Effects of Vitamin D and Calcium Supplementation on Falls: A Randomized Controlled Trial

• Published in: Journal of bone and mineral research Vol. 18; no. 2; pp. 343 - 351
• Main Authors: Bischoff, Heike A, Stähelin, Hannes B, Dick, Walter, Akos, Regula, Knecht, Margrith, Salis, Christian, Nebiker, Matthias, Theiler, Robert, Pfeifer, Michael, Begerow, Bettina, Lew, Robert A, Conzelmann, Martin
• Format: Journal Article
• Language: English
• Published: Washington, DC John Wiley and Sons and The American Society for Bone and Mineral Research (ASBMR) 01.02.2003; American Society for Bone and Mineral Research
• Subjects: Accidental Falls - prevention & control; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Bone and Bones - metabolism; bone metabolism; Calcifediol - metabolism; calcium; Calcium - metabolism; Calcium - pharmacology; Dietary Supplements; Double-Blind Method; elderly; fall prevention; Female; Fractures, Bone - prevention & control; Fundamental and applied biological sciences. Psychology; Humans; Middle Aged; Miscellaneous; muscle strength; Muscles - metabolism; Poisson Distribution; Time Factors; Vertebrates: osteoarticular system, musculoskeletal system; vitamin D; Vitamin D - metabolism; Vitamin D - pharmacology; Human; Calcium; fall prevention; Biological marker; Supplemented diet; Striated muscle; Metabolism; Inorganic element; Feeding; Micronutrient; Osteoarticular system; Prevention; muscle strength; bone metabolism; Randomized design; Vitamin D; Double blind study; Clinical trial; Fall; Bone; Elderly
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1359/jbmr.2003.18.2.343

Specific receptors for vitamin D have been identified in human muscle tissue. Cross‐sectional studies show that elderly persons with higher vitamin D serum levels have increased muscle strength and a lower number of falls. We hypothesized that vitamin D and calcium supplementation would improve musculoskeletal function and decrease falls. In a double‐blind randomized controlled trial, we studied 122 elderly women (mean age, 85.3 years; range, 63–99 years) in long‐stay geriatric care. Participants received 1200 mg calcium plus 800 IU cholecalciferol (Cal+D‐group; n = 62) or 1200 mg calcium (Cal‐group; n = 60) per day over a 12‐week treatment period. The number of falls per person (0, 1, 2–5, 6–7, >7 falls) was compared between the treatment groups. In an intention to treat analysis, a Poisson regression model was used to compare falls after controlling for age, number of falls in a 6‐week pretreatment period, and baseline 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D serum concentrations. Among fallers in the treatment period, crude excessive fall rate (treatment − pretreatment falls) was compared between treatment groups. Change in musculoskeletal function (summed score of knee flexor and extensor strength, grip strength, and the timed up&go test) was measured as a secondary outcome. Among subjects in the Cal+D‐group, there were significant increases in median serum 25‐hydroxyvitamin D (+71%) and 1,25‐dihydroxyvitamin D (+8%). Before treatment, mean observed number of falls per person per week was 0.059 in the Cal+D‐group and 0.056 in the Cal‐group. In the 12‐week treatment period, mean number of falls per person per week was 0.034 in the Cal+D‐group and 0.076 in the Cal‐group. After adjustment, Cal+D‐treatment accounted for a 49% reduction of falls (95% CI, 14–71%; p < 0.01) based on the fall categories stated above. Among fallers of the treatment period, the crude average number of excessive falls was significantly higher in the Cal‐group (p = 0.045). Musculoskeletal function improved significantly in the Cal+D‐group (p = 0.0094). A single intervention with vitamin D plus calcium over a 3‐month period reduced the risk of falling by 49% compared with calcium alone. Over this short‐term intervention, recurrent fallers seem to benefit most by the treatment. The impact of vitamin D on falls might be explained by the observed improvement in musculoskeletal function.