease in western Europe. Prog Biophys Mol Biol 2009, 99:104-113.
- [18]Bates CJ, Carter GD, Mishra GD, O’Shea D, Jones J, Prentice A: In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey. Osteoporos Int 2003, 14:152-159.
- [19]Ruston D, Hoare L, Henderson L, Gregory J, Bates CJ, Prentice A, Birch M, Swan G, Farron M: The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years. Nutritional Status (Anthropometry and Blood Analytes), Blood Pressure and Physical Activity. London: The Stationery Office; 2003.
- [20]Hypponen E, Power C: Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 2007, 85:860-868.
- [21]Hirani V, Primatesta P: Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey. Age Ageing 2005, 34:485-491.
- [22]Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011, 96:53-58.
- [23]Department of Health: Nutrition and Bone Health: with particular reference to calcium and vitamin D. London: The Stationery Office; 1998.
- [24]Aspray TJ, Stevenson P, Abdy SE, Rawlings DJ, Holland T, Francis RM: Low bone mineral density measurements in care home residents–a treatable cause of fractures. Age Ageing 2006, 35:37-41.
- [25]Meyer HE, Smedshaug GB, Kvaavik E, Falch JA, Tverdal A, Pedersen JI: Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 2002, 17:709-715.
- [26]Meyer HE, Falch JA, Sogaard AJ, Haug E: Vitamin D deficiency and secondary hyperparathyroidism and the association with bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway, The Oslo health study. Bone 2004, 35:412-417.
- [27]Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J: Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009, 339:b3692.
- [28]Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B: Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005, 293:2257-2264.
- [29]Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J: Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009, 169:551-561.
- [30]Boonen S, Bischoff-Ferrari HA, Cooper C, Lips P, Ljunggren O, Meunier PJ, Reginster JY: Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int 2006, 78:257-270.
- [31]DIPART (Vitamin D Individual Patient Analysis of Randomized Trials) Group: Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010, 340:b5463.
- [32]Avenell A, Gillespie WJ, Gillespie LD, O’Connell D: Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009, 2:CD000227.
- [33]Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC: Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010, 303:1815-1822.
- [34]Trivedi DP, Doll R, Khaw KT: 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 2003, 326:469.
- [35]Smith H, Anderson F, Raphael H, Maslin P, Crozier S, Cooper C: 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) 2007, 46:1852-1857.
- [36]Glendenning P, Zhu K, Inderjeeth C, Howat P, Lewis JR, Prince RL: 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 2012, 27:170-176.
- [37]Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, Lichtenstein A, Patel K, Raman G, Tatsioni A, Terasawa T, Trikalinos TA: Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep) 2009, (183):1-420.
- [38]Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V: Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007, (158):1-235.
- [39]Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P: Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007, 92:1415-1423.
- [40]Bischoff-Ferrari HA: The 25-hydroxyvitamin D threshold for better health. J Steroid Biochem Mol Biol 2007, 103:614-619.
- [41]Francis RM: The vitamin D paradox. Rheumatology (Oxford) 2007, 46:1749-1750.
- [42]Bischoff-Ferrari H: Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol 2009, 23:789-795.
- [43]Heaney RP: The case for improving vitamin D status. J Steroid Biochem Mol Biol 2007, 103:635-641.
- [44]Pearce SH, Cheetham TD: Diagnosis and management of vitamin D deficiency. BMJ 2010, 340:b5664.
- [45]Brannon PM, Yetley EA, Bailey RL, Picciano MF: Summary of roundtable discussion on vitamin D research needs. Am J Clin Nutr 2008, 88:587S-592S.
- [46]Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G: PTH level but not 25 (OH) vitamin D level predicts bone loss rates in the elderly. Osteoporos Int 2012, 23:971-980.
- [47]Hodsman AB, Hanley DA, Watson PH, Fraher LJ: Parathyroid hormone. In Principles of Bone Biology. Edited by Bilezikian JP, Raisz LG, Rodan GA. New York: Academic; 2002:1305-1324.
