Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial

Flicker, Leon; MacInnis, Robert J.; Stein, Mark S.; Scherer, Sam; Mead, Kate E.; Nowson, Caryl; Thomas, Jenny; Lowndes, Chris; Hopper, John L.; Wark, John D.

doi:10.1111/j.1532-5415.2005.00468.x

Cited by 263 publications

(260 citation statements)

References 33 publications

(77 reference statements)

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“…A small pilot study of 21 inpatient hospice patients showed an association between vitamin D deficiency and greater functional impairment [29], and a randomized trial of vitamin D supplementation in elderly women showed improved lower limb muscle strength and mobility [30]. Many studies in the elderly [31][32][33], but not all [34], demonstrate a beneficial effect of vitamin D supplementation in reducing the incidence of falls. One study reported that higher physiological testosterone levels in older men and women may protect against falls, and that the benefit may be additive in those taking vitamin D supplementation [35].…”

Section: Discussionmentioning

confidence: 99%

Preliminary Report: Vitamin D Deficiency in Advanced Cancer Patients with Symptoms of Fatigue or Anorexia

et al. 2011

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Background. Vitamin D deficiency in noncancer patients is associated with symptoms of fatigue, muscle weakness, and depression. These symptoms are common among advanced cancer patients. We investigated the prevalence of low serum vitamin D levels in cancer patients with fatigue or poor appetite and their association with symptom burden and other correctable endocrine abnormalities.Methods. This was a retrospective review of 100 consecutive cancer patients with appetite or fatigue scores of >4 of 10 referred to a supportive care clinic. We investigated serum levels of 25(OH) vitamin D, cortisol, thyroid-stimulating hormone, and bioavailable testosterone. Symptoms were measured by the Edmonton Symptom Assessment Scale. Serum 25(OH) vitamin D <20 ng/mL was considered deficient; >20 ng/mL and <30 ng/mL were considered insufficient.Results. Patients were predominantly male (68%) and

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Section: Discussionmentioning

confidence: 99%

Preliminary Report: Vitamin D Deficiency in Advanced Cancer Patients with Symptoms of Fatigue or Anorexia

et al. 2011

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“…In that study, however, serum 25(OH)D levels were initially higher (77 nmol l À1 ) compared with our group (36 nmol l À1 ). Other large dose calcium/ vitamin D supplementation studies in elderly residents have not documented rates of 25(OH)D deficiency (Krieg et al, 1999;Peacock et al, 2000;Grados et al, 2003) nor did they measure serum 25(OH)D at follow-up (Flicker et al, 2005;Law et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…In a randomized, P-controlled, double-blind trial for 2 years, among Australian aged care residents, vitamin D supplementation (ergocalciferol, initially 250 mg given once weekly and then 25 mg daily) in combination with 600 mg of calcium, reduced the rates of falls (Flicker et al, 2005); and among 84-year-old, ambulatory women, supplementation with 20 mg vitamin D 3 and 1200 mg calcium for 18 months, reduced hip fractures by 43% and total non-vertebral fractures by 32% (Chapuy et al, 1992). In a randomized, double blind, controlled trial, supplementation with folate (5 mg) and vitamin B12 (1500 mg) has been found to reduce hip fracture rates in elderly stroke patients (Sato et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Multivitamin supplementation improves nutritional status and bone quality in aged care residents

