EFEITOS DA SUPLEMENTAÇÃO DE CÁLCIO NO RISCO DE FRATURA EM ADULTOS IDOSOS

Li, Jianlei

doi:10.1590/1413-785220253306e284103

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Review Article/Trauma • Acta Ortop Bras 33 (6) • 2025 • https://doi.org/10.1590/1413-785220253306e284103 linkcopiar

EFEITOS DA SUPLEMENTAÇÃO DE CÁLCIO NO RISCO DE FRATURA EM ADULTOS IDOSOS

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Explorar o efeito da suplementação de cálcio no risco de fraturas em vários locais em adultos mais velhos com base em ensaios clínicos randomizados (ECRs). A PubMed, Embase e a Biblioteca Cochrane foram sistematicamente pesquisadas para ensaios clínicos randomizados (ECRs) elegíveis desde a sua criação até maio de 2023. Os ensaios inclusos investigaram o efeito da suplementação de cálcio no risco de fraturas em indivíduos com 50 anos ou mais, independentemente do uso ou não de vitamina D. As medidas de desfecho primárias e secundárias foram fraturas totais, vertebrais, não vertebrais e do quadril. Vinte e três ECRs envolvendo 70.837 indivíduos foram incluídos. A suplementação de cálcio demonstrou uma redução significativa no risco de fraturas totais (RR: 0,93; IC 95%: 0,88–0,99; P=0,019) e não vertebrais (RR: 0,93; IC 95%: 0,87–0,99; P=0,023). Não foram observadas diferenças significativas nas fraturas vertebrais (RR: 0,87; IC 95%: 0,75–1,01; P=0,074) e do quadril (RR: 0,90; IC 95%: 0,73–1,12; P=0,355) entre cálcio e placebo ou nenhum tratamento. A dose de cálcio influenciou o risco de fratura total (P=0,008), enquanto a história de fratura (P=0,044), dose de cálcio (P=0,041) e duração do acompanhamento (P=0,031) afetaram o risco de fratura não vertebral. A duração do acompanhamento impactou o risco de fratura do quadril (P=0,001). A suplementação de cálcio pode afetar significativamente o risco de fratura, particularmente as fraturas não vertebrais, em adultos mais velhos. Nivel de Evidência l; Estudos terapêuticos - Investigação dos resultados do tratamento.

