Comprehensive Interventions Including Vitamin D Effectively Reduce the Risk of Falls in Elderly Osteoporotic Patients

Abstract

Objective: To evaluate the effects of different intervention measures to prevent falls in elderly osteoporotic patients.Methods: A randomized controlled trial was conducted in our outpatient ward from August 2014 to September 2015.A total of 420 patients over 60 years of age were assigned to four groups. NA VitD group took 800 mg calcium and 800 IU non-active vitamin D. P-NA VitD group took 800 mg calcium, 800 IU non-active vitamin D, and received physical exercise. A VitD group took 800 mg calcium and 0.5 μg active vitamin D. P-A VitD took 800 mg calcium, 0.5 μg active vitamin D, and received physical exercise. Physical exercise includes guidance in improving muscle strength and balance ability. Short physical performance battery (SPPB), grip strength, modified falls efficacy scale (MFES), blood calcium, and 25-hydroxyl vitamin D were measured before interventions and at 3, 6, and 12 months after interventions. Bone mineral density (BMD) was detected before interventions and at 12 months after interventions. The incidence of falls and fractures, adverse events, and drug reactions were recorded for 12 months.Results: A total of 420 patients were allocated in the four groups: 98 cases into the NA VitD group (11 males, 87 females), 97 cases into the P-NA VitD group (13 males, 84 females), 99 cases in the A VitD group (15 males, 84 females), and 98 cases into the P-A VitD group (11 males, 87 females). At 6 months after interventions, the SPPB of A VitD group significantly increased from 6.9 AE 1.9 to 8.0 AE 2.4 (P < 0.05), and the SPPB of A VitD group significantly increased from 7.2 AE 2.1 to 8.6 AE 1.7 (P < 0.05). At 6 months after interventions, MFES of P-NA VitD group 7.0 AE 1.6 to 7.6 AE 1.6 (P < 0.05), and MFES of P-A VitD group significantly increased from 6.7 AE 1.6 to 7.5 AE 1.6 (P < 0.05). At 12 months after interventions, SPPB of all groups, grip strength, and MFES of P-NA VitD group, A VitD group, P-A VitD group were significantly improved (P < 0.05). The BMD of lumbar vertebrae of A VitD group significantly increased from 0.742 AE 0.042 to 0.776 AE 0.039, and P-A VitD group significantly increased from 0.743 AE 0.048 to 0.783 AE 0.042 (P < 0.05). No serious adverse events occurred during the 12 months of follow-up. Conclusion:Active vitamin D is better than non-active vitamin D to improve physical ability and the BMD of lumbar vertebrae and reduce the risk of falls.

Vitamin D and Calcium in Osteoporosis, and the Role of Bone Turnover Markers: A Narrative Review of Recent Data from RCTs

“…In total, nine studies fulfilling the inclusion criteria were identified (total n = 1568 subjects) [ 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 52 ]. The studies were conducted in several countries, i.e., USA [ 28 , 29 , 30 , 52 ], Lebanon [ 26 , 52 ], Turkey [ 25 ], Australia [ 21 ], India [ 27 ], and China [ 24 ]. The mean age of participants ranged from 32 to 71 y, and most of them included only women [ 25 , 28 , 29 , 30 , 52 ] or mostly women [ 24 ].…”

“…The studies were conducted in several countries, i.e., USA [ 28 , 29 , 30 , 52 ], Lebanon [ 26 , 52 ], Turkey [ 25 ], Australia [ 21 ], India [ 27 ], and China [ 24 ]. The mean age of participants ranged from 32 to 71 y, and most of them included only women [ 25 , 28 , 29 , 30 , 52 ] or mostly women [ 24 ]. The minimum treatment duration was 16 weeks [ 21 ], some studies had a 6 month intervention period [ 25 , 29 ], and most studies had a 12 month [ 24 , 26 , 27 , 28 , 30 , 52 ] intervention period.…”

“…The mean age of participants ranged from 32 to 71 y, and most of them included only women [ 25 , 28 , 29 , 30 , 52 ] or mostly women [ 24 ]. The minimum treatment duration was 16 weeks [ 21 ], some studies had a 6 month intervention period [ 25 , 29 ], and most studies had a 12 month [ 24 , 26 , 27 , 28 , 30 , 52 ] intervention period. The dose of vitamin D ranged from 400 IU per day to 4800 IU per day, and the dose of administered dietary and supplementary calcium ranged from 200 mg to 1500 mg per day.…”

“…All [ 21 , 24 , 25 , 26 , 27 , 29 , 30 , 52 ] but one study [ 28 ] measured BMD before and after the intervention. Increases in total BMD were observed in several studies [ 26 , 27 , 29 , 52 ], which were more significant in high-dose supplemented groups [ 26 , 52 ].…”

“…However, the recent data are quite contradictory. Some studies showed that calcium supplementation combined with vitamin D reduced the risk of fractures [ 24 , 25 , 26 ], while others showed no effect [ 21 , 27 , 28 , 29 , 30 ]. A meta-analysis suggested that concomitant supplementation with calcium and vitamin D led to a significantly reduced risk of total fractures by 15% (summary relative risk estimates, SRRE: 0.85; 95% CI, 0.73–0.98) and a 30% reduced risk of hip fractures (SRRE: 0.70; 95% CI, 0.56–0.87) [ 31 ].…”