NEW YORK (Reuters Health) – Vitamin D, especially in combination with calcium, may reduce the risk of falls, according to a report in the July 27th online issue of The Journal of Clinical Endocrinology & Metabolism.
“The combination of vitamin D and calcium (not just one of the two) should be given to those at risk of having deficiency or at risk of falls,” Dr. Mohammad Hassan Murad from Mayo Clinic, Rochester, Minnesota told Reuters Health in an email.
An earlier study by the U.S. Preventative Services Task Force suggested that vitamin D supplementation (with or without calcium supplementation) reduced the risk of falls by an average of 17 percent in 54 published studies that enrolled more than 26,000 patients.
Here, Dr. Murad and colleagues investigated the evidence regarding the effect of vitamin D supplementation on falls in a systematic review of 26 studies of moderate quality that enrolled 45,782 subjects.
Patients averaged 76 years old and had a median baseline risk of falling of 50% (range, 15-69%). Median duration of vitamin D supplementation in these studies was 12 months (range, 3-62 months).
Vitamin D supplementation was associated with a significant 14% reduction in the risk of suffering at least 1 fall and a significant 21% decrease in the number of falls.
The reduction in risk of suffering at least 1 fall persisted in subgroup analyses based on patients’ dwelling, vitamin D route of administration, the type of vitamin D-raising intervention, adherence in the intervention group, and whether the study documented an increase in vitamin D serum level in the intervention group.
Other subgroup analyses suggested that there was a greater reduction in falls among vitamin D deficient patients and when calcium was coadministered to both study arms (vitamin D supplementation and placebo).
In fact, among studies that compared vitamin D alone with placebo alone, the reduction in risk was trivial (3%) and nonsignificant, whereas the risk reductions were significant in studies comparing vitamin D plus calcium versus placebo (17% reduction) and in studies comparing vitamin D plus calcium versus calcium (37% reduction).
“Despite all these studies, there remains some uncertainty of the magnitude of benefit, but most likely there is benefit,” Dr. Murad said. “Harms (side effects of vitamin D) are in general minimal, and the cost is low.”
“The appropriate dose and duration of vitamin D treatment, as well as the target population for this intervention are yet to be fully defined,” the researchers note.
Dr. Murad concluded, “Elderly who are likely to benefit the most from vitamin D +calcium (for the purpose of fall prevention) fall into 2 categories: a. those at high risk of falls (have history of balance or gait issues, stroke, Parkinson, etc.), and b. those at risk of having vitamin D deficiency (elderly age, dark skin, living in a nursing home, living far from the equator, winter season, sunscreen use, wearing a veil, smoking, obesity, malabsorption disease, renal or liver disease, and use of medication such as anticonvulsants, glucocorticoids, antirejection, and HIV medications).”
The Effect of Vitamin D on Falls: A Systematic Review and Meta-Analysis
J Clin Endocrin Metab 27 July 2011.