Revista Biomédica Revisada Por Pares
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Las caídas en el adulto mayor son frecuentes y conllevan importante morbimortalidad, dependencia e institucionalización. Se ha planteado que la suplementación con vitamina D podría prevenir la ocurrencia de este evento. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 31 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de vitamina D probablemente no disminuye el riesgo de caídas en adultos mayores.
El síndrome de caídas es un importante problema en la población geriátrica. Un tercio de los pacientes mayores de 65 años se caen cada año, y el riesgo de caídas aumenta con la edad [1],[2]. Aproximadamente una de cada diez caídas tiene consecuencias graves, como fractura, hematoma subdural, lesión de tejidos blandos o traumatismo craneal [3],[4],[5]. Por otra parte, se asocia a un deterioro en la funcionalidad de los sujetos y su institucionalización temprana [6].
La vitamina D tiene variados efectos fisiológicos debido a que la mayoría de los tejidos del cuerpo humano contiene receptores para 1,25-dihidroxi-vitamina D. La presencia de receptores en los músculos explicaría la relación de la deficiencia de esta vitamina con miopatía, debilidad y dolor muscular [7]. Se ha planteado que la suplementación resultaría en una mejora en la fuerza muscular y prevención de caídas [8],[9], incluso en pacientes sin déficit de vitamina D.
Utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, para identificar revisiones sistemáticas y sus estudios primarios incluidos. Con esta información generamos un resumen estructurado, siguiendo un formato preestablecido, que incluye mensajes clave, un resumen del conjunto de evidencia (presentado como matriz de evidencia en Epistemonikos), metanálisis del total de los estudios, tablas de resumen de resultados con el método GRADE, y tabla de otras consideraciones para la toma de decisión.
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Mensajes clave
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Cuál es la evidencia. |
Encontramos 18 revisiones sistemáticas [10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27] que en total incluyen 31 estudios controlados aleatorizados reportados en 66 referencias [8],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43], [44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64], [65],[66],[67],[68],[69],[70],[71],[72][73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85], [86],[87],[88],[89],[90],[91]. |
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Qué tipo de pacientes incluyeron los estudios |
Fueron incluidos pacientes adultos mayores (65 años o más) hospitalizados, institucionalizados o provenientes de la comunidad. Los estudios no restringieron sus criterios de inclusión en relación a la certificación de hipovitaminosis D previo al inicio de la suplementación. En su mayoría correspondía a sexo femenino. |
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Qué tipo de intervenciones incluyeron los estudios |
Las intervenciones fueron variadas en cuanto a la combinación con calcio, dosis, esquemas y formas de administración de vitamina D. Se describen 24 formas distintas de intervención, todas incluyendo vitamina D de una u otra forma. Trece estudios [9],[34],[39],[49],[51],[63],[64],[68],[69],[70],[75],[76], [83],[84] incluyeron calcio en el grupo de intervención. Se utilizaron variados esquemas de dosis de vitamina D; en seis estudios [34],[38], [49],[58],[60],[64] se utilizaron dosis menores de 800 UI diarias. En 22 estudios [8],[9],[30],[38],[39],[45],[49],[51],[58],[60],[61],[63],[64],[68],[69],[70],[75],[76],[84] se administró la vitamina D con dosis diaria, en dos [33],[91] con dosis semanal, en uno cada 3 meses [57], en uno cada 4 meses [90], en dos con dosis anual [82],[87] y en tres en dosis única [18],[43],[61].La comparación fue contra placebo, grupo control, estrategias anticaída y por último administración de calcio en dosis de 600 mg, 1000 mg y 1200 mg. |
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Qué tipo de desenlaces midieron |
En el presente resumen, al igual que en la mayoría de las revisiones identificadas, se analiza solamente el desenlace caídas. |
La información sobre los efectos de la vitamina D sobre las caídas está basada en 31 estudios aleatorizados que incluyen 45 616 pacientes. Sin embargo, tres estudios no presentaron sus datos de una forma que pudiera ser combinada [33],[51],[82].
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A quién se aplica y a quién no se aplica esta evidencia |
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| Sobre los desenlaces incluidos en este resumen |
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| Balance riesgo/beneficio y certeza de la evidencia |
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| Consideraciones de recursos |
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Diferencias entre este resumen y otras fuentes |
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| ¿Puede que cambie esta información en el futuro? |
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Mediante métodos automatizados y colaborativos recopilamos toda la evidencia relevante para la pregunta de interés y la presentamos en una matriz de evidencia.
Siga el enlace para acceder a la versión interactiva: Vitamina D para la prevención de caídas
Si con posterioridad a la publicación de este resumen se publican nuevas revisiones sistemáticas sobre este tema, en la parte superior de la matriz se mostrará un aviso de “nueva evidencia”. Si bien el proyecto contempla la actualización periódica de estos resúmenes, los usuarios están invitados a comentar en Medwave o contactar a los autores mediante correo electrónico si creen que hay evidencia que motive una actualización más rápida.
Luego de crear una cuenta en Epistemonikos, al guardar las matrices recibirá notificaciones automáticas cada vez que exista nueva evidencia que potencialmente responda a esta pregunta. El detalle de los métodos para elaborar este resumen están descritos aquí: http://dx.doi.org/10.5867/medwave.2014.06.5997.
La Fundación Epistemonikos es una organización que busca acercar la información a quienes toman decisiones en salud, mediante el uso de tecnologías. Su principal desarrollo es la base de datos Epistemonikos (www.epistemonikos.org).
Los resúmenes de evidencia siguen un riguroso proceso de revisión por pares interno.
Declaración de conflictos de intereses
Los autores declaran no tener conflictos de intereses con la materia de este artículo.
Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.
Falls in elderly people are common and come with important effects on morbidity and mortality, dependence and institutionalization. It has been proposed that supplementation of vitamin D could prevent the occurrence of this event. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 18 systematic reviews including 31 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded the use of vitamin D probably leads to little or no difference in the risk of falling in elderly people.
Autores:
Franco Scheel[1,3], Marcela Carrasco[2,3]
Citación: Scheel F, Carrasco M. Is vitamin D supplementation effective for the prevention of falls in elderly people?. Medwave 2016;16(Suppl 1):e6368 doi: 10.5867/medwave.2016.6368
Fecha de publicación: 26/1/2016
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