Does Vitamin D Stop Inpatients Falling? A Randomised Controlled Trial

Elizabeth Burleigh; John McColl; Jan Potter

Disclosures

Age Ageing. 2007;36(5):507-513. 

In This Article

Abstract and Introduction

Abstract

Background: vitamin D deficiency is common in older people and may increase risk of falls and fracture. Hospital inpatients are at particular risk of falling. Previous studies suggest that vitamin D improves neuromuscular function and reduces falls.
Objective: to determine whether routine supplementation with vitamin D plus calcium reduces numbers of fallers and falls in a cohort of hospital admissions while they are inpatients.
Design: randomised, double-blind, controlled study.
Participants: two hundred and five acute admissions > 65 years to a geriatric medical unit.
Methods: patients were randomised to intervention of daily vitamin D 800 iu plus calcium 1,200 mg or control group of daily calcium 1,200 mg, until discharge or death.
Results: baseline characteristics were similar in both groups with a median age 84 years and a median length of stay = 30 days (IQR 14.75-71.00). In a pre-selected sub-group (54/205 participants), median admission vitamin D level = 22.00 nmol/l (IQR 15.00-30.50). This did not significantly increase in the treatment versus control group. Median study drug adherence = 88%, with no significant difference between study groups (Mann-Whitney: P = 0.711). Although there were fewer fallers in the vitamin D cohort, this did not reach statistical significance (vitamin D: calcium = 36:45 fallers; RR 0.82 (CI 0.59-1.16). Neither the mean number of falls (vitamin D: calcium = 1.040:1.155; Mann-Whitney P = 0.435) or time to first fall (Log-rank test P = 0.377) differed between groups.
Conclusions: in a population of geriatric hospital inpatients, vitamin D did not reduce the number of fallers. Routine supplementation cannot be recommended to reduce falls in this group.

Introduction

Falls are common and can cause considerable distress, minor injuries and fractures as a result.[1] Inpatients are at particular risk with the incidence of falls in hospital and nursing homes being almost triple that for community-dwelling older people.[1] Despite this, the evidence for effective falls prevention in hospitals, and indeed care homes, is limited.[2,3,4]

Vitamin D and calcium supplementation may reduce the incidence of non-vertebral fractures, albeit in selected patient groups.[5,6] In addition, vitamin D is involved in muscle metabolism with receptors identified in muscle tissue amongst others.[7] Deficiency in vitamin D is common in older adults.[8] High levels of vitamin D insufficiency have been demonstrated in community,[9] falls clinic,[10] general outpatient,[11] and medical inpatient[12] populations. Low vitamin D levels have been significantly correlated with reduced muscle strength,[13,14] impaired neuromuscular coordination,[15] increased falls risk,[16] and increased body sway.[17] Recently published randomised controlled trials have suggested that regular supplementation with vitamin D plus/minus calcium reduces falls perhaps through its influence on neuro-muscular functioning.[15,17,18,19,20,21,22] Other trials have been less positive showing no reduction in falls or fallers with regular vitamin D[23,24,25] although falls reduction was a secondary outcome.

Older geriatric inpatients are likely to be vitamin D deficient and are known to be at significant risk of falling. They have potentially much to gain if vitamin D does indeed reduce the risk of falling. For these reasons, this trial was designed to determine whether vitamin D supplementation has an effective role in falls prevention in older hospital inpatients.

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