钙剂对未成年健康人群骨密度影响的Meta分析

Effect of calcium supplementation on bone mineral density in healthy juveniles: systemic review of randomized controlled trials

目的评估钙剂对未成年健康人群骨密度的影响。方法以主题词"calcium supplementation、bone density、randomized controlled trials"在Pubmed,Medline,Embase,CINAHL,AMED,MANTIS,ISI Web of Science,CENTRAL等数据库搜索文献,选取1966年至2017年钙剂应用于未成年健康人群3个月以上,随访期6个月以上并且具有骨密度相关研究结果的随机对照研究进行meta分析。Meta分析用固定效应模型,提取数据和评估结果均由2位研究人员进行。结果共纳入21个随机对照研究,3 072例未成年健康人群。钙剂对股骨颈骨密度[SMD=0.09,95%CI(-0.06,0.21)]和腰椎骨密度[SMD=0.07,95%CI(-0.03,0.22)]的提高无明显作用(P>0.05)。停止补钙后,上肢骨骨密度仍显著增高[SMD=0.14,95%CI(0.01,0.28),P<0.05],全身骨矿物含量则无明显变化[SMD=0.00,95%CI(-0.40,0.40),P>0.05]。钙剂提高女性的骨密度较男性显著,钙剂对骨密度的影响与青春期前后,钙剂摄入基线,种族无明显关联。结论钙剂对上肢骨密度的影响不能够减少未成年人群发生骨折的概率,对公共卫生预防未成年人群骨折有参考意义。

Objective To determine whether calcium supplementation could improve the bone mineral density（ BMD） in healthy children. Methods Search strategies（ calcium supplementation,bone density,randomized controlled trials） was applied to the following databases： Pubmed,Medline,Embase,CINAHL,AMED,MANTIS,ISI Web of Science,CENTRAL. The researches that had randomized placebo controlled trials of calcium supplementation in healthy children lasted at least three months and had BMD outcomes measured after at least six months follow-up from 1966-2017 were seletced. Data were extracted from the text,two reviewers independently exracted data and analysis. Results Twenty-one eligible studies of 3072 healthy children were included. There was no effect on BMD on femoral neck[SMD = 0. 09,95% CI（-0. 06,0. 21） ] or lumbar spine[SMD = 0. 07,95% CI（-0. 03,0. 22） ] when treated with calcium supplementation（ P 〉 0. 05）. Calcium supplementation had persistent effect on upper limb BMD after stopping supplementation [SMD = 0. 14,95% CI（ 0. 01,0. 28）,P 〈 0. 05 ],while total body BMD content changed little[SMD = 0. 00,95% CI（-0. 40,0. 40）,P 〉 0. 05]. Female children were sensitive to the calcium compared with male children. There was no correlation of bone mineral content between pubertal stage,baseline calcium intake or ethnicity. Conclusion Healthy children who treated on calcium supplementation is impossible to reduce the risk of bone fracture.