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Дефицит витамина D: скелетные и внескелетные нарушения и их коррекция альфакальцидолом
Дыдыкина И.С., Коваленко П.С., Коваленко А.А. Дефицит витамина D: скелетные и внескелетные нарушения и их коррекция альфакальцидолом. Consilium Medicum. 2018; 20 (9): 82–87. DOI: 10.26442/2075-1753_2018.9.82-87
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Dydykina I.S., Kovalenko P.S., Kovalenko A.A. Vitamin D deficiency: skeletal and non-skeletal disorders and its treatment with alfacalcidol. Consilium Medicum. 2018; 20 (9): 82–87. DOI: 10.26442/2075-1753_2018.9.82-87
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Аннотация
В статье представлены сведения о физиологической роли витамина D и основных причинах дефицитных состояний. Описаны особенности метаболизма нативной и активной форм витамина D, в том числе в зависимости от возраста и коморбидных состояний. Указаны основные показания для назначения активных метаболитов витамина D. Отмечено, что альфакальцидол по причине отсутствия метаболизма в почках демонстрирует большую клиническую эффективность по сравнению с нативным витамином D в лечении различных типов остеопороза при схожем профиле безопасности. Альфакальцидол в виде монотерапии входит в клинические рекомендации по терапии данного заболевания в отличие от нативного витамина D, так как продемонстрировал более выраженный эффект в отношении повышения минеральной плотности кости, сокращения риска падений, уменьшения переломов и значимое снижение болевого синдрома. Широкие возможности подбора индивидуальных дозировок препарата Альфа Д3®-Тева (альфакальцидол) позволяют свести к минимуму риск развития побочных эффектов, что вместе с предупреждением возникновения новых переломов, устранением болевого синдрома и улучшением двигательной активности способствует повышению качества жизни пациентов всех возрастов.
Ключевые слова: дефицит витамина D, причины дефицита витамина D, остеопороз, остеопоротические переломы, нативный витамин D, активные метаболиты витамина D, метаболизм витамина D, альфакальцидол.
Ключевые слова: дефицит витамина D, причины дефицита витамина D, остеопороз, остеопоротические переломы, нативный витамин D, активные метаболиты витамина D, метаболизм витамина D, альфакальцидол.
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The article presents data on physiological role of vitamin D and primary causes of its deficiency. Aspects of native and active vitamin D forms metabolism including its dependence on age and comorbid conditions are discussed. Primary indications for active vitamin D metabolites prescription are described. It is noted that compared with native vitamin D alfacalcidol demonstrates better clinical effectiveness in different types of osteoporosis treatment due to the absence of its metabolism in kidneys and the safety profiles of the medications are similar. Unlike native vitamin D alfacalcidol monotherapy is included in clinical recommendations for this disorder treatment as it demonstrated better effectiveness in bone mineral density increase, risk of falls and fractures reduction, as well as significant relief of pain syndrome. Broad opportunities of Alpha D3-Teva® individual dosage (alfacalcidol) allow to minimize risk of adverse effects development that together with new fractures prevention, pain syndrome reduction and motor activity improvement results in quality of life of patients of all ages improvement.
Key words: vitamin D deficiency, vitamin D deficiency causes, osteoporosis, osteoporotic fracture, native vitamin D, vitamin D active metabolites, vitamin D metabolism, alfacalcidol.
Полный текст
Список литературы
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1. Spirichev V.B. Vitaminy, vitaminopodobnye i mineralnye veshestva. Spravochnik. M.: MCFER, 2004. [in Russian]
2. Pigarova E.A., Rozhinskaya L.Ya., Belaya Zh.E. i dr. Klinicheskie rekomendacii Rossijskoj associacii endokrinologov po diagnostike, lecheniyu i profilaktike deficita vitamina D u vzroslyh. Problemy endokrinologii. 2016; 62 (4): 60–84. [in Russian]
3. Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008; 88: 582S–6S.
4. Benevolenskaya L.I., Lesnyak O.M. Osteoporoz. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2009. [in Russian]
5. Gromova O.A., Torshin I.Yu. Vitamin D – smena paradigmy. Pod red. E.I.Guseva, I.N.Zaharovoj. M.: GEOTAR-Media, 2017. [in Russian]
6. Zotkin E.G., Shvarc G.Ya. Vozmozhnosti klinicheskogo primeneniya vitamina D i ego aktivnyh metabolitov. Effektivnaya farmakoterapiya. 2013; 38: 50–9. [in Russian]
7. Benevolenskaya L.I., Lesnyak O.M. Osteoporoz. Diagnostika, profilaktika i lechenie. Klinicheskie rekomendacii. M: GEOTAR-Media, 2005; s. 146–63. [in Russian]
8. Holick MF. Vitamin D status: Measurement, interpretation and clinical application. Ann Epidemiol 2009; 19 (2): 73–8.
9. Kumar J, Muntner P, Kaskel FJ, Hailpern SM. MLM prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics 2009; 124: 362–70.
10. Lee J, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007; 46: 42–4.
11. Zaharova I.N., Malcev S.V., Boro- vik T.E. i dr. Nedostatochnost vitamina D u detej rannego vozrasta v Rossii (rezultaty mnogocentrovogo issledovaniya – zima 2013–2014 gg.). Pediatriya. 2014; 93 (2): 75–80. [in Russian]
12. Van der Wielen RP, Löwik MR, van den Berg H et al. Serum Vitamin D concentrations among elderly people in Europe. Lancet 1995; 346 (8969): 207–10.
