Hochdosiertes Vitamin D und extensive Physiotherapie nach Hüftfraktur
Ältere Patienten haben nach Hüftfraktur ein beträchtliches Risiko, wieder zu stürzen und rehospitalisiert zu werden. Eine Schweizer Studie ist der Frage nachgegangen, durch welche Interventionen diese Komplikationen nach Hüftfraktur reduziert werden können.
173 im Durchschnitt 84 Jahre alte Patienten mit einer Hüftfraktur nahmen an der randomisierten Studie teil. Einerseits erfolgte neben der Akutbehandlung entweder eine extensive oder eine Standard-Physiotherapie (1 Stunde täglich in der Akutphase, danach Heimprogramm oder ½ Stunde täglich ohne Heimprogramm), andererseits eine doppelblinde Behandlung mit 2000 oder 800 IU Cholecalciferol pro Tag. Endpunkte waren die Sturz- und Rehospitalisationsraten während des einjährigen Follow-ups. Bei Studieneinschluss hatten 51% der Teilnehmer 25-Hydroxyvitamin D Spiegel < 12 ng/ml ( < 4.8ug/l) und 98% Spiegel < 30 ng/ml (< 12ug/l). Die Studienautoren registrierten 212 Stürze und 74 Rehospitalisationen. Die extensive Physiotherapie reduzierte die Sturzrate gegenüber der Standard-Physiotherapie um 25%, nicht jedoch die Rehospitalisationsrate. Hoch dosiertes Cholecalciferol reduzierte das Sturzrisiko nicht, dafür jedoch die Rehospitalisationsrate um 39%.
Konklusion der Autoren: Ausgedehnte Physiotherapie reduziert das Sturzrisiko und die höher dosierte Behandlung mit Cholecalciferol das Rehospitalisationsrisiko. Die Kombination der beiden Therapiestrategien könnte dazu beitragen, das Komplikationsrisiko nach Hüftfrakturen zu reduzieren.
ArchIntern Med 2010;170:813-820 - Bischoff-Ferrari HA et al
2008 - Kann Vitamin D Konsum Arthrosen verhindern?
Zusammenfassende Antwort: nein, aber möglicherweise eine bestehende Arthrose lindern
Consuming adequate amounts of vitamin D is certainly important for preventing and treating osteoporosis. But what about osteoarthritis?
In 1996, McAllindon et al. published a study in Annals of Internal Medicine in which they looked at this question. The authors screened 556 people who were part of the Framingham Heart Study and who also had knee radiography performed. The knee radiographs were taken once between 1983 and 1985 and again between 1992 and 1993. Vitamin D levels were assessed from self-reported dietary habits and supplementation as well as blood levels of vitamin D. The authors found that those people with pre-existing knee osteoarthritis who consumed less vitamin D and had low blood levels of vitamin D were three times more likely to develop worsening osteoarthritis.
However, in those people who did not already have pre-existing osteoarthritis, low vitamin D intake and low blood levels of vitamin D did not predict development of knee osteoarthritis over the time period studied.
In 2007, Felson et al. published a study in Arthritis and Rheumatism in which they also evaluated whether vitamin D levels may impact osteoarthritis. The authors evaluated 772 people who were part of the Framingham Osteoarthritis Study. They obtained baseline x-rays of the participants' knees in 1993-1994 and again in 2002-2005. Vitamin D levels in these participants were measured between 1996 and 2000. It was found in this subset of the study that Vitamin D levels did not correlate with radiographic worsening of the knees over the 9-year interval. As part of the same study, the authors also evaluated 277 subjects who were part of the Boston Osteoarthritis of the Knee Study. In this subset, all patients had symptomatic knee osteoarthritis. These participants had knee x-rays taken as well as MRI of the symptomatic knee at baseline, 15, and 30 months. At all visits, blood samples were obtained. Vitamin D levels were analyzed. As with the Framingham Osteoarthritis Study, vitamin D levels did not correlate with risk of worsening knee osteoarthritis.
From the available data, it appears that vitamin D levels may not correlate with development of knee osteoarthritis, but once osteoarthritis is present, consuming enough vitamin D may help prevent it from worsening. The bottom line, though, is that more research on this subject is needed.