Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trialsBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7441.680 (Published 18 March 2004) Cite this as: BMJ 2004;328:680
All rapid responses
The three papers in this issue of BMJ on preventing falls in elderly
people [1-3] are interesting and indicate the seriousness of the problem.
While vitamin D and calcium are essential for proper development and
maintenance of the musculoskeletal condition [4,5], there appeared to be
only one reference to vitamin D in [1-3], that of  in , and it did
not find a beneficial effect for vitamin D supplementation. However,
another review through July 2003 by the author of  identified 3 trials
involving 461 participants tested with vitamin D supplementation, with or
without calcium .
There are a number of papers indicating that vitamin D, often with
calcium supplements, can reduce falls in elderly people [8-18]. Vitamin D
and calcium improve the condition of both bones and muscles, as does
exercise, and muscle strength and fitness may be as important in
preventing falls among the elderly as is bone density [8-11,15].
Those living in nursing homes generally have low serum 25-
hydroxyvitamin D (25(OH)D) status . Calcium and vitamin D
supplementation has been identified as a cost-effective way to reduce
falls among the elderly in a number of studies [20-28].
Ways to obtain vitamin D include diet , supplements [8,16,17,25],
injections , sunlight , and artificial ultraviolet B (UVB) [30-
32]. One or more of these approaches may be chosen depending on the
circumstances. However, dietary sources are generally insufficient to
bring serum 25(OH)D up to adequate levels to combat diseases such as
colorectal cancer . Further work is required to determine whether
different levels of 25(OH)D are optimal for different diseases. It was
recently determined that average levels of serum 25(OH)D appear to provide
more protection against prostate cancer than do either lower or higher
It is also noted that UVB and vitamin D are important risk reduction
factors for over a dozen types of internal cancers , as well as a host
of other diseases [37-41] including muscle pain , multiple sclerosis
[43,44], and high blood pressure .
In my opinion, "Sunshine is the best medicine."
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MJ, et al. Interventions for the prevention of falls in older adults:
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Competing interests: No competing interests