补充维生素D对社区绝经后女性肌力、生活质量及骨折发生的影响

The impact of vitamin D supplementation on muscle strength,quality of life and fracture in community-dwelling postmenopausal women

目的观察运动、补充维生素D及钙剂对绝经后女性肌力、生活质量和发生骨折的影响。方法共纳入北京、上海、成都、广州市多个社区绝经后女性2 519名,随机分为4组:对照组、强化运动组、钙+普通维生素D组、钙+活性维生素D组,随访观察2年,分别检测基线、干预12及24个月后的双手握力及站立试验时间变化,通过SF-36调查问卷了解患者生活质量,比较各组治疗前后上述指标的变化,记录随访期间跌倒及新发骨折次数。结果与对照组相比,强化运动、钙+普通维生素D、钙+活性维生素D在2年随访期间未观察到跌倒、新发骨折发生率的显著变化;对照组随访2年出现握力及生活质量多项评分下降,强化运动组站立试验时间缩短[基线(8.76±3.34)s,随访2年[(8.31±3.46)s],SF-36评分中总体健康、活力、社会功能及健康变化较基线改善;钙剂(600 mg/d)+普通维生素D(800 U/d)组SF-36评分结果显示身体疼痛、活力及健康变化较基线改善,生理功能、生理职能、总体健康评分较基线无下降;补充钙和活性维生素D[1,25(OH)2D 0.25μg/d]组站立试验时间缩短(基线(8.86±3.46)s,随访2年[(8.61±3.36)s];握力改善[基线(22.04±8.48)N],随访2年[(22.47±4.61)N];SF-36评分中身体疼痛、活力、社会功能、健康变化较基线改善,生理职能及总体健康评分较基线无下降。结论对照组绝经后女性随访2年出现肌力下降及生活质量评分降低,强化运动能够增加肌力及改善生活质量(总体健康、活力、社会功能及健康变化),补充钙剂(600 mg/d)及普通维生素D(800 U/d)能够维持或改善绝经后女性生活质量,补充钙剂和活性维生素D(0.25μg/d)能够增加肌力及改善或维持生活质量,提示强化运动及钙剂和维生素D补充对绝经后女性肌力和生活质量的改善具有重要作用。

Objective To investigate the impact of exercise, vitamin D and calcium supplementation on muscle strength, quality of life and fracture in postmenopausal women. Methods 2 519 community-dwelling postmenopausal women from Beijing, Shanghai, Chengdu and Guangzhou were enrolled in this study and followed for two years. The sub- jects were randomized to four groups including group A （ control）, group B （ intense exercise ）, group C （ calcium 600 mg/d and plain vitamin D 800 IU/d）, and group D （ calcium 600 mg/d and calcitriol 0. 25 μg/d）. The muscle strength assessed by grip strength and sit-to-stand test, and the quality of life evaluated by SF-36 questionnaire were per- formed at baseline, 1-year and 2-year. Failing and incident fracture during the follow-up were recorded. Results There was no significant difference in the incidence of falling and fracture among each groups during two years. The grip strength and scales of several items in SF-36 decreased in group A. In group B, the sit-to-stand test reduced significantly （ 8.76 ± 3.34 s at baseline vs. 8.31± 3.46 s at the end of 2nd year, P = 0. 005 ） and scales of general health, vitality and social function improved during the two years. In group C, the scales of bodily pain, vitality and reported health transition im- proved compared to baseline. In group D, the sit-to-stand time reduced （8.86 ±3.46 s at the end of 1st year vs. 8. 61 ± 3.36 s at end of 2nd year, P =0. 009）, the grip strength improved （22. 04 ± 8.48 N at baseline vs. 22.47±4. 61 N at the end of 2nd year, P = 0. 016） , and the scales of bodily pain, vitality, social function, reported health transition improved compared to baseline. Conclusion Among this study population, the muscle strength and life of quality tended to decline in postmenopausal women. Intense exercise could improve muscle strength and life of quality. Supplemental calcium and plain vitamin D could maintain the life of quality. And calcium plus calcitriol could effectively improve the muscle strength and improve the quality of life in this group of postmenopausal women. It is suggested that intense exercise and vitamin D are beneficial for maintaining or even improving muscle strength and quality of life in community-dwelling postmenopausal women.