Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials

Bischoff-Ferrari, H. A.; Dawson-Hughes, B.; Staehelin, H. B.; Orav, J. E.; Stuck, A. E.; Theiler, R.; Wong, J. B.; Egli, A; Kiel, D. P.; Henschkowski, J.
October 2009
BMJ: British Medical Journal (Overseas & Retired Doctors Edition;10/10/2009, Vol. 339 Issue 7725, p843
Academic Journal
Objective To test the efficacy of supplemental vitamin D and active forms of vitamin D with or without calcium in preventing falls among older individuals. Data sources We searched Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008 for relevant articles. Further studies were identified by consulting clinical experts, bibliographies, and abstracts. We contacted authors for additional data when necessary. Review methods Only double blind randomised controlled trials of older individuals (mean age 65 years or older) receiving a defined oral dose of supplemental vitamin D (vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D3 (1α-hydroxycalciferol) or 1,25-dihydroxyvitamin D3 (1,25-dihydroxycholecalciferol)) and with sufficiently specified fail assessment were considered for inclusion. Results Eight randomised controlled trials (n=2426) of supplemental vitamin D met our inclusion criteria. Heterogeneity among trials was observed for dose of vitamin D (700-1000 IU/day v 200-600 IU/day, P=O.02) and achieved 25-hydroxyvitamin D3 concentration (25(OH)D concentration: <60 nmol/Iv ≥60 nmol/l; P=0.005). High dose supplemental vitamin D reduced fall risk by 19% (pooled relative risk (RR) 0.81, 95%Cl 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/I or more resulted in a 23% fall reduction (0.77, 0.65 to 0.90). Falls were not notably reduced by low dose supplemental vitamin D (1.10, 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (1.35, 0.98 to 1.84). Two randomised controlled trials (n=624) of active forms of vitamin D met our inclusion criteria. Active forms of vitamin D reduced fail risk by 22% (0.78, 0.64 to 0.94). Conclusions Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 I U or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.


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