Prophylactic Vitamin D to Reduce Falls in Older Persons

A meta-analysis 1 included 5 studies with a total of 1 237 community dwelling or institutionalised older persons (mean age 70 years, 81% women). Vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR 0.78; 95% confidence interval [CI] 0.64-0.92) compared with patients receiving calcium or placebo. The number needed to treat (NNT) was 15 (95% CI 8-53). The inclusion of 5 additional studies (n=10 001) in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR 0.87; 95% CI, 0.80-0.96).

A meta-analysis 2 included 8 RCTs (n=2426) of supplemental vitamin D in individuals of 65 years or older. The dose of vitamin D varied between 700-1000 IU/day (high dose group) and 200-600 IU/day (low dose group). High dose vitamin D reduced fall risk by 19% (pooled RR 0.81, 95% CI 0.71 to 0.92; 7 trials, n=1921), 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 reduced by low dose vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; 2 trials, n=505) 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 RCTs (n=624) of active forms of vitamin D reduced fall risk by 22% (pooled RR 0.78, 95% CI 0.64 to 0.94).

References

• Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004 Apr 28;291(16):1999-2006. [PubMed]
• Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009 Oct 1;339():b3692. [PubMed]