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

doi:10.1136/bmj.b3692

Published 1 October 2009, doi:10.1136/bmj.b3692
Cite this as: BMJ 2009;339:b3692

Research

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

H A Bischoff-Ferrari, director of centre on aging and mobility¹^,2, B Dawson-Hughes, director of bone metabolism laboratory³, H B Staehelin, professor emeritus ⁴, J E Orav, associate professor of biostatistics⁵, A E Stuck, professor of geriatrics⁶, R Theiler, head of rheumatology⁷, J B Wong, professor of medicine ⁸, A Egli, fellow¹, D P Kiel, associate professor of medicine⁹, J Henschkowski, fellow¹^,6

¹ Centre on Aging and Mobility, University of Zurich, Switzerland, ² Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland, ³ Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA, ⁴ Department of Geriatrics, University Hospital Basel, Switzerland, ⁵ Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA, ⁶ Department of Geriatrics, Inselspital and Spital Netz Bern Ziegler, University of Bern, Switzerland, ⁷ Department of Rheumatology, Triemli Hospital, Zurich, Switzerland, ⁸ Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA, ⁹ Hebrew Senior Life Institute for Aging Research, Harvard Medical School, Boston, MA, USA

Correspondence to: H A Bischoff-Ferrari, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland heike.bischoff{at}usz.ch

Objective To test the efficacy of supplemental vitamin D andactive forms of vitamin D with or without calcium in preventingfalls among older individuals.

Data sources We searched Medline, the Cochrane central registerof controlled trials, BIOSIS, and Embase up to August 2008 forrelevant articles. Further studies were identified by consultingclinical experts, bibliographies, and abstracts. We contactedauthors for additional data when necessary.

Review methods Only double blind randomised controlled trialsof older individuals (mean age 65 years or older) receivinga defined oral dose of supplemental vitamin D (vitamin D₃ (cholecalciferol)or vitamin D₂ (ergocalciferol)) or an active form of vitaminD (1 ${alpha}$ -hydroxyvitamin D₃ (1 ${alpha}$ -hydroxycalciferol) or 1,25-dihydroxyvitaminD₃ (1,25-dihydroxycholecalciferol)) and with sufficiently specifiedfall assessment were considered for inclusion.

Results Eight randomised controlled trials (n=2426) of supplementalvitamin D met our inclusion criteria. Heterogeneity among trialswas observed for dose of vitamin D (700-1000 IU/day v 200-600IU/day; P=0.02) and achieved 25-hydroxyvitamin D₃ concentration(25(OH)D concentration: <60 nmol/l v $≥$ 60 nmol/l; P=0.005).High dose supplemental vitamin D reduced fall risk by 19% (pooledrelative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seventrials), whereas achieved serum 25(OH)D concentrations of 60nmol/l or more resulted in a 23% fall reduction (pooled RR 0.77,95% CI 0.65 to 0.90). Falls were not notably reduced by lowdose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitaminD concentrations of less than 60 nmol/l (pooled RR 1.35, 95%CI 0.98 to 1.84). Two randomised controlled trials (n=624) ofactive forms of vitamin D met our inclusion criteria. Activeforms of vitamin D reduced fall risk by 22% (pooled RR 0.78,95% CI 0.64 to 0.94).

Conclusions Supplemental vitamin D in a dose of 700-1000 IUa day reduced the risk of falling among older individuals by19% and to a similar degree as active forms of vitamin D. Dosesof supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitaminD concentrations of less than 60 nmol/l may not reduce the riskof falling among older individuals.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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