- [48]Bischoff-Ferrari HA: Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol 2008, 624:55-71.
- [49]Malabanan A, Veronikis IE, Holick MF: Redefining vitamin D insufficiency. Lancet 1998, 351:805-806.
- [50]Macdonald HM, Wood AD, Aucott LS, Black AJ, Fraser WD, Mavroeidi A, Reid DM, Secombes KR, Simpson WG, Thies F: Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1 year double-blind RCT in postmenopausal women. J Bone Miner Res 2013. doi:10.1002/jbmr.1959.
- [51]Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997, 7:439-443.
- [52]Durazo-Arvizu RA, Dawson-Hughes B, Sempos CT, Yetley EA, Looker AC, Cao G, Harris SS, Burt VL, Carriquiry AL, Picciano MF: Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older. J Nutr 2010, 140:595-599.
- [53]Patel S, Hyer S, Barron J: Glomerular filtration rate is a major determinant of the relationship between 25-hydroxyvitamin D and parathyroid hormone. Calcif Tissue Int 2007, 80:221-226.
- [54]Al-oanzi ZH, Tuck SP, Raj N, Harrop JS, Summers GD, Cook DB, Francis RM, Datta HK: Assessment of vitamin D status in male osteoporosis. Clin Chem 2006, 52:248-254.
- [55]Sahota O, Mundey MK, San P, Godber IM, Hosking DJ: Vitamin D insufficiency and the blunted PTH response in established osteoporosis: the role of magnesium deficiency. Osteoporos Int 2006, 17:1013-1021.
- [56]Bouxsein ML, Delmas PD: Considerations for development of surrogate endpoints for antifracture efficacy of new treatments in osteoporosis: a perspective. J Bone Miner Res 2008, 23:1155-1167.
- [57]Ish-Shalom S, Segal E, Salganik T, Raz B, Bromberg IL, Vieth R: Comparison of daily, weekly, and monthly vitamin D3 in ethanol dosing protocols for two months in elderly hip fracture patients. J Clin Endocrinol Metab 2008, 93:3430-3435.
- [58]Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39:142-148.
- [59]McCloskey EV, Johansson H, Oden A, Kanis JA: From relative risk to absolute fracture risk calculation: the FRAX algorithm. Curr Osteoporos Rep 2009, 7:77-83.
- [60]Power M, Quinn K, Schmidt S: Development of the WHOQOL-old module. Qual Life Res 2005, 14:2197-2214.
- [61]Skevington SM, Lotfy M, O’Connell KA: The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004, 13:299-310.
- [62]Nelson M, Hague GF, Cooper C, Bunker VW: Calcium intake in the elderly: validation of a dietary questionnaire. J Hum Nutr Diet 1988, 1:115-127.
- [63]Macdonald HM: Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int 2013, 92:163-176.
- [64]Yan L, Schoenmakers I, Zhou B, Jarjou LM, Smith E, Nigdikar S, Goldberg GR, Prentice A: Ethnic differences in parathyroid hormone secretion and mineral metabolism in response to oral phosphate administration. Bone 2009, 45:238-245.
- [65]Vickers AJ: The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study. BMC Med Res Methodol 2001, 1:6. BioMed Central Full Text
- [66]European Medicines Agency: ICH Topic E 6 (R1): Guideline for Good Clinical Practice. London: EMEA; 2002.
- [67]European Medicines Agency: COMMISSION DIRECTIVE 2005/28/EC:laying down principles and detailed guidelines for good clinical practice as regards investigational medicinal products for human use, as well as the requirements for authorisation of the manufacturing or importation of such products. Available at: http://ec.europa.eu/health/files/eudralex/vol-1/dir_2005_28/dir_2005_28_en.pdf webcite
- [68]Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR: Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 2011, 342:d2040.
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