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

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3692 (Published 01 October 2009) Cite this as: BMJ 2009;339:b3692
  1. H A Bischoff-Ferrari, director of centre on aging and mobility12,
  2. B Dawson-Hughes, director of bone metabolism laboratory3,
  3. H B Staehelin, professor emeritus 4,
  4. J E Orav, associate professor of biostatistics5,
  5. A E Stuck, professor of geriatrics6,
  6. R Theiler, head of rheumatology7,
  7. J B Wong, professor of medicine 8,
  8. A Egli, fellow1,
  9. D P Kiel, associate professor of medicine9,
  10. J Henschkowski, fellow16
  1. 1Centre on Aging and Mobility, University of Zurich, Switzerland
  2. 2Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland
  3. 3Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
  4. 4Department of Geriatrics, University Hospital Basel, Switzerland
  5. 5Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
  6. 6Department of Geriatrics, Inselspital and Spital Netz Bern Ziegler, University of Bern, Switzerland
  7. 7Department of Rheumatology, Triemli Hospital, Zurich, Switzerland
  8. 8Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
  9. 9Hebrew Senior Life Institute for Aging Research, Harvard Medical School, Boston, MA, USA
  1. Correspondence to: H A Bischoff-Ferrari, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland heike.bischoff{at}usz.ch
  • Accepted 19 June 2009

Abstract

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 fall 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=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% (pooled relative risk (RR) 0.81, 95% CI 0.71 to 0.92; n=1921 from seven trials), whereas achieved serum 25(OH)D concentrations of 60 nmol/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 low dose supplemental vitamin D (pooled RR 1.10, 95% CI 0.89 to 1.35; n=505 from two trials) or by achieved serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l (pooled RR 1.35, 95% CI 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 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 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 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.

Footnotes

  • Contributors: All authors contributed to the conception and design of the study and interpretation of data. The analysis was performed by HAB-F and JH, with methodological support by JEO, DPK, and JBW. HAB-F drafted the manuscript with input from all authors. The approval of the final version of the manuscript was given by all co-authors. HAB-F acts as guarantor.

  • Funding: This project was funded by a Swiss National Foundations Professorship Grant (PP00B-114864), the Velux Foundation, the Baugarten Foundation, the Vontobel Foundation, and a fellowship from the Robert Bosch Foundation. DPK was funded by the National Institute on Aging (grant P01 AG004390).

  • Sponsors: No sponsors participated in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

  • Competing interests: None declared.

  • In order to ensure compliance with the National Institutes of Health policy, all US authors retain the rights to: provide a copy of the authors’ final manuscript, including all modifications from the publishing and peer review process, to the National Library of Medicine’s PubMed Central database at the time the manuscript is accepted for publication; authorise the NIH to make such copy of the manuscript available in digital form for public access in PubMed Central no later than 12 months after publication; prepare derivative works from the manuscript; authorise others to make any use of the manuscript provided that it is not sold for a profit and that the author receives credit as author and the journal in which the manuscript has been published is cited as the source of first publication; and distribute copies of the manuscript in connection with teaching and research by the author and by the author’s employer.

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