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BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2614 (Published 17 May 2010) Cite this as: BMJ 2010;340:c2614

Falls and fractures increase after high dose vitamin D

High doses of oral vitamin D may not be safe, say researchers, who found an excess of both falls (incidence rate ratio 1.15, 95% CI 1.02 to 1.30) and fractures (1.26, 1.00 to 1.59) in older women who took 500 000 international units (IU) once a year during a placebo controlled trial. The hazard looked greatest in the first three months after treatment, as serum concentrations of 25 hydroxycholecalciferol peaked before falling slowly for the rest of the year.

These women had a median age of 76, a median baseline concentration of 49 nmol/l, and a higher than average risk of fractures. They took their assigned treatment every autumn for three to five years, a practical regimen designed to offset the usual winter dip in vitamin D concentrations, and to improve adherence.

The extra falls and fractures were unexpected and hard to explain, although an editorial (p 1861) speculates that women given vitamin D might have had fewer infections, better mobility, and been more active during the winter than controls, paradoxically leading to more falls. The safety of annual high dose treatment needs further study. Meanwhile, doctors should stick to more traditional regimens using lower doses given daily, weekly, or monthly, says the editorial. Vitamin D deficiency remains widespread in this population and doctors should continue to treat it.

No evidence of worsening mental health in UK veterans of Afghanistan and Iraq

The mental health of UK armed forces is in reasonable shape despite prolonged operations in both Iraq and Afghanistan. A survey of 9990 regular service personnel and reservists from all three forces (response rate 56%) found a generally low prevalence of post-traumatic stress disorder (4%, 95% CI 3.5% to 4.5%) and no more symptoms of mental illness than respondents had reported in a similar survey between 2003 and 2005 (19.7%, 18.7% to 20.6%). Common mental illnesses such as anxiety and …

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