From Geriatrics Pharmacy Intern, Phuong Pham, PharmD(c)
University of Florida College of Pharmacy
Fall prevention in the elderly has become a public health goal since “each year, one in three individuals aged 65 years or older experiences at least one fall, with 9% of falls leading to an emergency room visit and 5-6% resulting in a fracture.” There have been debates on whether vitamin D can play a role in fall prevention, with some studies showing no benefits while others showing the importance of vitamin D on improving the strength, function, and balance of muscle tissues. Thus, a meta-analysis, which is, a combination of related studies used to draw a common conclusion, was performed to analyze whether vitamin D (in its active and supplemental form) with or without calcium was beneficial in older individuals in preventing falls.
They gathered eight randomized, clinical fall prevention studies that included individuals 65 years or older who were given either supplemental (in the form of D2 or D3) or the active form (1alpha-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3) of vitamin D. When people receive vitamin D from food, supplements, or the sun, it must undergo conversions in the body to its active form. The liver first converts vitamin D to 25-hydroxyvitamin D. The kidney then converts the previous product to the more physiologically active form, called 1,25-dihydroxyvitamin D. When the study looked at those taking high dose supplemental vitamin D (700-1000 IU/day), they found that these individuals had a 19% reduction in fall risk. Vitamin D is measured in international units (IU), which is an estimate of the biologically active substance that is required to produce a specific response. In addition, those who achieved a serum 25-hydroxyvitamin D [25(OH)D] concentrations of 60 nmol/l or more had a 23% fall reduction. Measuring the serum 25(OH)D is the best indicator of vitamin D concentration since it indicates the amount of vitamin D intake from food, supplements, and those produced from the skin. Patients taking less than 700 IU/day of vitamin D had no significant reduction in falls.
The study also found that taking the active form of vitamin D only had a fall risk reduction of 22%, which is not significantly greater than the supplemental form since the active form of vitamin D costs more and can put patients at risk for an elevated blood calcium level. The result of the study was not dependent on age, gender, or additional calcium supplementation. Results can be seen as early as two to five months after treatment, and can last beyond twelve months. The study’s authors concluded that “a daily intake of at least 700 IU supplemental vitamin D is warranted in all individuals age 65 and older.”
From Geriatrics Pharmacy Intern, Phuong Pham, PharmD(c)
University of Florida College of Pharmacy
Fall prevention in the elderly has become a public health goal since “each year, one in three individuals aged 65 years or older experiences at least one fall, with 9% of falls leading to an emergency room visit and 5-6% resulting in a fracture.” There have been debates on whether vitamin D can play a role in fall prevention, with some studies showing no benefits while others showing the importance of vitamin D on improving the strength, function, and balance of muscle tissues. Thus, a meta-analysis, which is, a combination of related studies used to draw a common conclusion, was performed to analyze whether vitamin D (in its active and supplemental form) with or without calcium was beneficial in older individuals in preventing falls.
They gathered eight randomized, clinical fall prevention studies that included individuals 65 years or older who were given either supplemental (in the form of D2 or D3) or the active form (1alpha-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3) of vitamin D. When people receive vitamin D from food, supplements, or the sun, it must undergo conversions in the body to its active form. The liver first converts vitamin D to 25-hydroxyvitamin D. The kidney then converts the previous product to the more physiologically active form, called 1,25-dihydroxyvitamin D. When the study looked at those taking high dose supplemental vitamin D (700-1000 IU/day), they found that these individuals had a 19% reduction in fall risk. Vitamin D is measured in international units (IU), which is an estimate of the biologically active substance that is required to produce a specific response. In addition, those who achieved a serum 25-hydroxyvitamin D [25(OH)D] concentrations of 60 nmol/l or more had a 23% fall reduction. Measuring the serum 25(OH)D is the best indicator of vitamin D concentration since it indicates the amount of vitamin D intake from food, supplements, and those produced from the skin. Patients taking less than 700 IU/day of vitamin D had no significant reduction in falls.
The study also found that taking the active form of vitamin D only had a fall risk reduction of 22%, which is not significantly greater than the supplemental form since the active form of vitamin D costs more and can put patients at risk for an elevated blood calcium level. The result of the study was not dependent on age, gender, or additional calcium supplementation. Results can be seen as early as two to five months after treatment, and can last beyond twelve months. The study’s authors concluded that “a daily intake of at least 700 IU supplemental vitamin D is warranted in all individuals age 65 and older.”