Descritores:
Cálcio; Fratura; Idoso Fragilizado; Metanálise

Study	Country	Sample size	Age (years)	Male (%)	Prior fracture	Vitamin D	Baseline 25 OHD	Intervention	Control	Follow-up	Jadad
Inkovaar²⁰	Finland	130 (88/42)	79.8	17.9/18.7	NA	(1000 IU/d)	NA	Calcium (1.2 g/d)	Placebo	9.0 months	3
Hansson²¹	Sweden	50 (25/25)	65.9	0.0	Yes	No	NA	Calcium (1.0 g/d)	Placebo	3.0 years	2
Chapuy²²	France	3,270 (1,634/1,636)	84.0	0.0	No	(800 IU/d)	NA	Calcium (1.2 g/d)	Placebo	1.5 years	4
Reid²³	New Zealand	122 (61/61)	58.0	0.0	No	No	37.5	Calcium (1.0 g/d)	Placebo	4.0 years	4
Recker²⁴	USA	191 (91/100)	73.5	0.0	Partial	No	25.5	Calcium (1.2 g/d)	Placebo	4.0 years	3
Dawson-Hughes²⁵	USA	389 (187/202)	71.1	46.0	NA	(700 IU/d)	29.6	Calcium (0.5 g/d)	Placebo	3.0 years	4
Riggs²⁶	USA	236 (119/117)	66.2	0.0	No	No	30.1	Calcium (1.6 g/d)	Placebo	4.0 years	2
Baron²⁷	USA	930 (464/466)	61.0	72.3	NA	No	NA	Calcium (1.2 g/d)	Placebo	4.0 years	5
Peacock²⁸	USA	253 (124/129)	73.8	28.4	Partial	No	25.0	Calcium (0.75 g/d)	Placebo	4.0 years	2
Chapuy²⁹	France	583 (393/190)	85.2	0.0	No	(800 IU/d)	8.9	Calcium (1.2 g/d)	Placebo	2.0 years	4
Avenell³⁰	UK	99 (64/35)	78.0	17.0	Yes	(800 IU/d)	NA	Calcium (1.0 g/d)	No treatment	3.8 years	3
Harwood³¹	UK	112 (75/37)	81.7	0.0	Yes	(800 IU/d)	11.9	Calcium (1.0 g/d)	No treatment	1.0 year	3
Porthouse³²	UK	3,314 (1,321/1,993)	76.8	0.0	Partial	(800 IU/d)	NA	Calcium (1.0 g/d)	No treatment	2.1 years	3
Grant³³	UK	3,949 (2,617/1,332)	77.3	15.3	Yes	(800 IU/d)	15.2	Calcium (1.0 g/d)	Placebo	2.0-5.2 years	5
Larsen³⁴	Denmark	7,073 (4,957/2,116)	74.0	39.8	No	(400 IU/d)	NA	Calcium (1.0 g/d)	No treatment	3.0 years	3
Jackson³⁵	USA	36,282 (18,176/18,106)	62.4	0.0	Partial	(400 IU/d)	18.9	Calcium (1.0 g/d)	Placebo	7.0 years	4
Prince³⁶	Australia	1,460 (730/730)	75.2	0.0	Partial	No	31.0	Calcium (0.48 g/d)	Placebo	5.0 years	4
Reid³⁷	New Zealand	1,471 (732/739)	74.3	0.0	Partial	No	20.7	Calcium (1.0 g/d)	Placebo	5.0 years	3
Bolton-Smith³⁸	UK	123 (62/61)	68.6	0.0	NA	(400 IU/d)	23.9	Calcium (1.0 g/d)	Placebo	2.0 years	3
Salovaara³⁹	Finland	3,195 (1,586/1,609)	67.3	0.0	Partial	(800 IU/d)	19.8	Calcium (1.0 g/d)	Placebo	3.0 years	3
Liu⁴⁰	China	98 (50/48)	62.1	0.0	No	(600 IU/d)	NA	Calcium (1.5 g/d)	Placebo	1.0 year	2
Xue⁴¹	China	312 (139/173)	63.6	0.0	Partial	(800 IU/d)	30.8	Calcium (0.6 g/d)	Placebo	1.0 year	3

