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Vitamin D

Mehr als ein Knochenhormon

Vitamin D

More than just a bone hormone

  • Schwerpunkt: Metabolische Knochen- und Gelenkerkrankungen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

In der Behandlung der Osteoporose gehört Vitamin D zur Basistherapie. Vitamin-D-Wirkungen auf die Kalzium- und Phosphatresorption in Darm und Niere sowie auf die Knochenmineralisation sind gut etabliert. Durch die weite Verbreitung des Vitamin-D-Rezeptors aus der Gruppe der nukleären Steroidhormonrezeptoren gibt es umfangreiche Hinweise auf pleiotrope Effekte des Liganden Vitamin D. Ein Vitamin-D-Mangel ist verbreitet und konnte in zahlreichen Studien als Risikofaktor unterschiedlichster Erkrankungen beschrieben werden. Aus der Grundlagenforschung kommen viele Hinweise auf Vitamin-D-Wirkungen auch außerhalb des Kalzium-, Phosphat- und Knochenstoffwechsels. Für viele chronische Erkrankungen laufen aktuell kontrollierte Studien mit hoch dosiertem Vitamin D. Der vorliegende Beitrag fasst die aktuellen Erkenntnisse zu Vitamin-D-Wirkungen auf die Muskulatur, den Glukosestoffwechsel bei Diabetes mellitus Typ 2 sowie auf kardiovaskuläre Erkrankungen zusammen. Ferner wird der Einfluss von Vitamin D auf das Immunsystem diskutiert, insbesondere auf Manifestation und Verlauf von Infektionen sowie von Autoimmunerkrankungen wie Diabetes mellitus Typ 1. Die publizierte Studienlage lässt zum gegenwärtigen Zeitpunkt den Schluss zu, dass ein Vitamin-D-Mangel bei diesen Erkrankungen vermieden werden soll. In diesem Zusammenhang werden optimale Dosierungsempfehlungen vorgestellt.

Abstract

Vitamin D plays an essential role in the primary therapy and prevention of osteoporosis. Established vitamin D effects are renal and intestinal resorption of calcium and phosphate for optimal bone mineral density; however, the widespread distribution of the vitamin D receptor (VDR), a member of the nuclear steroid hormone receptor family, provides extensive evidence for additional pleiotropic effects of the vitamin D ligand. Vitamin D deficiency and insufficiency are common and were reported as risk factors for a variety of diseases in observational studies. In addition, extensive research from experimental studies also illustrated extraskeletal effects of vitamin D. More randomized controlled trials are ongoing to test the effects of high dose vitamin D supplementation in numerous chronic diseases. This article summarizes the current state of knowledge regarding effects on muscle, on glucose metabolism in type 2 diabetes mellitus and on cardiovascular risk factors and diseases. Furthermore, we discuss the influence of vitamin D on the immune system, whereby vitamin D might provide beneficial effects not only for infectious but also for autoimmune diseases, such as type 1 diabetes mellitus. Current evidence leads to the conclusion that vitamin D deficiency should be avoided in these diseases. Recommendations for optimal dosage are discussed.

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Correspondence to F. Schlereth.

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Interessenkonflikt

K. Badenhoop wird von der Else Kröner-Fresenius Stiftung (EKFS) im Rahmen des Promotionskollegs Translational Research Innovation-Pharma (TRIP) gefördert; es besteht kein Interessenkonflikt. F. Schlereth gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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H. Lehnert, Lübeck

M. Reincke, München

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Schlereth, F., Badenhoop, K. Vitamin D. Internist 57, 646–655 (2016). https://doi.org/10.1007/s00108-016-0082-2

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  • DOI: https://doi.org/10.1007/s00108-016-0082-2

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