天津医院，你的宣传能不能别断章取义、别浮夸？赵嘉国、曽宪铁，恭喜你们出名了。

渐近故乡时 2017-12-28

展开全文

今天，微信朋友圈里被天津医院的一个微信宣传稿刷屏了。标题骇人听闻：《国际顶级医学期刊JAMA(IF=44.405)发表天津医院赵嘉国和曾宪铁团队论文，彻底颠覆骨质疏松防治理念》。宣传稿的内容将原文章的标题进行删改为《钙剂/维生素D补充和社区居住的老年人骨折发生的相关性》。并在整个内容报到中，用尽极其溢美夸大之词，误导读者以为该文章的作者研究了5万余名患者，进行了调查研究。当我读到此处的时候，我就相信，这个报导是假的。因为在中国，完成5万人的临床对照研究是不可能的。没有那个学者能做到这一点。

然后该报导被丁香园、骨科在线、医学界等等医学媒体转载，各医学同行微信朋友圈广为转发，刷屏。都用了“颠覆”二字。

脑子是个好东西，一定要珍惜着用。

然后就查阅原始文章。标题为：《Association Between Calcium orVitamin D Supplementation and Fracture Incidence in Community-Dwelling Older AdultsA Systematic Reviewand Meta-analysis》找到原始文章后大吃一惊，该篇文章只不过是一篇Meta分析，也就是把别人的已发表的文章拿过来分析分析，然后综合捏把捏把出个结论来，还不一定是客观正确的，所有的综述和Meta分析文章都有一定的作者偏倚性的，作为循证指南的制定来说，一般不建议使用综述和Meta分析文章作为证据文献的。而天津医院的微信公号报道却把题目进行删改，让读者误以为是这些数据是天津医院骨科赵嘉国和曽宪铁医生团队做的调查研究。

下面是原始文章的英文摘要：

Abstract

Importance The increased social and economic burdens for osteoporosis-relatedfractures worldwide make the prevention of such injuries a major public healthgoal. Previous studies have reached mixed conclusions regarding the associationbetween calcium, vitamin D, or combined calcium and vitamin D supplements andfracture incidence in older adults.

Objective To investigate whether calcium, vitamin D, or combined calcium andvitamin D supplements are associated with a lower fracture incidence incommunity-dwelling older adults.

Data Sources The PubMed, Cochrane library, and EMBASEdatabases were systematically searched from the inception dates to December 24,2016, using the keywords calcium, vitamin D, and fracture to identifysystematic reviews or meta-analyses. The primary randomized clinical trialsincluded in systematic reviews or meta-analyses were identified, and anadditional search for recently published randomized trials was performed fromJuly 16, 2012, to July 16, 2017.

Study Selection Randomized clinical trials comparing calcium,vitamin D, or combined calcium and vitamin D supplements with a placebo or notreatment for fracture incidence in community-dwelling adults older than 50years.

Data Extraction and Synthesis Two independent reviewers performed the dataextraction and assessed study quality. A meta-analysis was performed tocalculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIsusing random-effects models.

Main Outcomes and Measures Hip fracture was defined as the primaryoutcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, andtotal fracture.

Results A total of 33 randomized trials involving 51 145participants fulfilled the inclusion criteria. There was no significantassociation of calcium or vitamin D with risk of hip fracture compared withplacebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01[95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00[95% CI, −0.00 to 0.01]. There was no significantassociation of combined calcium and vitamin D with hip fracture compared withplacebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found betweencalcium, vitamin D, or combined calcium and vitamin D supplements and theincidence of nonvertebral, vertebral, or total fractures. Subgroup analysesshowed that these results were generally consistent regardless of the calciumor vitamin D dose, sex, fracture history, dietary calcium intake, and baselineserum 25-hydroxyvitamin D concentration.

Conclusions and Relevance In this meta-analysis of randomized clinicaltrials, the use of supplements that included calcium, vitamin D, or bothcompared with placebo or no treatment was not associated with a lower risk offractures among community-dwelling older adults. These findings do not supportthe routine use of these supplements in community-dwelling older people.

该文章摘要的中文翻译：

题目: 社区居住老年人群中，钙剂或维生素D摄入对骨折发病率的关系：系统综述与Meta分析

问题：摄入维生素D或钙剂或合用是否能够降低社区居住老年人的骨折发生率？

发现：本Meta分析纳入33个RCT研究，包含51145例样本。与安慰剂对照组或空白对照组比较，无论摄入补充剂包括钙剂、维生素D、或钙加维生素D都不能显著降低髋关节骨折，三种治疗方案的RR分别为1.53,1.21,1.09

意义：本文的发现并不支持在社区居住的老年人给予常规钙剂补充

Abstract：

意义：由于骨质疏松导致的骨折在全世界范围内带来巨大的社会与经济负担，对此类骨折的预防是一个重要的公共健康课题。前期研究关于补充钙剂、维生素D对预防老年人骨折发病率的研究结果混杂不一（mixed conclusion）

目的：探究补充钙剂维生素D或两者联用是否能够降低社区老年人骨折发生率。

数据来源：在PubMed，Cochranelibrary, 与EMBASE中系统性搜索系统综述或Meta分析，截止日为2016年12月24日。关键词为calcium, vitamin D, 与fracture。首次搜索纳入了系统综述与Meta分析，并加入了在2012年7月16日至2017年7月16日的随机临床试验。

研究选择：比较钙剂、维生素D或两者联用VS 安慰剂或空白对照在社区居住的大于50岁以上老人中是否能够降低骨折发生率的随机临床试验。

数据提取与合成：两位独立的审阅人分别进行了数据提取与研究质量评估，META分析使用随机效应模型计算RR ARD，95%CI。

结局与指标：定义髋关节骨折为原发结局，继发结局为非椎体骨折，椎体骨折与其他所有骨折

结果：33个RCT研究纳入51145个符合标准的样本，没有发现使用钙剂、维生素D相比安慰剂治疗或空白对照显著降低髋关节骨折发病率。(calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]。也没有发现钙剂与维生素D合用相比安慰剂治疗或空白对照显著降低髋关节骨折发病率(RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00])。更没有发现钙剂、维生素D、或两者合用相比安慰剂治疗或空白对照显著降低非椎体骨折、椎体骨折、所有骨折（total fracture）发病率。亚组分析进一步确认，无论钙剂或维生素D剂量或人群性别，骨折既往史，每日钙剂摄入、血清25-羟化维生素D含基线水平，以上结论依然正确。