Falls Relate to Vitamin D and Parathyroid Hormone in an Australian Nursing Home and Hostel

Stein, Mark S.; Wark, John D.; Scherer, Samuel; Walton, Sarah L.; Chick, Patricia; Carlantonio, M. Di; Zajac, Jeffrey D; Flicker, Leon

doi:10.1111/j.1532-5415.1999.tb05199.x

Cited by 196 publications

(154 citation statements)

References 57 publications

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“…The low D-hormone serum levels observed with a creatinine clearance of <65 ml/min may also be one reason for the increased osteopenia and osteoporosis observed with low creatinine clearance by other authors [15,16]. Our result enhances the theory suggested by other studies [4,5,6,7,17,18,19,20,21,22] that D-hormone is an independent risk factor for falls [1,2,5,23], and that D-hormone is directly involved in the causal pathogenic pathway of decreased muscle strength related falls [9,23,24]. It has been recently confirmed in VDR gene deleted mice that the absence of VDR causes muscle abnormality independently of secondary metabolic changes, e.g.…”

Section: Discussionsupporting

confidence: 79%

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

et al. 2004

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We previously observed that a creatinine clearance (CrCl) of <65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 lg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of <65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08-0.80, P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09-0.88, P=0.028). No such association was observed in participants with a CrCl of ‡65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34-2.52, P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34-2.54, P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of <65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.

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Section: Discussionsupporting

confidence: 79%

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

et al. 2004

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“…Both factors-increasing IL-6 and decreasing IGF-I-are synergistic risk factors for functional disability [42]. The results from these studies [9,10,11,28,29,30,40,41,42] suggest that 1.25(OH) 2 D 3 is an independent risk factor for decreased muscle strength [12,13], reduced functional mobility [14], and for falls [8,16,17,43], suggesting a direct involvement of 1.25(OH) 2 D 3 in the causal pathogenic pathway of decreased muscle strength-related falls [39].…”

Section: Discussionmentioning

confidence: 98%

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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“…Thus it is difficult to distinguish any separate effects on muscle function. Stein and colleagues (39) have suggested that the muscle effect of 25(OH)D insufficiency could be due to iPTH and not to a direct action of vitamin D on muscle. This relationship between serum iPTH concentrations and muscle has been known for a long time in patients with primary hyperparathyroidism, whose clinical features include muscle weakness (40) that was reversed after parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: The EPIDOS study

Annweiler

Schott

Montero‐Odasso

et al. 2010

Journal of Bone and Mineral Research

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The purpose of this study was to determine whether there was an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and walking speed measured at usual and fast pace among older women. Usual-and fast-pace walking speeds and 25(OH)D concentrations were assessed in 739 randomized older women (mean age 80.2 AE 3.5 years) from the EPIDOS study. The following 25(OH)D thresholds were used: 10, 20, and 30 ng/mL. Walking speed was dichotomized on being in the worst quintile or not. Age, body mass index, number of chronic diseases, physical activity, quadriceps strength, cognition, use of psychoactive drugs, and serum parathyroid hormone were used as potential confounders. The results show that 90% of subjects had 25(OH)D insufficiency. Only fast-pace walking speed was significantly different between groups ( p ¼ .

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Falls Relate to Vitamin D and Parathyroid Hormone in an Australian Nursing Home and Hostel

Abstract: In ambulant nursing home and hostel residents, residents who fall have lower serum 25-hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.

Cited by 196 publications

References 57 publications

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

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

Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: The EPIDOS study

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