Vitamin D Status Predicts Physical Performance and Its Decline in Older Persons

Abstract

Context: Vitamin D deficiency is common among older people and can cause mineralization defects, bone loss, and muscle weakness.Objective: The aim of this study was to investigate the association of serum 25-hydroxyvitamin D (25-OHD) concentration with current physical performance and its decline over 3 yr among elderly. Design:The study consisted of a cross-sectional and longitudinal design (3-yr follow-up) within the Longitudinal Aging Study Amsterdam.Setting: An age-and sex-stratified random sample of the Dutch older population was used.Other Participants: Subjects included 1234 men and women (aged 65 yr and older) for cross-sectional analysis and 979 (79%) persons for longitudinal analysis.Main Outcome Measure(s): Physical performance (sum score of the walking test, chair stands, and tandem stand) and decline in physical performance were measured.Results: Serum 25-OHD was associated with physical performance after adjustment for age, gender, chronic diseases, degree of urbanization, body mass index, and alcohol consumption. Compared with individuals with serum 25-OHD levels above 30 ng/ml, physical performance was poorer in participants with serum 25-OHD less than 10 ng/ml [regression coefficient (B) ϭ Ϫ1.69; 95% confidence interval (CI) ϭ Ϫ2.28; Ϫ1.10], and with serum 25-OHD of 10 -20 ng/ml (B ϭ Ϫ0.46; 95% CI ϭ Ϫ0.90; Ϫ0.03). After adjustment for confounding variables, participants with 25-OHD less than 10 ng/ml and 25-OHD between 10 and 20 ng/ml had significantly higher odds ratios (OR) for 3-yr decline in physical performance (OR ϭ 2.21; 95% CI ϭ 1.00 -4.87; and OR ϭ 2.01; 95% CI ϭ 1.06 -3.81), compared with participants with 25-OHD of at least 30 ng/ml. The results were consistent for each individual performance test.Conclusions: Serum 25-OHD concentrations below 20 ng/ml are associated with poorer physical performance and a greater decline in physical performance in older men and women. Because almost 50% of the population had serum 25-OHD below 20 ng/ml, public health strategies should be aimed at this group. V ITAMIN D DEFICIENCY is common in the older population (1-3) and can result in secondary hyperparathyroidism, bone loss, and fractures (4 -7). Osteomalacia, caused by severe vitamin D deficiency, is characterized by mineralization defects, bone and muscle pain, and weakness of the proximal muscles (8, 9). Older people are especially at risk of developing vitamin D deficiency due to low exposure to sunshine (10), decreased capacity of the older skin to synthesize vitamin D (11), and low dietary vitamin D intake (9).Although the role of vitamin D in maintaining skeletal health is well known, knowledge about its role in relation to physical performance is still limited, and it is unknown whether vitamin D status can predict decline in physical performance. It was demonstrated in a randomized double-blind clinical trial that supplementation with vitamin D and calcium can prevent hip fractures and other nonvertebral fractures in nursing home residents (12). The effect of vitamin D supplementation on f...

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

“…Observational data have revealed that 25(OH)D levels predict the decline in bone mineralization and physical performance when 25(OH)D falls below 8 and 20 ng/mL (20 and 50 nmol/L), respectively 8, 56. Although the underlying mechanisms remain to be elucidated, vitamin D may represent a pathway by which bone and muscle may work together, enabling cross‐talk between these tissues ( Figure  3).…”

“…Vitamin D deficiency is common in patients with chronic kidney disease (CKD),4 a population in whom muscle wasting and weakness are also highly prevalent 5, 6, 7. Observational studies have shown that circulating 25‐hydroxyvitamin D [25(OH)D] levels are reduced in parallel to the severity of muscle symptoms 8. Similarly, emerging evidence suggests that vitamin D receptor (VDR) is expressed in muscle and that VDR regulates gene expression and modulates the uptake of 25(OH)D in skeletal muscle cells, which may also act as a storage site for this vitamin D 9, 10.…”

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

“…(1)(2)(3) Indeed, there is increasing evidence that when accounting not for skeletal health but the salutary effects of vitamin D on nonskeletal organs, the optimal health-promoting concentration of 25(OH)D is around 30 ng/mL. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) In particular, adverse neuromuscular events such as muscle weakness, balance impairment, and reduced nerve conduction have been described for serum 25(OH)D concentrations below 30 ng/mL. (3)(4)(5)(6)(7)(8)(9)(10)(11) Walking speed is a simple, objective performance-based measure of lower limb neuromuscular function that not only allows detection of subtle impairments and preclinical diseases but also is a sensitive marker of functional capacity in older adults.…”

“…(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) In particular, adverse neuromuscular events such as muscle weakness, balance impairment, and reduced nerve conduction have been described for serum 25(OH)D concentrations below 30 ng/mL. (3)(4)(5)(6)(7)(8)(9)(10)(11) Walking speed is a simple, objective performance-based measure of lower limb neuromuscular function that not only allows detection of subtle impairments and preclinical diseases but also is a sensitive marker of functional capacity in older adults. (10)(11)(12)(13)(14)(15)(16) For instance, Suzuki and colleagues recently demonstrated that walking speed in older adults was positively ORIGINAL ARTICLE J JBMR correlated with physical performance tests such as handgrip strength or stork standing time.…”

“…(3)(4)(5)(6)(7)(8)(9)(10)(11) Walking speed is a simple, objective performance-based measure of lower limb neuromuscular function that not only allows detection of subtle impairments and preclinical diseases but also is a sensitive marker of functional capacity in older adults. (10)(11)(12)(13)(14)(15)(16) For instance, Suzuki and colleagues recently demonstrated that walking speed in older adults was positively ORIGINAL ARTICLE J JBMR correlated with physical performance tests such as handgrip strength or stork standing time. (16) Furthermore, these authors also found a significant positive association between walking speed at a usual pace and serum 25(OH)D concentrations.…”