John Robbins, MD
Does oral vitamin D prevent falls in older persons?
Included studies evaluated the effect of a defined dose of oral supplemental vitamin D or active vitamin D (with or without calcium) on falls in persons ≥ 65 years of age. Studies in patients with conditions placing them at high risk for falls were excluded. Outcome was occurrence of ≥ 1 fall.
MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE/Excerpta Medica (to Aug 2008); BIOSIS (to Jul 2008); abstracts from the American Society of Bone and Mineral Research (1995 to 2008); and reference lists were searched, and experts were contacted for randomized controlled trials (RCTs) with ≥ 3 months of follow-up. For inclusion in the primary analysis, additional requirements were double-blinding and sufficient specification of the assessment of falls. 8 RCTs (11 comparisons) of supplemental vitamin D (n = 2426, mean age 80 y, 81% women) and 2 RCTs of active vitamin D (n = 624, mean age 73 y, 70% women) met selection criteria for the primary analysis. 7 poorer-quality RCTs of supplemental vitamin D (n = 15 360) were also included.
Meta-analysis of 8 RCTs of supplemental vitamin D showed a reduction in falls (Table), but statistically significant heterogeneity was present. Vitamin D doses of 700 to 1000 IU/d prevented falls, but doses < 700 IU/d did not (Table). Adding the 7 poorer-quality trials (which all used high-dose vitamin D) to the high-dose primary analysis subgroup (n = 17 281) resulted in a relative risk reduction for falls of 8% (95% CI 1 to 15). Meta-analysis of 2 RCTs of active vitamin D showed a reduction in falls similar to that of high-dose supplemental vitamin D (Table).
High-dose oral vitamin D supplements and active vitamin D prevent falls in older persons.
Oral vitamin D supplements or active vitamin D to prevent falls in older persons*
*NS = not significant; other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
John Robbins. Review: High-dose oral vitamin D supplements and active vitamin D prevent falls in older persons. Ann Intern Med. 2010;152:JC1–3. doi: 10.7326/0003-4819-152-2-201001190-02003
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Published: Ann Intern Med. 2010;152(2):JC1-3.
Geriatric Medicine, Prevention/Screening.
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