13. Holik MF. Vitamin D deficiency. New Engl J Med 2007; 357: 266–81.
14. Kulie T, Groff A, Redmer J et al. Vitamin D. An evidence-based review. J Am Board Family Med 2009; 22 (6): 698–706.
15. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (7): 1911–30. DOI: 10.1210/jc.2011-0385
16. Henderson L, Irving K, Gregori J et al. The National Diet and Nutrition Survey: Adults aged 19–64 years. Vol. 3: Vitamin and mineral intake and urinary analysis. The Stationery Office. London, 2003.
17. Snellman GL, Byberg L, Lemming EW et al. Long-term dietary vitamin D intake and risk of fracture and osteoporosis: a longitudinal cohort study of Swedish middle-aged and elderly women. J Clin Endocrinol Metab 2014; 99 (3): 781–90.
18. Hwang YC, Ahn HY, Jeong IK et al. Optimal serum concentration of 25-hydroxivitamin D for bone health in older Korean adults. Caicified Tissue Int 2013; 92 (1): 68–74.
19. Chernichow S, Fan T, Nocea G, Sen SS. Calcium and vitamin D intake by postmenopausal women with osteoporosis in France. Curr Med Res Opin 2010; 26 (7): 1667–74.
20. Ardawi MS, Sibiany AM, Bakhsh TM et al. High prevalence of vitamin D deficiency among healthy Saudi Arabien men: Relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors. Osteoporos Int 2012; 23 (2): 675–86.
21. Murad MH, Elamin KB, Abu Elnour NO et al. The effect of vitamin D on falls. A systematic review and metaanalysis. J Clin Endocrinol Metab 2011; 96 (10): 2997–3006.
22. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692. DOI: 10.1136/bmj.b3692
23. Dukas L, Bischoff HA, Lindpaintner LS et al. 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: 230–6.
24. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007; 92 (6): 2017–29.
25. De Boer IH, Tinker LF, Connelly S et al. Calcium plus vitamin D supplementation and the risk of incident diabetes in the Women's Health Initiative. Diabetes Care 2008; 31 (4): 701–7.
26. Pittas AG, Chung M, Trikalinos T et al. Systematic review: vitamin D and cardiometabolic outcomes. Ann Intern Med 2010; 152 (5): 307–14.
27. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25OHD and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008; 168 (11): 1174–80.
28. Marniemi J, Alanen E, Impivaara O et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis 2005; 15 (3): 188–97.
29. Elamin MB, Abu Elnour NO, Elamin KB et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96 (7): 1931–42.
30. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Inern Med 2007; 167 (16): 1730–7.
31. Rejnmark L, Avenell A, Masud T et al. Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials. J Clin Endocrinol Metab 2012; 97 (8): 2670–81.
32. Dobnig H, Pilz S, Scharnagl H et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all cause and cardiovascular mortality. Arch Intern Med 2008; 168 (12): 1340–9.
33. Johansson H, Oden A, Kanis J et al. Low serum vitamin D is associate with increased mortality in elderly men: MrOS Sweeden. Osteoporos Int 2012; 23 (3): 991–9.
34. Shvarc G.Ya. Deficit vitamina D i ego farmakologicheskaya korrekciya. RMZh. 2009; 17 (7): 477–86. [in Russian]
35. Shvarc G.Ya. Tipy deficita vitamina D i ih farmakologicheskaya korrekciya. Lekarstvennye sredstva. Prikladnaya farmakologiya i personalizirovannaya farmakoterapiya. 2011; 2 (3): 33–42. [in Russian]
36. Shvarc G.Ya. Vitamin D i D-gormon. M.: Anaharsis, 2005. [in Russian]
37. 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; 82: 102–7.
38. Richy F, Schacht E, Bruyere O et al. Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures – a comparative meta-analysis. Calcif Tissue Int 2005; 76 (3): 176–86.
39. Ringe JD, Dorst A, Faber H et al. Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoid-induced osteoporosis. Rheumatol Int 2004; 24: 63–70.
40. Orimo H. Akt Rheumatol 1994; 19 (Suppl.): 27–30.
41. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B et al. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 2010; 21(7): 1121–32.
42. Lesnyak O.M. Effektivnost i bezopasnost alfakalcidola v lechenii osteoporoza i preduprezhdenii perelomov: obzor sovremennyh dannyh. Effektivnaya farmakoterapiya. Revmatologiya, travmatologiya i ortopediya. 2014; 10 (1): 16–22. [in Russian]
43. Richy F, Ethgen O, Bruyere O, Reginster JY. Efficacy of alfacalcidol and calcitriol in primary and corticoid-induced osteoporosis: meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int 2004; 15 (4): 301–10.
44. Del Valle E, Negri AL, Fradinger E et al. Weekly high-dose ergocalciferol to correct vitamin D deficiency/insufficiency in hemodialysis patients: A pilot trial. Hemodial Int 2014. DOI: 10.1111/hdi.12209
45. Mager DR, Jackson ST, Hoffmann MR et al. Vitamin D supplementation and bone health in adults with diabetic nephropathy: the protocol for a randomized controlled trial. BMC Endocr Dis 2014; 14: 66. DOI: 10.1186/1472-6823-14-66
Авторы
И.С.Дыдыкина1*, П.С.Коваленко1, А.А.Коваленко2
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34А;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*dydykina_is@mail.ru
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34А;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*dydykina_is@mail.ru
________________________________________________
I.S.Dydykina*1, P.S.Kovalenko1, A.A.Kovalenko2
1 V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34A;
2 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*dydykina_is@mail.ru
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