Vitamin D & Falls in the Elderly
By, Robert A. Wascher, MD, FACS
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.
Vitamin D & Falls in the Elderly
Regular readers of this column are already aware of the intense research underway regarding the potential health benefits of Vitamin D beyond its long understood role in calcium absorption and bone health. A growing body of research suggests important potential roles for Vitamin D in maintaining good cardiovascular health and in the prevention of some types of cancer. More recently, clinical research has also suggested that Vitamin D may also help to directly improve muscle strength.
Falls among the elderly are a major public health problem, and are the most common cause of injury-related death in persons older than 65 years of age. It has been estimated that 30 percent of people over the age of 65 sustain falls every year, while 45 to 60 percent of people aged 80 years or greater experience significant falls every year. Falls among the elderly are also an ominous predictor of future health decline as well, and are associated with up to 40 percent of all nursing home admissions.
While Vitamin D and calcium supplementation have previously been linked with a decrease in fractures among elderly patients, recent prospective, randomized, placebo-controlled clinical research trials have also suggested that Vitamin D supplements may act directly on muscle tissue to improve muscle strength and tone. However, because of inconsistent results among several of these prospective Vitamin D clinical trials, the true benefit of Vitamin D supplements on muscle strength, and on the risk of falls among the elderly, has been rather unclear. Now, a new meta-analysis study has exhaustively reviewed and analyzed the results of 8 different prospective, randomized, placebo-controlled Vitamin D clinical research trials that, together, included more than 2,400 research volunteers. This study has just been published in the British Medical Journal.
In this meta-analysis study, the authors identified a 19 percent decrease in the risk of falls among older patients who received high-dose (700 to 1,000 IU per day) Vitamin D supplements, when compared to research volunteers who were secretly randomized to receive lower dose (200 to 600 IU per day) Vitamin D supplements, or placebo (sugar) pills.
Interestingly, and as has also been shown in several different Vitamin D cancer prevention research studies, the amount of Vitamin D taken, and the level of Vitamin D that is present in the blood, appeared to be very important factors in reducing the risk of falls in elderly patients. Specifically, there appeared to be no significant protective effect against falls among the study volunteers who received less than 700 IU of Vitamin D per day, and in those patients who had less than 60 nanomoles per liter of active Vitamin D in their blood (elderly patients with at least 60 nanomoles per liter of the active form of Vitamin D in their blood experienced a very significant 23 percent reduction in the risk of falls!).
The findings of this meta-analysis are similar to those of other Vitamin D supplement studies that have focused on the prevention of fractures, cardiovascular disease, and cancer, in that the apparent benefit of Vitamin D in reducing the risk of these serious health complications was only observed with supplementation of Vitamin D above the typically recommended levels of 400 to 600 IU per day. In summary, the findings of this study suggest that certain levels of Vitamin D intake, as well as the level of the active form of Vitamin D in the blood, may significantly reduce the risk of falls among the elderly.
The greatest limitation of this study is that it is a meta-analysis. Meta-analysis is a retrospective research technique that is used to combine the results of multiple relatively small clinical research studies, so that a larger number of patients can be analyzed. Because individual clinical research studies rarely use identical methodologies, the most critical aspect of meta-analysis is the “equalization” of methodological differences between similar but non-identical clinical studies, so that the data produced by these different studies can be uniformly analyzed, and accurate conclusions can be drawn. Because there is some subjectivity involved in this “equalization” process, meta-analysis studies are generally not considered to provide the highest possible level of clinical research evidence, although such studies are often useful when the available clinical research data on a particular topic is scattered among multiple small prospective clinical research trials.
Before you run out to the drugstore to load up on Vitamin D supplements, let me first provide a few words of caution. First of all, high doses of Vitamin D can lead to significant toxicity and health problems. Moreover, in patients with certain chronic illnesses, Vitamin D supplementation, even at lower doses, can result in clinically significant toxicity. (These chronic illnesses include excessive parathyroid gland function, certain cancers, chronic inflammatory or infectious disorders, and some forms of kidney disease, among other less common conditions.)
Therefore, before making significant changes in your diet, to include increased Vitamin D intake, or the use of other dietary supplements, I recommend that you first discuss these proposed changes with your personal physician.
For a comprehensive update on the role of Vitamin D in cancer prevention, watch for the publication of my new book, “A Cancer Prevention Guide for the Human Race,” in early 2010.
Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California
(Anticipated Publication Date: March 2010)
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