For Fall Prevention, Exercise: 1, Vitamin D: 0

Marcia Frellick

March 24, 2015

Strength and balance training was associated with a steep drop in both the rate of injurious falls and the number of injured fallers among home-dwelling older women. However, neither exercise nor vitamin D affected the overall rate of falls, researchers have found.

Fall rates per 100 person-years were 118.2, 132.1, 120.7, and 113.1, respectively, in the four intervention groups the authors compared: placebo without exercise, vitamin D (800 IU/day) without exercise, placebo and exercise, and vitamin D (800 IU/day) and exercise. However, injurious fall rates were 13.2, 12.9, 6.5, and 5.0, respectively.

Kirsti Uusi-Rasi, PhD, from the UKK Institute for Health Promotion Research, Tampere, Finland, and colleagues write that conditioning may lead to better and safer landing techniques, and thus explain the lower rate of injuries, a finding consistent with previous meta-analyses.

With respect to vitamin D, they conclude that more research is needed to investigate the role of the vitamin in enhancing physical functioning in elderly women. The researchers published their results online March 23 in JAMA Internal Medicine.

The investigators conducted the 2-year randomized, double-blind trial with 409 home-dwelling women 70 to 80 years old between April 2010 and March 2013. The main inclusion criteria were at least one fall in the previous year, no use of vitamin D supplements, and no contraindication to exercise.

Study results differ from results that led the US Preventive Services Task Force and the American Geriatric Society to recommend vitamin D supplements for people at high risk for falls, write Erin LeBlanc, MD, MPH, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, and Roger Chou, MD, of the Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland in an invited commentary. Falls are the leading cause of unintentional injuries and fractures in older adults, the investigators write, and although fewer than 1 in 10 falls results in a fracture, approximately 20% of them result in the need for medical attention.

Dr LeBlanc and Dr Chou offered perspective on how to interpret this study in light of current recommendations.

"Updating the [US Preventive Services Task Force] review meta-analysis with this trial and other new data does not change the overall conclusion that vitamin D remains associated with an 11% decreased risk of falls," they write.

The researchers say there may be reasons vitamin D did not appear beneficial in the study, among them that participants' deficiencies may not have been low enough to benefit from the vitamin D or that the dosage may have been inadequate.

They also point out that the trial was conducted on white European women and may not apply to others outside that demographic.

They advise physicians to continue to recommend vitamin D for patients at risk of falling, given its low cost and low risk, at least until more data are available.

What is more clear in the study, the authors write, is the benefit of exercise in reducing serious injuries in a fall and its role in improving other health aspects as well.

This study was supported by the Academy of Finland, Ministry of Education and Culture, Competitive Research Fund of Pirkanmaa Hospital District, and Juho Vainio Foundation. The authors have disclosed no relevant financial relationships. Dr LeBlanc and Dr Chou reported receiving funding from the Agency for Healthcare Research and Quality to conduct a systematic evidence review on screening for vitamin D for the US Preventive Services Task Force. Dr LeBlanc reported that her institution receives funding from the National Institute of Diabetes and Digestive and Kidney Diseases for a trial of the effects of vitamin D on the prevention of diabetes and reported that her institution has received funding from Bristol-Meyers Squibb, AstraZeneca, and Amgen for research unrelated to vitamin D.

JAMA Intern Med. Published online March 23, 2015. Article abstract, Commentary extract

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