Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials

By H.A. Bischoff-Ferrari, B. Dawson-Hughes, H. Staehelin, J. Orav, A. Stuck, R. Theiler, John B. Wong, A. Egli, D. Kiel, J. Henschkowski. British medical journal, 2009

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Objective To test the efficacy of supplemental vitamin D and active forms of vitamin D with or without calcium in preventing falls among older individuals. Data sources We searched Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008 for relevant articles. Further studies were identified by consulting clinical experts, bibliographies, and abstracts. We contacted authors for additional data when necessary. Review methods Only double blind randomised controlled trials of older individuals (mean age 65 years or older) receiving a defined oral dose of supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D3 (1α-hydroxycalciferol) or 1,25-dihydroxyvitamin D3 (1,25-dihydroxycholecalciferol)) and with sufficiently specified fall assessment were considered for inclusion. Results Eight randomised controlled trials (n=2426) of supplemental vitamin D met our inclusion criteria. Heterogeneity among trials was observed for dose of vitamin D (700-1000 IU/day v 200-600 IU/day; P=0.02) and achieved 25-hydroxyvitamin D3 concentration (25(OH)D concentration: <60 nmol/l v ≥60 nmol/l; P=0.005). High dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/l or more resulted in a 23% fall reduction (pooled RR 0.77, 95% CI 0.65 to 0.90). Falls were not notably reduced by low dose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (pooled RR 1.35, 95% CI 0.98 to 1.84). Two randomised controlled trials (n=624) of active forms of vitamin D met our inclusion criteria. Active forms of vitamin D reduced fall risk by 22% (pooled RR 0.78, 95% CI 0.64 to 0.94). Conclusions Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.

Subfields: Orthopedics and Sports Medicine, Pathology and Forensic Medicine, Physiology

View Paper: https://www.semanticscholar.org/paper/a06b24e4d4b088524fca4b7efc1c7fa42a06731b

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Citations in the corpus

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management (2019, background): “Several double-blind RCTs comparing vitamin D with or without calcium against placebo among frail older adults reduced the risk of falling with daily applications of 700 to 1000 IU vitamin D (160).”
IOF position statement: vitamin D recommendations for older adults (2010, background): “In prospective studies, lower serum 25OHD levels have been associated with decreased grip strength and appendicular muscle mass in older men and women [10, 11] Supplementation with vitamin D has improved lower extremity muscle performance and reduced risk of falling in several high-quality double bl”
Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. (2012, background): “The importance of dose of supplemental vitamin D in minimizing the risk of falls was confirmed by a multidose, double-blind RCT among the 124 nursing home residents receiving 200, 400, 600, or 800 IU/d vitamin D or placebo for 5 months and by a 2009 meta-analysis (12, 13).”
European guidance for the diagnosis and management of osteoporosis in postmenopausal women (2008, background): “Vitamin D supplements alone may reduce the risk of fracture and of falling provided the daily dose of vitamin D is greater than 700 IU [144].”
European guidance for the diagnosis and management of osteoporosis in postmenopausal women (2018, background): “ture and falls provided the daily dose of vitamin D is greater than 700 IU [165, 166].”
UK clinical guideline for the prevention and treatment of osteoporosis (2017, background): “This dose of vitamin D may also reduce falls [62] (Evidence level 1a).”
Vitamin D: The “sunshine” vitamin (2012, background): “[45,46] VDD also causes muscle weakness; affected children have difficulty in standing and walking,[46,47] whereas the elderly have increasing sway and more frequent falls,[48,49] thereby increasing their risk of fracture.”
Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. (2011, background): “Vitamin D deficiency also causes muscle weakness; affected children have difficulty standingandwalking (47,50),whereas theelderlyhave increasing sway and more frequent falls (51, 52), thereby increasing their risk of fracture.”