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.”