CDK 168/vol.36 no.2/Maret - April 2009
83
TINJAUAN PUSTAKA
kenaikan 25-(OH)D kurang dari 30 ng/mL, karena penelitian
terhadap populasi orang dewasa yang mengonsumsi segelas
susu dan multivitamin setiap hari ditambah dengan ikan salmon
minimal sekali per minggu menunjukkan 32% defisiensi vitamin
D.
31
Rekomendasi di atas semakin diperlemah dengan sedikitnya
jumlah makanan yang diperkuat dengan vitamin D serta fakta
bahwa 40-100% lansia di Eropa dan AS menderita defisiensi
atau insufisiensi vitamin D.
5,12
Berkurangnya efisiensi sintesis vitamin D
3
melalui radiasi UVB
mengharuskan adanya kompensasi setara lewat makanan dan
suplemen adisional.
2,9
Tabel 1 memuat daftar sumber vitamin D
2
dan D
3
pada makanan alami, makanan yang diperkuat vitamin
D, dan suplementasi farmakologi bila diperlukan. Penelitian
Chapuy dkk. membuktikan penurunan risiko fraktur tulang
pinggul sebesar 43% dan fraktur nonvertebral sebesar 32%
pada kelompok lansia wanita yang mengonsumsi 800 IU vitamin
D
3
dan 1200 mg kalsium selama tiga tahun.
32
Penelitian lain
menyebutkan dosis vitamin D
3
sebesar 700 IU ditambah 500 mg
kalsium per hari dapat menurunkan risiko fraktur nonvertebral
hingga 58% pada populasi berusia 65 ke atas.
33
Studi populasi lain dengan 9605 peserta usia 66 tahun keatas
menemukan penurunan risiko fraktur 16% pada kelompok
yang mengonsumsi 400 IU vitamin D dan 1000 mg kalsium.
34
Sebaliknya, meta-analisis 7 studi RCT yang mengevaluasi penga-
ruh asupan vitamin D
3
sebanyak 400 IU per hari pada lansia tidak
mengurangi insiden kedua jenis fraktur.
2
Pada studi Women»s
Health Initiative yang memberi asupan 400 IU vitamin D
3
serta
1000 mg kalsium per hari dan plasebo pada 36.000 wanita pos-
menopause melaporkan tidak adanya pengurangan risiko
fraktur namun justru meningkatkan insiden batu ginjal.
35
Berbagai hasil penelitian di atas mengindikasikan pentingnya
kombinasi dan ketepatan dosis asupan vitamin D dan kalsium.
Perlindungan dari kedua jenis risiko fraktur akan optimal pada
pemberian 700 sampai 800 IU vitamin D
3
per hari pada subjek
dengan peningkatan konsentrasi 25-(OH)D hingga 40 ng/mL.
2,12
Namun pemberian vitamin D
3
tanpa disertai kalsium tidak dapat
mencegah insiden fraktur, walaupun tetap dapat meningkatkan
konsentrasi 25-(OH)D.
5,9
Hal ini terbukti melalui penelitian Broe
dkk. yang memberikan 800 IU vitamin D per hari disertai kalsium
dan menurunkan risiko jatuh sebesar 72% dibanding plasebo
(RR 0,28; 95% CI, 0,11 0,75).
21
Pemberian suplemen vitamin D
3
800 hingga 1000 IU/hari atau
50.000 IU vitamin D
2
setiap 2-4 minggu dibutuhkan bagi lansia
(usia 50 tahun keatas) atau orang dewasa dengan paparan sinar
matahari rendah.
5,12,19,32,33
Apabila terjadi defisiensi, maka
vitamin D
2
perlu diberikan sebanyak 50.000 IU/minggu selama 8
minggu dan dilanjutkan dengan dosis yang sama per 2-4
minggu.
5,36
Pemberian tersebut ekivalen dengan terapi vitamin
D
2
3000 IU/ hari atau vitamin D
3
1000 IU/hari.
5,37,38
Terjadi
perbedaan dosis antara vitamin D
2
dan D
3
karena efektivitas
vitamin D
2
hanya sebesar 30% vitamin D
3
.
39
Bagi lansia penderita penyakit ginjal kronis derajat 2 dan 3 dapat
diberikan vitamin D
3
1000 IU/hari atau 50.000 IU vitamin D
2
per
2-4 minggu dan mungkin membutuhkan analog vitamin D
setelah serum 25-(OH)D mencapai 30 ng/mL.
40,41
Bagi pasien
derajat 4 dan 5, 50.000 IU vitamin D
2
dapat diberikan per 2
minggu disertai dengan 1,25-(OH)
2
D3 atau analognya, mengingat
ketidakmampuan ginjal memproduksi 1-OHase.
40-42
Tabel 1. Sumber Dietari, Suplementasi, dan Farmakoterapi Vitamin D
2
dan D
3
.
2,3
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Sumber alami
Kandungan Vitamin D
Salmon segar (99 g)
600-1000 IU vitamin D
3
Salmon segar budidaya (99 g)
100-250 IU vitamin D
2
atau D
3
Salmon kaleng (99 g)
300-600 IU vitamin D
3
Sarden kaleng (99 g)
300 IU vitamin D
3
Makarel (99 g)
250 vitamin D
3
Tuna kaleng (99 g)
230 IU vitamin D
3
Minyak liver cod (1 sdk teh)
400-1000 IU vitamin D
3
Jamur shitake
Segar (99 g)
100 IU vitamin D
2
Kering (99 g)
1600 IU vitamin D
2
Kuning telur
20 IU vitamin D
2
dan D
3
Makanan diperkuat vitamin D
Susu
100 IU/236 mL vitamin D
3
Jus jeruk
100 IU/236 mL vitamin D
3
Yoghurts
100 IU/236 mL vitamin D
3
Margarin
430 IU/99 mL vitamin D
3
Suplemen
Peresepan
Vitamin D
2
(ergokalsiferol)
50.000 IU/ kapsul
Drisdol (vitamin D
2
cair)
8000 IU/mL
Over the counter
Multivitamin
400 IU vitamin D, D
2
, D
3
Vitamin D
3
400, 800, 1000, 2000 IU