Активные метаболиты витамина D в лечении остеопороза и профилактике переломов


И.А. Скрипникова

ФГБУ ГНИЦПМ Минздрава России, Москва
Обзор посвящен клиническим эффектам активных метаболитов витамина D, которые обладают многоплановым действием на разные органы и ткани, имея оптимальный профиль безопасности, в связи с чем области применения и возрастной диапазон пациентов, которым можно назначать эти препараты, достаточно широки. Поскольку наиболее убедительные результаты были показаны в отношении увеличения минеральной плотности кости в 2–5 раз, снижения риска переломов в 2 раза и уменьшения риска падений в 3,5 раза, аналоги D-гормона могут активно использоваться в управлении риском переломов, связанных с первичным и вторичным остеопорозом.

Литература


  1. Kanis J.A., McCloskey E.V., Johansson H., Cooper C., Rissoli R., Reginster J.-Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int.2013;24:23–57.
  2. Kanis J.A., Johnell O., Oden A., Sembo I., Redlund-Johnell I., Dawson A., De Laet C., Jonsson B. Long term risk of osteoporotic fracture in Malmo. Osteoporos Int.2000;11:669–74.
  3. Elliot-Gibson V., Bogoch E.R., Jamal S.A., Beaton D.E. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporosis Int. 2004;15:767–78.
  4. Haaland D.A., Cohen D.R., Kennedy C.C., Khalidi N.A., Adachi J.D., Papaioannou A. Closing the osteoporosis care gap: increased osteoporosis awareness among geriatrics and rehabilitation teams. BMC Geriatr. 2009;9:28.
  5. Sambrook P., Cooper C. Osteoporos. Lancet. 2006;367:2010–18.
  6. Boonen S., Vanderschueren D., Haentjens P., Lips P. Calcium and vitamin D in the prevention and treatment of osteoporosis – a clinical update. J Intern Med 2006;258:539–552.
  7. Group D. Patient level pooled analysis of 68500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010;340:b5463.
  8. Tang B.M., Eslick G.D., Nowson C., Smith C., Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370:657–66.
  9. Avenel A., Gillespie W.J., Gillespie J.D., O’Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Library. 2009;Issue 2. http/www.thecochranelibrary.com
  10. Boonen S., Lips P., Bouillon R., Bischoff-Ferrari H.A., Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. Clin. Endocrinol .Metab. 2007;92:1415–23.
  11. Boonen S., Bischoff-Ferrari H.A., Cooper C., Lips, P., Ljunggren O., Meunier P.J., Reginster J.Y. Adressing the musculoskeletal components of fracture risk with calcium and vitamin D; a review of the evidence. Calcif. Tissue Int. 2006;78:257–70.
  12. Gallagher J.C., Fowler S.E., Detter J.R. Combination treatment with estrogen and calcitriol in the prevention of age-relation bone loss. J. Clin. Endocrinol. Metab. 2001;86:3618–28.
  13. Gallagher J.C. The effects of calcitriol on falls and fractures and physical performance tests. J. Steroid. Biochem. Mol. Biol. 2004;89–90:497–501.
  14. Ones K., Schacht E., Dukas L. Effects of combined treatment with alendronate and alfacalcidol on bone mineral density and bone turnover in poatmenopausal osteoporosis: a two-years randomized multiarm controlled trial. Inrernet J. Endocrinol. 2007;4:published online.
  15. Richy F., Schacht E., Bruyere O., Ethgen O., Gourlay M., Reginster J.Y. Vitamin D Analogues Versus Native Vitamin D in Preventing Bone Loss and Osteoporosis-Related Fractures: A Comparative Meta-analysis. Calcif Tissue Int. 2005;76:176–86
  16. Richy F., Dukas L., Schacht E. Differential effects of D-Hormone analogs and native vitamin D on the risk of falls: a comparative meta–analysis. Calcific Tissue Int. 2008. Epub ahead of print.
  17. de Nijs R. N., Jacobs J. W., Algra A., Lems W. F., Bijlsma J.W. Prevention and treatment of glucocorticoid–induced osteoporosis with active vitamin D3 analogues: a review with meta–analysis of randomized controlled trials including organ transplantation studies. Osteoporos. Int. 2004;15(8):589–602.
  18. Lekamwasam S., Adachi J. D., Agnusdei J. Bilezikian J., Boonen S., Borgstrom F., Cooper C. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis Osteoporos Int 2012; 23(9): 2257–76.
  19. Jarvinen T.L.N., Sievanen H., Khan K.M., Heinonen A., Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. Br. Med. J. 2008;336;124–26.
  20. Kannus P., Sievanen H., Palvanen M., Jarvinen T., Parkkari J. Prevention of falls and consequent injuries in elderly people. Lancet. 2005;366:1885–93.
  21. Barret-Connor E., Weiss T.W., McHorney C.A., Miller P.D., Siris E.S. Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos. Int. 2009;20:715–22.
  22. Group D. Patient level pooled analysis of 68500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010; 340:b5463.
  23. Ducas L., Bischoff H.A,, Lindpaintner L.S., Schacht E., Birkner-Binder D., Damm T.N., Thalmann B., Stahelin H.B. Alfacalcidol Reduces the Number of Fallers in a Community-Dwelling Elderly Population with a Minimum Calcium Intake of More Than 500 mg Daily. J. Am. Geriatr. Soc. 2004;52(2):230–36.
  24. Schacht E., Richy F., Reginster J.-Y. The therapeutic effects of alfacalcidol on bone strength muscle metabolism and prevention of falls and fractures. J. Musculoscelet. Neuronal. Interact. 2005;5(3):273–384.
  25. Ducas L., Schacht E., Mazor Z. Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min. Osteoporos. Int. 2005;16(2):198–203.
  26. Sorensen O.H., Lund B.I., Saltin B., Lund B.J., Andersen R.B., Hjorth L., Melson F., Mosekilde F. Myopathy in bone loss of ageing: improvement by treatment with 1-alphahydroxycholecalciferol and calcium. Clin. Sci. 1979;56:157–61.
  27. Verhaar H.J.J., Samson M.M., Jansen P.AF., de Vreede P.L., Manten J.W., Duursma S.A. Muscle strength, functional mobility and vitamin D in older women. Aging Clin. Exp. Res. 2000;12:455–60.
  28. Orimo H. Clinical application of 1α(OH)D3 in Japan. Act. Rheumatol.1994;89:27.


Об авторах / Для корреспонденции


И.А. Скрипникова – д.м.н., рук. отдела профилактики остеопороза ФГБУ ГНИЦПМ Минздрава России, Москва; e-mail: ISkripnikova@gnicpm.ru


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