Vitamina D: effetti extrascheletrici

F. Vescini

Patologie e condizioni cliniche

associate all’ipovitaminosi D

• Rachitismo/Osteomalacia/Osteoporosi

• Fratture

• Mialgia/Sarcopenia/Astenia/Aumentato rischio di cadute

• Ridotta salute dentaria

• Neoplasie (colon, mammella, prostata)

• Malattie cardiovascolari/Ipertensione Arteriosa

• Diabete mellito

• Malattie infettive

• Osteoartrite e fibromialgia

• Malattie respiratorie

• Aumentata mortalità

Patologie e condizioni cliniche

associate all’ipovitaminosi D

CADUTE

MALATTIE CV CANCRO

HIV

MORTALITA’ GLOBALE

CADUTE

Bischoff-Ferrari HA et al. JAMA 2004

Vitamina D e rischio di cadute

Murad MH et al.

2012, Issue 12.

Art. No.:

CD005465

INFEZIONE DA HIV

2010 May 15;24(8):1127-34

J Acquir Immune Defic Syndr. 2011 oct 1;58(2):163-172

Véronique Fabre-Mersseman, et al.

MORTALITA’ PER

CANCRO

VITAMIN D AND CANCER RISK

Garland CF Am J Pub Health 2006 Giovannuci E Cancer Causes Control 2005

Level vit D Incidence Severity

Breast <40 ng/ml +30-40% +5 fold

Prostate <16ng/ml +70% +6.3 fold

Colon <30 ng/ml +50% +4 fold

Chowdhury R, et al. BMJ 2014;348:g1903

Relative risks of cancer mortality for baseline 25(OH)

vitamin D levels in observational cohort studies

MORTALITA’ PER

MALATTIE CV

Ipotesi patogenetiche dell’associazione tra carenza di

vitamina D ed eventi cardiovascolari

Lee et al, J Am Coll Cardiol, 2008

Chowdhury R, et al. BMJ 2014;348:g1903

Relative risks of cardiovascular mortality for baseline

25(OH) vitamin D levels in observational cohort studies

The RECORD trial: Estimated effects of vitamin D on outcomes

CARDIAC FAILURE

STROKE

MYOCARDIAL INFARCTION

MORTALITA’ GLOBALE

Overall effect size for all-cause mortality for the lowest category of

25OHD compared to the highest category (reference)

Chowdhury R, et al. BMJ 2014;348:g1903

Relative risks of nonvascular, noncancer mortality for baseline

25(OH) vitamin D levels in observational cohort studies

Schöttker B, et al. BMJ 2014;348:g3656

Dose-response trend of pooled effect estimates for the

comparison of 25-hydroxyvitamin D quintiles (top

quintile as reference) with respect to mortality outcomes

Chowdhury R, et al. BMJ 2014;348:g1903

Relative risks of all cause mortality in vitamin D3

supplementation trials

Chowdhury R, et al. BMJ 2014;348:g1903

Relative risks of all cause mortality in vitamin D2

supplementation trials

Vitamin D decreased mortality in all 56 trials analysed.

RR 0.97 (95% CI 0.94 to 0.99; P = 0.02; I2 = 0%)

When different forms of vitamin D were assessed in separate analyses, only vitamin

D3 decreased mortality.

RR 0.94 (95% CI 0.91 to 0.98; P = 0.002; I2 = 0%)

Vitamin D2, alfacalcidol and calcitriol did not significantly affect mortality.

Trial sequential analysis supported our finding regarding vitamin D3, corresponding

to 150 people treated over five years to prevent one additional death.

Vitamin D3 statistically significantly decreased cancer mortality.

RR 0.88 (95% CI 0.78 to 0.98; P = 0.02; I2 = 0%)

Vitamin D3 combined with calcium increased the risk of nephrolithiasis.

RR 1.17 (95% CI 1.02 to 1.34; P = 0.02; I2 = 0%)

Alfacalcidol and calcitriol increased the risk of hypercalcaemia.

RR 3.18 (95% CI 1.17 to 8.68; P = 0.02; I2 = 17%)

“Meta-analyses of RCTs report that vitamin D reduces mortality risk by

3-4%, suggesting that if vitamin D supplements have an effect on

mortality, it is small and of doubtful clinical relevance.”