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Vitamin D failed to reduce risk for falls in elderly
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Supplementing vitamin D did not appear to decrease the risk for falls in older patients, according to study findings published in The Lancet Diabetes & Endocrinology.
The findings do not support a recent trend of broader vitamin D supplementation that is purported to treat a broad range of diseases, researchers wrote.
“Other recent analyses have suggested no benefit of vitamin D supplements on a wide range of conditions (including preventing fractures, cardiovascular events, or cancer) in people who do not live in residential care,” study author Mark J. Bolland, PhD, told Endocrine Today. “When these results are taken together with the current results for vitamin D and falls, it suggests that healthy, active people are likely to receive enough sunshine to have adequate vitamin D levels and don’t need to take vitamin D supplements,” he said.
However, Bolland and colleagues at the University of Auckland, New Zealand noted that earlier pooled analyses showed that vitamin D supplementation was linked to improvements in related measures, including gait speed and motor function.
A commentary on the study attributed the contradictory nature of prior trials to a dearth in trials designed to specifically measure falls risk; the limited design of the existing trials and the difficulty of accurately measuring fall risk in older patients; and oddities in reporting data consistently from trial to trial.
“Falls can be devastating for older people,” wrote Clifford J. Rosen, MD, in an editorial on Bolland and colleagues’ study. “Their futility analysis raises new and important questions about
the likelihood of showing an effect of vitamin D supplementation on falls from small, underpowered, randomized trials.
“Whether a large trial is feasible in this vulnerable population remains to be established. Until then, we are left with uncertainty about the benefits of vitamin D supplementation for reduction in fall risk, particularly among vulnerable older people,” Rosen said.
“Older, frailer people with other illnesses are likely to have both lower vitamin D levels and higher risk of fall,” Bolland told Endocrine Today. “Evidence from current trials shows that raising vitamin D levels does not prevent falls. This suggests that low vitamin D levels are a marker of frailty and high risk of falls rather than a cause of falls.”
Study design and results
In a survey of 20 existing randomized controlled trials, the researchers examined effect estimates for 29,535 patients who were given dosages of vitamin D with or without coadministered calcium supplements. Bolland and colleagues determined the risk for falls in intention-to-treat statistical analysis.
The overall effect estimate of vitamin D supplementation lay within the futility boundary designated, according to the researchers’ hypothesis.
Vitamin D supplementation did not alter the RR for a fall by more than 15%, which was the limit the researchers determined to be significant for falls risk reduction.
In a sensitivity analysis that reduced the risk reduction threshold to 10%, the effect estimate also lay within the futility boundary. The case was the same for a risk reduction threshold of 15% for patients who took calcium supplements in addition to vitamin D.
“Future trials with similar designs are unlikely to alter these conclusions,” the study researchers wrote. “At present, there is little justification for prescribing vitamin D supplements to prevent falls.” — by Reagan Copeland
Disclosure: This study was supported in part by the Funding Research Health Council of New Zealand.
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