- Geoff Venning, consultant in pharmaceutical medicine (firstname.lastname@example.org)1
- 1 14 Lucas Road, High Wycombe HP13 6QG
- Correspondence to: G Venning
Elderly people's liability to falls and fractures is increased by many factors, including visual impairment, neurological disorders, orthopaedic disabilities, and drug effects. In one study showing that more than a third of people aged over 65 fell each year, the main risk factor was muscle weakness.1 Poor muscle strength and weakness may be associated with vitamin D deficiency, which is common among elderly people2 because the capacity of the skin to synthesise the provitamin calcidiol (25-hydroxycholecalciferol) decreases with age. Serious deficiency of vitamin D is common among elderly housebound people in old people's homes, nursing homes, and long stay wards and has been identified as an important public health problem.2–5 In this review I discuss recent developments in screening and treating vitamin D deficiency among elderly housebound people aimed at reducing the incidence of falls and fractures.
Sources and selection criteria
This review is based on material identified through Medline searches and the author's personal library, and through discussions with researchers.
Evidence of association
Higher plasma concentrations of calcidiol are associated with muscle strength, physical activity, and ability to climb stairs and lower concentrations with falls among elderly people.6 7 Indeed, in a randomised controlled trial elderly women given 800 IU vitamin D daily with calcium had a 47% reduction in falls and fractures compared with controls receiving calcium alone over 12 months.8 In another trial with three month follow up, the incidence of falls was almost halved and musculoskeletal function improved among elderly people who had 800 IU vitamin D with calcium compared with calcium alone.9
Being housebound as a risk factor
The prevalence of falls at age 85 is double that at ages 65-75.10 Most studies of osteoporosis among elderly people cover a wide age range and do not focus specifically on those who are housebound, despite the fact that age and …