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Vitamina D e Saúde Musculoesquelética

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How vitamin D affects bone, muscle strength, falls, fracture and tendon healing, and surgical outcomes — including who benefits from supplementation.

Um sol brilhando sobre um osso.
A vitamina D, a 'vitamina do sol', é essencial para a força óssea e a função muscular. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que é

A vitamina D é um nutriente que ajuda o seu corpo a utilizar o cálcio para manter os ossos fortes. Ela também desempenha um papel na função muscular e na cicatrização. O seu médico pode verificar os níveis de vitamina D antes da cirurgia para garantir que o seu corpo esteja preparado para a recuperação. Isto é especialmente importante se estiver a realizar uma cirurgia por fratura de quadril ou uma artroplastia.

Níveis baixos de vitamina D estão associados a um maior risco de lesões ósseas. Por exemplo, a deficiência está associada a um aumento da probabilidade de roturas do ligamento cruzado anterior e falha da reconstrução. Está também associada a fraturas por stress em atletas e militares. Em adultos mais velhos, a deficiência é mais comum no inverno e pode afetar a saúde óssea. O rastreio da deficiência ajuda a orientar estratégias preventivas para estes grupos.

A vitamina D pode apoiar a cicatrização dos tendões, particularmente na reparação do manguito rotador. As evidências para isto são atualmente de baixa qualidade e limitadas a um único grupo de tendões. No entanto, corrigir a deficiência antes da cirurgia pode ajudar a prevenir a cicatrização tardia das feridas. A administração de uma única dose elevada de vitamina D antes de uma artroplastia pode ter um impacto positivo nos resultados. O tratamento com vitamina D3 ativa também promove a cicatrização das fraturas ao afetar os fatores imunitários no corpo.

O seu médico pode recomendar um rastreio se o seu nível de vitamina D for inferior a 20 ng/mL. Isto é comum em pacientes submetidos a cirurgia por fratura de quadril sob anestesia geral. Para a reparação artroscópica do manguito rotador, a suplementação não seletiva é frequentemente mais custo-efetiva do que testar todos os pacientes primeiro. Esta abordagem poupa dinheiro em exames sanguíneos, garantindo ao mesmo tempo que os pacientes recebem os nutrientes de que necessitam. A suplementação regular reduz significativamente a probabilidade de deficiência em pacientes submetidos a artroplastia.

Nas crianças, a força da preensão manual, o estado da vitamina D e a dieta são preditores da saúde óssea. As intervenções direcionadas podem otimizar a saúde musculoesquelética e metabólica nos adolescentes. Para a maioria dos pacientes, manter níveis adequados de vitamina D apoia a saúde musculoesquelética global e a recuperação.

Funciona?

As evidências sobre a vitamina D são contraditórias. Ela ajuda claramente a corrigir os níveis baixos no sangue. Também pode apoiar a força óssea e a cicatrização após certas cirurgias. No entanto, não é uma cura milagrosa para todas as lesões ou dores.

Para pacientes submetidos a artroplastias, a vitamina D desempenha um papel claro. Se você tiver níveis baixos antes da cirurgia, o médico pode recomendar suplementos para ajudar o corpo a cicatrizar. Alguns estudos mostram que a correção da deficiência antes da artroplastia total do joelho ou do quadril pode melhorar a recuperação inicial e reduzir as taxas de complicações. Uma abordagem envolve uma única dose grande de 300.000 U para corrigir a deficiência rapidamente. Isso pode impactar positivamente os resultados após a artroplastia total primária de articulações. Outro estudo constatou que a administração de 50.000 unidades internacionais no dia da cirurgia não alterou significativamente a função inicial ou as complicações em comparação com um placebo. Portanto, o momento e a dosagem são importantes.

A vitamina D também está ligada à saúde óssea de outras maneiras. A suplementação regular reduz a probabilidade de deficiência em pacientes submetidos a artroplastias. Para aqueles com osteoporose, a combinação de vitamina D com treinamento intervalado de alta intensão oferece benefícios maiores para a densidade óssea do que qualquer um dos métodos isoladamente. Em adolescentes, a deficiência está associada a uma composição corporal adversa, portanto, intervenções direcionadas são importantes. Para adultos mais velhos, a conscientização sobre as necessidades de vitamina D após fraturas por fragilidade permanece baixa, embora as diretrizes estejam melhorando.

A prevenção de lesões é menos certa. Embora a baixa vitamina D esteja associada a um risco maior de rupturas do ligamento cruzado anterior e fraturas por estresse, são necessárias mais pesquisas para confirmar se os suplementos previnem essas lesões em atletas. As evidências para a cicatrização de tendões, como nas reparações do manguito rotador, são limitadas e de baixa qualidade. Pode ajudar, mas precisamos de mais estudos para ter certeza.

No geral, verificar seus níveis de vitamina D é um passo inteligente. Isso ajuda o médico a elaborar um plano personalizado para você. Se você precisa de uma pequena dose diária ou de uma dose corretiva maior depende das suas necessidades específicas e da cirurgia que está sendo realizada.

É adequado para você?

Você pode se beneficiar ao verificar seus níveis de vitamina D se for atleta, militar ou idoso. Níveis baixos estão associados a um maior risco de lesões dos ligamentos do joelho e fraturas por estresse. Seu médico pode recomendar testes antes de uma cirurgia de substituição do quadril ou do joelho. Isso é especialmente verdadeiro se você estiver tendo cirurgia no inverno ou tiver histórico de fraturas por fragilidade. Corrigir uma deficiência antes da substituição articular pode ajudar seu corpo a cicatrizar melhor.

Se você estiver passando por uma reparação do manguito rotador ou uma descompressão do túnel carpal, seu médico pode verificar seus níveis para prevenir a cicatrização lenta da ferida. Para pacientes com substituição do joelho, a ingestão de vitamina D ajuda a manter níveis saudáveis. No entanto, apenas 33,7% dos pacientes com deficiência atingiram níveis saudáveis com suplementos padrão de dose média a alta. Você pode precisar de uma única dose grande de 300.000 U para corrigir uma deficiência rapidamente. Essa abordagem pode melhorar os resultados após a substituição articular total primária.

Provavelmente você não verá benefícios significativos se for um atleta de elite saudável sem uma deficiência conhecida. Mais pesquisas são necessárias para provar que os suplementos reduzem o risco de lesões neste grupo. Além disso, embora o exercício e a vitamina D juntos ajudem na densidade óssea em mulheres com osteoporose, as evidências sobre a cicatrização dos tendões permanecem limitadas.

A principal desvantagem é que os suplementos podem não corrigir totalmente uma deficiência grave por si só. Administrar suplementos a todos é frequentemente mais custo-efetivo do que testar todos primeiro, porque as pílulas são mais baratas do que os exames de sangue. Fale com seu médico sobre se o teste ou a suplementação direta é o mais adequado para sua situação específica.

A conclusão

Seu médico pode verificar seus níveis de vitamina D antes da cirurgia para ajudar seus ossos e a cicatrização. Tomar suplementos pode reduzir o risco de complicações e melhorar a recuperação após a substituição articular. No entanto, os resultados variam. Apenas 33,7% dos pacientes com deficiência atingiram níveis saudáveis com doses padrão. Mais pesquisas são necessárias para confirmar os benefícios para atletas e reparos tendíneos. Pergunte ao seu médico se os testes ou a suplementação são adequados para você.


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