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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #236747
Title: Fall prevention with supplemental and alpha-hydroxylated vitamin D: a meta-analysis of randomized controlled trials

Author
item BISCHOFF-FERRARI, HEIKE - UNIV OF ZURICH & HNRCA
item Dawson-Hughes, Bess
item STAEHELIN, HANNES - UNIV HOSPITAL BASEL
item ORAV, JOHN - BRIGHAM & WOMEN'S HOSP
item STUCK, ANDREAS - UNIV HOSPITAL BASEL
item THEILER, ROBERT - UNIVERSITY OF BERN
item WONG, JOHN - TUFTS MED CTR PHYS ORG
item EGLI, ANDREAS - UNIVERSITY OF ZURICH
item HENSCHKOWSKI, J - UNIV ZURICH & UNIV BERNE

Submitted to: British Medical Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/29/2009
Publication Date: 10/1/2009
Citation: Bischoff-Ferrari, H., Dawson-Hughes, B., Staehelin, H.B., Orav, J.E., Stuck, A.E., Theiler, R., Wong, J.B., Egli, A., Henschkowski, J. 2009. Fall prevention with supplemental and alpha-hydroxylated vitamin D: a meta-analysis of randomized controlled trials. British Medical Journal. 339:b3692.

Interpretive Summary: Fall prevention is a key public health target in the older segment of the population. Several clinical trials have shown a reduction in falls with supplemental vitamin D whereas others have shown no benefit. The objective of this meta-analysis was to assess the impact of supplementation with vitamin D on risk of falling and to seek to identify the dose of vitamin D and the corresponding 25(OH)D level needed for optimal fall prevention in older subjects. Only double-blind randomized clinical trials in older individuals were considered. Ten of 17 identified studies met the inclusion criteria. In 1921 subjects from 7 trials, we found that supplemental vitamin D in doses of 700 to 1000 IU/d significantly reduced fall risk by 19%. Falls were not reduced by supplemental vitamin D in doses lower than 700 IU/d. From these analysis, it also appears that an average serum 25(OH)D level of at least 60 nmol/L is needed to reduce risk of falling. We conclude that supplemental vitamin D in a dose of 700 to 1000 IU per day is needed to reduce the risk of falling among older individuals and that the magnitude of the reduction is about 19%.

Technical Abstract: Results from fall prevention trials with supplemental vitamin D have been mixed and a possible differential benefit of supplemental versus alpha-hydroxylated vitamin D (activeD) has not been established. We performed a meta-analysis on the efficacy of supplemental vitamin D and activeD with or without calcium in preventing falls among older individuals. We searched MEDLINE, the Cochrane Controlled Trials Register, BIOSIS, EMBASE, clinical experts, bibliographies, and abstracts up to August 2008. Only double-blind RCTs among older individuals (mean age 65+) with prospective fall assessment. 10 of 17 identified studies met the inclusion criteria, 7 were included in a sensitivity analysis. Supplemental vitamin D: 8 RCTs (n = 2426) met our inclusion criteria. For supplemental vitamin D, heterogeneity was observed for dose of vitamin D (low-dose: < 700 IU / day versus higher dose: 700 to 1000 IU / day; p-value 0.02) and achieved 25-hydroxyvitamin D level (< 60 nmol/l versus '' 60 nmol/l; p-value = 0.005). Higher dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) = 0.81; 95% CI, 0.71-0.92; n = 1921 from seven trials). Falls were not reduced by low dose supplemental vitamin D (pooled RR = 1.10, 95% CI, 0.89-1.35 from 2 trials) or by achieved serum 25-hydroxyvitamin D concentrations less than 60 nmol/l (pooled RR = 1.35, 95% CI, 0.98-1.84). ActiveD: 2 RCTs, (n = 624) met our inclusion criteria. ActiveD reduced fall risk by 22% (pooled RR = 0.78; 95% CI, 0.64-0.94). Supplemental vitamin D in a dose of 700 to 1000 IU per day reduced the risk of falling among older individuals by 19% and to a similar degree as activeD. Low dose supplemental vitamin D less than 700 IU or achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.