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

Creator:

BMJ

Type: Report
Region: Republic of Ireland
Northern Ireland
Description:

H A Bischoff-Ferrari, director of centre on aging and mobility1,2, B Dawson-Hughes, director of bone metabolism laboratory3, H B Staehelin, professor emeritus 4, J E Orav, associate professor of biostatistics5, A E Stuck, professor of geriatrics6, R Theiler, head of rheumatology7, J B Wong, professor of medicine 8, A Egli, fellow1, D P Kiel, associate professor of medicine9, J Henschkowski, fellow1,6 1 Centre on Aging and Mobility, University of Zurich, Switzerland, 2 Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland, 3 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA, 4 Department of Geriatrics, University Hospital Basel, Switzerland, 5 Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA, 6 Department of Geriatrics, Inselspital and Spital Netz Bern Ziegler, University of Bern, Switzerland, 7 Department of Rheumatology, Triemli Hospital, Zurich, Switzerland, 8 Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA, 9 Hebrew Senior Life Institute for Aging Research, Harvard Medical School, Boston, MA, USA Correspondence to: H A Bischoff-Ferrari, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland heike.bischoff@usz.ch 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 (1-hydroxyvitamin D3 (1-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.  This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

Date:

07/10/2009

Rights: Public
Suggested citation:

BMJ. (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials [Online]. Available from: http://publichealthwell.ie/node/9557 [Accessed: 21st May 2019].

  

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