Authors’ reply to Seemungal and Bolland and colleaguesBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3006 (Published 01 June 2016) Cite this as: BMJ 2016;353:i3006
- Edgar R Vieira, assistant professor and graduate program director On behalf of the authors
We agree with Seemungal that vertigo is a well known risk for falls—for example, odds ratio 1.81 2 3—and that benign paroxysmal positional vertigo (BPPV) causes balance impairment and can lead to falls. While symptomatic patients are often seen initially in primary care, diagnostic studies, including the Dix-Hallpike manoeuvre, and particularly treatment approaches, including the Epley manoeuvre, are often best performed by specialists in secondary or tertiary care.4 Currently, systematic screening for asymptomatic BPPV in all community dwelling older adults who have experienced a fall is not included in multifactorial interventions shown to be effective for falls (US Preventive Services Task Force (USPSTF) recommendations, National Institute for Health and Care Excellence (NICE) guidance, Cochrane reviews). Research is needed to optimise the clinical evaluation and management of BPPV in symptomatic and asymptomatic older people by general practitioners and geriatricians in the context of falls.
As Bolland and colleagues state, major methodological differences and the varying results in different population subsets make it difficult to synthesise evidence and make broad conclusions about the impact of vitamin D supplements on the risk of falls.5 However, investigation of the effect of vitamin D supplementation on health outcomes remains a fruitful area of research, with novel findings constantly being added to the literature base. Our review listed important studies that provide major support for current recommendations (American Geriatrics Society/British Geriatrics Society, USPSTF, Cochrane reviews) for vitamin D supplementation in the prevention of falls, although not all organisations (NICE 2013) support such an approach. Controversy and unanswered questions remain and will hopefully be addressed as new evidence becomes available.
Competing interests: None declared.