Dietary Supplements for the Prevention of Falls and Fall-Related Injuries

Aleah M. Rodriguez, PharmD

Disclosures

January 11, 2017

Creatine

Aging leads to sarcopenia (loss of muscle mass and strength). Studies suggest that supplementation with creatine may help improve muscle mass, strength, and functional performance both in the general adult population and in older adults, with or without exercise.[9,10,11,12] Theoretically, these potential benefits may help reduce fall risk, but currently there is no clinical evidence to support the use of creatine for fall prevention.

There are also safety concerns with creatine supplementation, especially in the elderly. The duration of studies using creatine for sarcopenia has been a month or less, and the long-term safety for use in older patients is unknown.[12]

Creatine supplementation may also negatively affect renal function. Patients with existing renal disease may experience a worsening of renal function, which may be difficult to recognize because creatine supplements are metabolized to creatinine and cause an increase in serum creatinine unrelated to renal function. Patients with a history of renal disease or those taking nephrotoxic medications may also be at an increased risk for kidney dysfunction.[13] Due to these concerns, older patients with reduced kidney function may require a creatine dose reduction, but the current evidence is inconsistent.[12]

Short-term creatine supplementation might improve sarcopenia, but there is not enough data to recommend it for fall prevention.

Vitamin B12

Studies addressing the impact of vitamin B12 supplementation on fall risk have not been published, but moderate to severe vitamin B12 deficiency can cause gait disturbances and ataxia, which increase fall risk.[14,15]

Absorption of vitamin B12 from food becomes less efficient with aging. The prevalence of vitamin B12 deficiency (serum concentration < 200 pg/mL) in the United States is about 6% in patients ≥ 60 years. Approximately 20% of patients in this age group are borderline deficient (200-300 pg/mL). In patients aged 40-59 years, approximately 4% are deficient and 14%-16% are borderline deficient.[16] Patients with deficiency and borderline deficiency may present with symptoms of inadequate B12.

Risk factors for vitamin B12 deficiency include pernicious anemia, gastrectomy, pancreatic insufficiency, malnutrition, genetic causes, and medications such as metformin, long-term histamine-2 receptor antagonists, and/or proton pump inhibitor therapy. Because vitamin B12 is naturally found only in animal products, people following a vegetarian or vegan diet are also at an increased risk for deficiency.[15]

Commonly, mild vitamin B12 deficiency presents as fatigue and anemia, while moderate deficiency presents as anemia with some mild neurologic symptoms; however, not all patients experience anemia. Severe vitamin B12 deficiency can include bone marrow suppression, neurologic symptoms, and cardiomyopathy. Neurologic symptoms may include neuropathy, balance and gait issues, abnormal reflexes, and motor and/or cognitive disturbances.[15]

Patients diagnosed with deficiency and borderline deficiency should receive vitamin B12 supplementation. High-dose (1000-2000 µg daily) oral treatment is as effective as intramuscular treatment in patients with neurologic symptoms and is more cost-effective.[15,17] Parenteral treatment is generally preferred with severe neurologic symptoms or in those with malabsorption.[15]

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