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

Bischoff, H.; Stähelin, Hannes; Dick, W.; Akos, Regula; Knecht, Margrith; Salis, Christian; Nebiker, Matthias; Theiler, Robert; Pfeifer, Michael; Begerow, Bettina; Lew, Robert A.; Conzelmann, Martin

doi:10.1359/jbmr.2003.18.2.343

Cited by 867 publications

(678 citation statements)

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“…(42) Clinical findings in vitamin D deficiency myopathy include proximal muscle weakness, diffuse muscle pain, and gait impairments such as waddling way of walking. (43) Third, vitamin D supplementation increased muscle strength and balance, (24,44) and reduced the risk of falling in communitydwelling participants of double-blind randomized-controlled trials that gave 700 to 1000 IU vitamin D per day as summarized in a 2009 meta-analysis. (45) Notably, a threshold of 25(OH)D that may confer a maximum benefit on lower extremity function suggested to be at least 24 ng/mL and best 30 to 40 ng/mL based on the large National Health and Nutrition Examination Survey (NHANES) III study, (46) and the same thresholds were suggested for fall prevention based on the 2009 meta-analysis of doubleblind randomized controlled trials (RCTs).…”

Section: Discussionmentioning

confidence: 99%

“…The baseline visit (visit 2) included 24-hour pharmacokinetic profiling for HyD and vitamin D 3 , with repeated measurements of serum levels of calcium, creatinine, and 25(OH)D. Additionally, a baseline level of intact parathyroid hormone (PTH), albumin, insulin, fasting glucose, 1,25(OH) 2 Further, all subjects underwent functional testing of lower extremities, including validated and standardized procedures for knee flexor/extensor strength, timed up-and-go test, and repeated sit-to-stand test. (24) The remaining four daily visits of the first week (visits 3-6) included measurements of circulating 25(OH)D, immunity markers, albumin, serum calcium, and creatinine.…”

Section: Clinical Visitsmentioning

confidence: 99%

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Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

Bischoff‐Ferrari

Dawson‐Hughes

Stöcklin³

et al. 2011

Journal of Bone and Mineral Research

162

176

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To test the effect of 25(OH)D 3 (HyD) compared to vitamin D 3 on serum 25-hydroxyvitamin D levels (25(OH)D), lower extremity function, blood pressure, and markers of innate immunity. Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 AE 3.9 ng/mL (mean AE SD) and a mean age of 61.5 AE 7.2 years were randomized to either 20 mg of HyD or 20 mg (800 IU) of vitamin D 3 per day in a double-blind manner. We measured on 14 visits over 4 months, 25(OH)D serum levels, blood pressure, and seven markers of innate immunity (eotaxin, interleukin [IL]-8, IL-12, interferon gamma-induced protein 10 kDa , monocyte chemotactic protein-1 [MCP-1], macrophage inflammatory protein beta , and ''Regulated upon Activation, Normal T-cell Expressed, and Secreted'' [RANTES]). At baseline and at 4 months, a test battery for lower extremity function (knee extensor and flexor strength, timed up and go, repeated sit-to-stand) was assessed. All analyses were adjusted for baseline measurement, age, and body mass index. Mean 25(OH)D levels increased to 69.5 ng/mL in the HyD group. This rise was immediate and sustained. Mean 25(OH)D levels increased to 31.0 ng/mL with a slow increase in the vitamin D 3 group. Women on HyD compared with vitamin D 3 had a 2.8-fold increased odds of maintained or improved lower extremity function (odds ratio [OR] ¼ 2.79; 95% confidence interval [CI], 1.18-6.58), and a 5.7-mmHg decrease in systolic blood pressure ( p ¼ 0.0002). Both types of vitamin D contributed to a decrease in five out of seven markers of innate immunity, significantly more pronounced with HyD for eotaxin, IL-12, MCP-1, and MIP-1 b. There were no cases of hypercalcemia at any time point. Twenty micrograms (20 mg) of HyD per day resulted in a safe, immediate, and sustained increase in 25(OH)D serum levels in all participants, which may explain its significant benefit on lower extremity function, systolic blood pressure, and innate immune response compared with vitamin D 3 . ß

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Visitsmentioning

confidence: 99%

Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

Bischoff‐Ferrari

Dawson‐Hughes

Stöcklin³

et al. 2011

Journal of Bone and Mineral Research

162

176

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“…Glerup et al reported that 88 % of Danish women of Arab descent who presented with muscle pains and weakness were severely vitamin D-deficient (26,27) . Bischoff et al observed that adults with vitamin D deficiency had muscle weakness and were more likely to fall (28) . Few data exist on children/adolescents.…”

Section: Discussionmentioning

confidence: 99%

Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

Al-Ghamdi

Lanham-New

Kahn

2012

Public Health Nutr.

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Objective: Few data exist looking at vitamin D status and bone health in schoolaged boys and girls from Saudi Arabia. The present study aimed to determine the extent of poor vitamin D status in school boys and girls aged 6-18 years and to examine if there was any difference in status with age, physical activity and veiling and concomitant effects on bone. Design: Cross-sectional study. Setting: Jeddah, Kingdom of Saudi Arabia. Subjects: A total of 150 boys (7-16 years) and 150 girls (6-18 years) from local schools were divided into age categories: 6-9 years (elementary school); 10-12 years (secondary school); 13-14 years (middle years); 15-18 years (high school). Results: Vitamin D status was significantly lower in girls than boys in all age groups (P , 0?01), with the 15-18-year-old girls having the lowest level (22?0 (SD 9?4) nmol/l) in comparison to the 15-18-year-old boys (39?3 (SD 14?0) nmol/l) and the 6-9-year-old girls (41?2 (SD 9?3) nmol/l). Parathyroid hormone status was highest in the 15-18-year-old girls in comparison to boys of the same age. A total of 64 % of 15-18-year-old girls had 25-hydroxyvitamin D (25OHD) status ,25 nmol/l in comparison to 31 % in the 13-14 years age category, 26 % in the 10-12 years category and 2?5 % in the 6-9 years category. No boys had 25OHD status ,25 nmol/l. Fully veiled girls had lower 25OHD status than partly veiled or unveiled girls (P , 0?05). Low 25OHD and high parathyroid hormone was associated with lower bone mass in the 6-9 years and 13-14 years age groups (P , 0?05). Conclusions: These data suggest significant hypovitaminosis D in older adolescent females, which is a cause for concern given that there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia.

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“…Among others, vitamin D deficiency and/or low D-hormone (calcitriol/1,25(OH) 2 D 3 ), associated with a decrease of muscle strength [8,9,10,11], decreased balance [8,12,13], and loss of functional mobility [13,14], are more and more recognized to be important risk factors for falls in the elderly. Several recently published studies have shown that supplementation of vitamin D in vitamin D-deficient institutionalized women [15] and treatment with either calcitriol in osteopenic vitamin D-replete women [16] or alfacalcidol, a D-hormone prodrug, in a population of community-dwelling elderly non-vitamin D-deficient men and women [17] can significantly reduce frequency of falls [15,16,17] and number of fallers [17].…”

Section: Introductionmentioning

confidence: 99%

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

et al. 2004

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Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH) 2 D 3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D 3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH) 2 D 3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of <65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ‡65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/ 116; OR=3.68; 95% CI, 1.38-9.82; p=0.009). Conclusions: For the first time we showed that in a communitydwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls.

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

Cited by 867 publications

References 47 publications

Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

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