Voldoende vitamine D tegen
het vallen bij ouderen*
Uit een nieuwe uitgebreide analyse van verschillende studies over vitamine D blijkt dat dagelijkse inname van minimaal 20-25 mcg vitamine D(3) de kans op vallen bij ouderen wel met 26% doet verminderen. 1 op de 3 ouderen maakt ieder jaar wel een val mee met alle mogelijk nare gevolgen zodat inname van voldoende vitamine D voor hen belangrijk is.
High-Dose Vitamin D Supplement May Reduce Risk of Falling Among Older People
High-dose vitamin D supplementation may reduce the risk of falling among older people, according to the results of a meta-analysis reported in the BMJ.
"In several trials of older individuals at risk for vitamin D deficiency, vitamin D supplementation improved strength, function, and balance in a dose-related pattern," write H.A. Bischoff-Ferrari, MD, MPH, from the University of Zurich in Zurich, Switzerland, and colleagues. "Most importantly, these benefits translated into a reduction in falls. Overall, however, results have been mixed for fall prevention with vitamin D; for example, several trials of vitamin D have had non-significant results."
The goal of this meta-analysis was to evaluate the efficacy of supplemental and active forms of vitamin D with or without calcium in preventing falls among older individuals. The reviewers searched for relevant articles in Medline, the Cochrane central register of controlled trials, BIOSIS, and Embase up to August 2008, and they found additional studies from bibliographies and abstracts and by consulting clinical experts. When indicated, the reviewers contacted study authors for additional data.
Inclusion criteria were double-blind, randomized controlled trials enrolling groups of individuals of mean age 65 years or older, with sufficiently specified fall assessment. Participants in included trials were given 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]).
There were 8 randomized controlled trials of supplemental vitamin D that met inclusion criteria, enrolling a total of 2426 participants. The investigators observed heterogeneity among trials for dose of vitamin D (700 - 1000 IU/day vs 200 - 600 IU/day; P = .02) and for achieved 25-hydroxyvitamin D3 concentration (25 [OH]D concentration: < 60 nmol/L vs ≥ 60 nmol/L; P = .005).
In 7 trials enrolling a total of 1921 subjects, use of high-dose supplemental vitamin D was associated with a 19% reduction in fall risk (pooled relative risk [RR], 0.81; 95% confidence interval [CI], 0.71 - 0.92). Achieved serum 25 (OH)D concentrations of at least 60 nmol/L were associated with a 23% reduction in fall risk (pooled RR, 0.77; 95% CI, 0.65 - 0.90).
In contrast, 2 trials enrolling a total of 505 subjects showed that use of low-dose supplemental vitamin D was not associated with a notable reduction in fall risk (pooled RR, 1.10; 95% CI, 0.89 - 1.35). Also, achieved serum 25 (OH)D concentrations of less than 60 nmol/L appeared to affect fall risk significantly (pooled RR, 1.35; 95% CI, 0.98 - 1.84). In 2 randomized controlled trials (n = 624) meeting inclusion criteria, active forms of vitamin D were associated with a 22% reduction in fall risk (pooled RR, 0.78; 95% CI, 0.64 - 0.94).
"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," the study authors write. "Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals."
Limitations of this study include potential publication bias and larger-than-expected variation between trials. "Doses of 700 IU to 1000 IU supplemental vitamin D a day could reduce falls by 19% or by up to 26% with vitamin D3," the study authors conclude. "This benefit may not depend on additional calcium supplementation, was significant within 2-5 months of treatment, and extended beyond 12 months of treatment....Active forms of vitamin D do not appear to be more effective than 700-1000 IU of supplemental vitamin D for fall prevention in older persons."
A Swiss National Foundations Professorship grant, the Velux Foundation, the Baugarten Foundation, the Vontobel Foundation, and a fellowship from the Robert Bosch Foundation supported this study. One of the review authors was funded by the National Institute on Aging. The other review authors have disclosed no relevant financial relationships.
Clinical Context
One in 3 persons older than 65 years experiences at least 1 fall annually. Fall prevention is an important public health goal in older persons, and a previous meta-analysis from 2004 showed that any vitamin D supplementation can reduce falls by 22% in elderly patients and that vitamin D3 had a larger effect than vitamin D2. However, the question of what minimal doses of vitamin D are needed to prevent falls remains open because results have been mixed and active forms of vitamin D may also have fall prevention effects.
This is a systematic review and meta-analysis of randomized controlled trials to examine the role of vitamin D and the doses needed to prevent falls in elderly patients older than 65 years.
Study Highlights
· The investigators searched Medline, the Cochrane Central register, BIOSIS, and Embase to 2008 for randomized controlled trials of fall prevention using defined doses of vitamin D2, vitamin D3, or oral active forms of vitamin D or 25 (OH)D with a minimal follow-up of 3 months.
· Falls had to be a primary or secondary endpoint, a definition of falls had to be given, and falls had to be assessed for the entire study period.
· Excluded were reviews, observational studies, studies on patients with Parkinson's disease and stroke, or studies assessing intramuscular injection of vitamin D.
· The primary outcome was risk of having at least 1 fall in those receiving vitamin D with or without calcium.
· Both dose and levels of 25(OH)D concentration achieved were assessed for their effect on falls.
· Of 164 articles found, only 10 met inclusion criteria, of which 8 used vitamin D2 or vitamin D3 and 2 used the active forms of vitamin D.
· The 8 randomized controlled trials included 2426 individuals with 81% women and a mean age of 80 years.
· All participants were in stable health and were either community dwelling or resided in nursing homes.
· 5 studies used vitamin D3 and 3 used vitamin D2, with a dose ranging from 200 to 1000 IU daily.
· 1 study had multiple-dose groups ranging from 200 to 800 IU daily vs placebo.
· Treatment duration varied from 2 to 36 months.
· Calcium was used in both treatment and placebo groups in 5 studies, with a dose from 500 to 1200 mg daily; adherence varied from 68% to 100%.
· 7 of 8 trials had an adherence rate from 80% to 100%.
· The pooled RR for any dose of vitamin D preventing falls was 0.87, but heterogeneity was seen, which resolved when the dose was accounted for.
· The pooled RR for a dose of 700 to 1000 IU of vitamin D2 or vitamin D3 daily was 0.81, with a risk reduction of 19% and a number needed to treat of 11 to prevent 1 fall, for a treatment duration of 2 to 36 months.
· The active forms of vitamin D were also protective at doses of 700 to 1000 IU daily.
· The protective effect of vitamin D was seen as early as 2 to 5 months after treatment started and extended beyond 12 months of treatment.
· Daily doses of less than 700 IU did not protect against falls.
· Achieved serum 25(OH)D concentrations of 60 mmol/L or more resulted in a 23% reduction in the risk for falls (RR, 0.77), but levels below that had no effect on fall prevention.
· In meta-regression, there was a significant inverse relationship between active forms of vitamin D at doses above 700 IU daily and 1000 IU daily for fall prevention, with a threshold of 700 IU daily.
· A similar inverse relationship was seen for serum 25(OH)D levels above vs below 60 mmol/L.
· The authors concluded that vitamin D2, vitamin D3, or active forms of vitamin D at doses above 700 IU daily and serum 25(OH)D levels above 60 mmol/L protected against falls in elderly patients.
· The suggested that vitamin D supplementation should be provided at a minimal daily dose of 700 IU daily.
Clinical Implications
· Vitamin D supplementation at doses of 700 to 1000 IU daily prevents falls in elderly patients.
· Serum 25(OH)D levels of 60 mmol/L or higher are protective against falls in elderly
patients. (November
2009)