et al. 2007

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Objectives: To assess the effectiveness of a multivitamin (MV) tablet on nutritional status, quantitative heel ultrasound (QUS), mobility, muscle strength and falls. The design comprised two groups matched on mobility levels, randomized to receive a daily MV or placebo (P) tablet for 6 months. The setting was an Australian residential care facility. Subjects: A total of 92 aged care residents. Serum micronutrients, body weight, QUS, rate of falls, hand grip strength, and the timed up and go test were assessed at baseline and 6 months. Results: A total of 49 participants consumed a MV and 43, a matched P for 6 months. There was a greater increase in the MV vs P group for serum 25(OH)D (mean difference ± standard error, 33.4 ± 2.6 nmol l À1 ), folate (13.4 ± 2.8 nmol l À1 ), and vitamin B12 (178.0±40.3 pmol l À1 ) (all Po0.001). Adequate 25(OH)D concentrations (X50 nmol l À1 ) were found among 77% of participants in the MV group vs 10% taking P (Po0.001). Adjusting for baseline levels, the increase in QUS was greater in the MV vs P group (3.0±2.0 dB MHz À1 vs À2.9±2.1 dB MHz À1 , respectively, P ¼ 0.041). There was a trend towards a 63% lower mean number of falls in the MV vs P group (0.3 ± 0.1 falls vs 0.8 ± 0.3 falls, P ¼ 0.078). Conclusions: MV supplementation raised serum vitamin B12 and folate concentrations and increased serum 25(OH)D, which was accompanied by an apparent positive effect on bone density. We also found a trend towards a reduction in falls and this could contribute to a reduction in fractures.

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“…Calciferol supplementation in the elderly general population has been associated with a reduction in falls and fractures as well as improvement in myopathy, including grip and lower limb strength (34)(35)(36). However, contrasting results have been reported with high-dose therapy (37).…”

Section: Muscle Strength Functional Capacity and Hrqolmentioning

confidence: 99%

Effects of Cholecalciferol on Functional, Biochemical, Vascular, and Quality of Life Outcomes in Hemodialysis Patients

Hewitt

O'Connor

O’Shaughnessy

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Observational studies suggest that calciferol supplementation may improve laboratory and patient-level outcomes of hemodialysis patients with reduced 25-hydroxyvitamin D [25(OH)D] levels. This randomized controlled trial examined effects of cholecalciferol supplementation in patients on hemodialysis.Design, setting, participants, & measurements Sixty patients with 25(OH)D levels #24 ng/ml (#60 nmol/L) were randomized to receive 50,000 IU oral cholecalciferol or placebo, once weekly for 8 weeks and then monthly for 4 months. At baseline (autumn 2011) and 6 months, testing evaluated muscle strength, functional capacity, laboratory parameters, pulse wave velocity (PWV), and health-related quality of life (HRQOL) using the Kidney Disease Quality of Life-36 survey.Results Patients were well matched by treatment allocation. Median age was 62 years (range, 20-86), 52% were women, 55% had a history of diabetes, and mean serum 25(OH)D was 1765 ng/ml (43613 nmol/L). Patients were assessed over 6 months by repeated-measures ANOVA. Patients allocated to cholecalciferol had significantly higher values of 25(OH)D (P,0.001), 1,25-dihydroxyvitamin D (P=0.04), and tartrate-resistant acid phosphatase-5b) (P=0.04) and a greater reduction in phosphorus values (P=0.03) than placebo-treated patients Values of serum calcium, intact parathyroid hormone, and episodes of hypercalcemia and hyperphosphatemia did not differ significantly between the groups. No significant differences were detected in muscle strength, functional capacity, PWV, or HRQOL.Conclusions In this randomized controlled trial, patients supplemented with cholecalciferol had higher 25(OH)D, 1,25-dihydroxyvitamin D, and tartrate-resistant acid phosphatase-5b levels, without increased calcium or phosphorus values. However, no effects were detected in muscle strength, functional capacity, PWV, or HRQOL.

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Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial

Abstract: Older people in residential care can reduce their incidence of falls if they take a vitamin D supplement for 2 years even if they are not initially classically vitamin D deficient.

Cited by 263 publications

References 33 publications

Preliminary Report: Vitamin D Deficiency in Advanced Cancer Patients with Symptoms of Fatigue or Anorexia

Preliminary Report: Vitamin D Deficiency in Advanced Cancer Patients with Symptoms of Fatigue or Anorexia

Multivitamin supplementation improves nutritional status and bone quality in aged care residents

Effects of Cholecalciferol on Functional, Biochemical, Vascular, and Quality of Life Outcomes in Hemodialysis Patients

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