Outcomes	Factors	Subgroup	RR and 95%CI	P value	I2 (%)	P value for I2	RRR between subgroups	P value between subgroups
Total fracture	Mean age	≥ 70.0	0.92 (0.86-0.99)	0.031	0.0	0.662	1.11 (0.83-1.49)	0.494
	Mean age	< 70.0	0.83 (0.62-1.10)	0.198	44.1	0.111	1.11 (0.83-1.49)	0.494
	Sex	Female	0.96 (0.91-1.01)	0.081	0.0	0.673	1.07 (0.93-1.22)	0.359
	Sex	Both	0.90 (0.79-1.02)	0.112	30.6	0.164	1.07 (0.93-1.22)	0.359
	Prior fracture	Yes	0.95 (0.90-0.99)	0.027	0.0	0.703	1.08 (0.81-1.44)	0.600
	Prior fracture	No	0.88 (0.66-1.16)	0.357	51.1	0.085	1.08 (0.81-1.44)	0.600
	Baseline 25 OHD	≥ 20.0	0.89 (0.76-1.04)	0.146	0.0	0.396	0.93 (0.79-1.09)	0.369
	Baseline 25 OHD	< 20.0	0.96 (0.91-1.01)	0.127	0.0	0.785	0.93 (0.79-1.09)	0.369
	Dose of calcium	≥ 1.2	0.29 (0.12-0.69)	0.005	0.0	0.918	0.31 (0.13-0.73)	0.008
	Dose of calcium	< 1.2	0.95 (0.91-0.99)	0.022	0.0	0.656	0.31 (0.13-0.73)	0.008
	Combined with vitamin D	Yes	0.96 (0.92-1.01)	0.117	0.0	0.820	1.16 (0.98-1.37)	0.089
	Combined with vitamin D	No	0.83 (0.71-0.98)	0.030	31.9	0.173	1.16 (0.98-1.37)	0.089
	Follow-up duration	≥ 3.0	0.95 (0.91-1.00)	0.041	0.0	0.491	1.20 (0.96-1.51)	0.110
	Follow-up duration	< 3.0	0.79 (0.63-0.98)	0.034	0.0	0.426	1.20 (0.96-1.51)	0.110
	Study quality	High	0.88 (0.78-1.00)	0.058	51.6	0.053	0.94 (0.80-1.10)	0.410
	Study quality	Low	0.94 (0.85-1.03)	0.171	0.0	0.820	0.94 (0.80-1.10)	0.410
Vertebral fracture	Mean age	≥ 70.0	0.83 (0.65-1.05)	0.121	0.0	0.833	0.92 (0.68-1.25)	0.602
	Mean age	< 70.0	0.90 (0.75-1.09)	0.291	0.0	0.946	0.92 (0.68-1.25)	0.602
	Sex	Female	0.88 (0.76-1.03)	0.112	0.0	0.975	1.35 (0.62-2.94)	0.443
	Sex	Both	0.65 (0.30-1.37)	0.254	0.0	0.688	1.35 (0.62-2.94)	0.443
	Prior fracture	Yes	0.87 (0.75-1.02)	0.083	0.0	0.935	1.07 (0.4-2.62)	0.875
	Prior fracture	No	0.81 (0.34-1.97)	0.646	0.0	0.583	1.07 (0.4-2.62)	0.875
	Baseline 25 OHD	≥ 20.0	0.82 (0.65-1.04)	0.109	0.0	0.881	0.90 (0.66-1.22)	0.505
	Baseline 25 OHD	< 20.0	0.91 (0.75-1.11)	0.352	0.0	0.613	0.90 (0.66-1.22)	0.505
	Dose of calcium	≥ 1.2	0.85 (0.58-1.25)	0.417	0.0	0.964	0.97 (0.64-1.47)	0.871
	Dose of calcium	< 1.2	0.88 (0.74-1.03)	0.111	0.0	0.918	0.97 (0.64-1.47)	0.871
	Combined with vitamin D	Yes	0.90 (0.74-1.09)	0.292	0.0	0.789	1.08 (0.80-1.47)	0.600
	Combined with vitamin D	No	0.83 (0.66-1.05)	0.127	0.0	0.916	1.08 (0.80-1.47)	0.600
	Follow-up duration	≥ 3.0	0.87 (0.75-1.01)	0.074	0.0	0.970	-	-
	Follow-up duration	< 3.0	-	-	-	-	-	-
	Study quality	High	0.93 (0.78-1.11)	0.433	0.0	0.768	1.22 (0.89-1.69)	0.217
	Study quality	Low	0.76 (0.58-0.99)	0.043	0.0	0.990	1.22 (0.89-1.69)	0.217
Non-vertebral fracture	Mean age	≥ 70.0	0.88 (0.80-0.97)	0.009	2.7	0.417	0.91 (0.81-1.01)	0.087
	Mean age	< 70.0	0.97 (0.92-1.03)	0.391	0.0	0.674	0.91 (0.81-1.01)	0.087
	Sex	Female	0.91 (0.84-1.00)	0.046	14.5	0.309	0.99 (0.84-1.17)	0.897
	Sex	Both	0.92 (0.80-1.06)	0.253	3.2	0.396	0.99 (0.84-1.17)	0.897
	Prior fracture	Yes	0.97 (0.92-1.02)	0.203	0.0	0.944	1.21 (1.01-1.46)	0.044
	Prior fracture	No	0.80 (0.67-0.96)	0.018	5.4	0.366	1.21 (1.01-1.46)	0.044
	Baseline 25 OHD	≥ 20.0	0.87 (0.71-1.05)	0.147	7.9	0.368	0.90 (0.73-1.10)	0.292
	Baseline 25 OHD	< 20.0	0.97 (0.92-1.02)	0.271	0.0	0.917	0.90 (0.73-1.10)	0.292
	Dose of calcium	≥ 1.2	0.80 (0.68-0.95)	0.009	0.0	0.380	0.83 (0.70-0.99)	0.041
	Dose of calcium	< 1.2	0.96 (0.91-1.01)	0.137	0.0	0.636	0.83 (0.70-0.99)	0.041
	Combined with vitamin D	Yes	0.89 (0.79-1.00)	0.052	35.0	0.138	0.96 (0.80-1.14)	0.630
	Combined with vitamin D	No	0.93 (0.81-1.06)	0.260	0.0	0.752	0.96 (0.80-1.14)	0.630
	Follow-up duration	≥ 3.0	0.96 (0.91-1.01)	0.144	0.0	0.614	1.22 (1.02-1.45)	0.031
	Follow-up duration	< 3.0	0.79 (0.67-0.94)	0.007	0.0	0.540	1.22 (1.02-1.45)	0.031
	Study quality	High	0.89 (0.79-0.99)	0.040	49.4	0.054	0.94 (0.76-1.16)	0.546
	Study quality	Low	0.95 (0.79-1.13)	0.551	0.0	0.960	0.94 (0.76-1.16)	0.546
Hip fracture	Mean age	≥ 70.0	0.92 (0.69-1.22)	0.559	49.7	0.025	1.03 (0.73-1.46)	0.851
	Mean age	< 70.0	0.89 (0.73-1.08)	0.236	0.0	0.490	1.03 (0.73-1.46)	0.851
	Sex	Female	0.90 (0.68-1.20)	0.481	44.8	0.070	0.98 (0.61-1.57)	0.928
	Sex	Both	0.92 (0.63-1.35)	0.682	36.8	0.148	0.98 (0.61-1.57)	0.928
	Prior fracture	Yes	1.02 (0.77-1.35)	0.886	46.8	0.043	1.44 (0.99-2.08)	0.056
	Prior fracture	No	0.71 (0.56-0.91)	0.007	0.0	0.618	1.44 (0.99-2.08)	0.056
	Baseline 25 OHD	≥ 20.0	1.76 (0.69-4.48)	0.237	31.9	0.221	1.85 (0.71-4.82)	0.206
	Baseline 25 OHD	< 20.0	0.95 (0.78-1.16)	0.612	16.4	0.308	1.85 (0.71-4.82)	0.206
	Dose of calcium	≥ 1.2	0.72 (0.56-0.92)	0.008	0.0	0.580	0.72 (0.50-1.04)	0.081
	Dose of calcium	< 1.2	1.00 (0.76-1.31)	0.984	40.4	0.065	0.72 (0.50-1.04)	0.081
	Combined with vitamin D	Yes	0.84 (0.73-0.97)	0.018	0.0	0.655	0.69 (0.36-1.33)	0.270
	Combined with vitamin D	No	1.21 (0.64-2.27)	0.554	65.8	0.007	0.69 (0.36-1.33)	0.270
	Follow-up duration	≥ 3.0	1.14 (0.89-1.47)	0.306	21.4	0.239	1.70 (1.23-2.36)	0.001
	Follow-up duration	< 3.0	0.67 (0.54-0.82)	< 0.001	0.0	0.808	1.70 (1.23-2.36)	0.001
	Study quality	High	0.85 (0.69-1.05)	0.139	42.0	0.078	0.62 (0.30-1.30)	0.204
	Study quality	Low	1.37 (0.68-2.79)	0.381	22.6	0.264	0.62 (0.30-1.30)	0.204

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