Common cause of dizziness (BPPV) reduced 5 X by several doses of 50,000 IU of vitamin D – 2015, 2016

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BPPV risk factors include Low Vitamin D, Migraine, Head Trauma, and Osteoporosis - June 2022

Risk Factors for the Occurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis
Front. Neurol., Sec. Neuro-Otology Vol 11 - 2020 | https://doi.org/10.3389/fneur.2020.00506
Jinbao Chen1 Weisong Zhao1 Xuejing Yue2* Ping Zhang3*

Background and Purpose: The lifetime prevalence of benign paroxysmal positional vertigo (BPPV) is high, especially in the elderly. Patients with BPPV are more susceptible to ischemic stroke, dementia, and fractures, severely reducing quality of life of patients. Many studies have analyzed risk factors for the occurrence of BPPV. However, the results of these studies are not identical. We performed this meta-analysis to determine potential risk factors associated with the occurrence of BPPV.

Methods: PubMed, EMBASE, and the Cochrane Library (January 2000 through March 2020) were systematically searched for eligible studies analyzing risk factors for the occurrence of BPPV. Reference lists of eligible studies were also reviewed. We selected observational studies in English with a control group and sufficient data. Pooled odds ratios (ORs) or the mean differences (MDs) and 95% confidence intervals (CIs) were calculated to measure the impacts of all potential risk factors. Heterogeneity among studies was evaluated using the Q-test and I2 statistics. We used the random-effect model or the fixed-effect model according to the heterogeneity among the included studies.

Results: We eventually included 19 studies published between 2006 and 2019, including 2,618 patients with BPPV and 11,668 participants without BPPV in total. In this meta-analysis, the occurrence of BPPV was significantly associated with female gender (OR = 1.18; 95% CI, 1.05–1.32; P = 0.004), serum vitamin D level (MD = −2.12; 95% CI, −3.85 to −0.38; P = 0.02), osteoporosis (OR = 2.49; 95% CI, 1.39–4.46; P = 0.002), migraine (OR = 4.40; 95% CI, 2.67–7.25; P < 0.00001), head trauma (OR = 3.42; 95% CI, 1.21–9.70; P = 0.02), and total cholesterol level (MD = 0.32; 95% CI, 0.02–0.62; P = 0.03).

Conclusion: Female gender, vitamin D deficiency, osteoporosis, migraine, head trauma, and high TC level were risk factors for the occurrence of BPPV. However, the effects of other risk factors on BPPV occurrence need further investigations.
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Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review - Aug 2022

Otology & Neurotology, Vol 43, # 7, 1 Aug 2022, pp. e704-e711(8) https://doi.org/10.1097/MAO.0000000000003586
Hong, Xinyuan 1 ; Christ-Franco, Marina 2 ; Moher, David; Tse, Darren; Lelli, Daniel A. 3 ; Schramm, David; Caulley, Lisa; Kontorinis, Georgios 4 ;

Benign paroxysmal positional vertigo (BPPV) is commonly attributed to displaced otoconia. These have been shown to have biomineralization close to that of bone, and vitamin D deficiency has been associated with BPPV. We aim to systematically review the available literature on vitamin D supplementation and BPPV intensity and recurrence in adults.

Databases Reviewed
PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials, and ClinicalTrials.gov.

Methods
We systematically reviewed the available literature from 1947 to April 2020. The study protocol was registered in the PROSPERO database (trial registration: CRD42020183195).

Results
A total of 179 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, six studies were selected and subjected to a quality assessment. In one randomized clinical trial (RCT), vitamin D supplementation was found to reduce annual recurrence rate of vertigo in patient with BPPV and subnormal serum vitamin D levels compared with placebo (odds ratio, 0.69; 95% confidence interval, 0.54–0.90). Non-RCTs demonstrated the possibility of a null effect in the random effects model (odds ratio, 0.08; 95% confidence interval, 0.00–1.56). The RCT considered as low risk of bias. All of the nonrandomized studies were assessed as serious risk of bias.

Conclusions
The intervention studies identified consistently demonstrated a decrease in BPPV recurrence with supplementation of vitamin D in patients with subnormal vitamin D levels. Although there is a paucity of high-quality studies, the present literature does highlight a role for optimization of vitamin D levels in patients with BPPV.

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BPPV treated by low dose Vitamin D plus Ca - RCT Sept 2022

Prevention of benign paroxysmal positional vertigo with vitamin D supplementation - A randomized trial
Neurology DOI: https://doi.org/10.1212/WNL.0000000000010343
Seong-Hae Jeong, View ORCID ProfileJi-Soo Kim, Hyo-Jung Kim, Jeong-Yoon Choi, Ja-Won Koo, Kwang-Dong Choi, Ji-Yun Park, Seung-Han Lee, Seo-Young Choi, Sun-Young Oh, Tae-Ho Yang, Jae Han Park, Ileok Jung, Soyeon Ahn, Sooyeon Kim

Objective To assess the effect of vitamin D and calcium supplementation in preventing recurrences of benign paroxysmal positional vertigo (BPPV).

Methods We performed an investigator-initiated, blinded-outcome assessor, parallel, multicenter, randomized controlled trial in 8 hospitals between December 2013 and May 2017. Patients with confirmed BPPV were randomly assigned to the intervention (n = 518) or the observation (n = 532) group after successful treatment with canalith repositioning maneuvers. The primary outcome was the annual recurrence rate (ARR). Patients in the intervention group had taken vitamin D 400 IU and 500 mg of calcium carbonate twice a day for 1 year when serum vitamin D level was lower than 20 ng/mL. Patients in the observation group were assigned to follow-ups without further vitamin D evaluation or supplementation.

Results The intervention group showed a reduction in the ARR (0.83 [95% confidence interval (CI), 0.74–0.92] vs 1.10 [95% CI, 1.00–1.19] recurrences per 1 person-year) with an incidence rate ratio of 0.76 (95% CI, 0.66–0.87, p < 0.001) and an absolute rate ratio of −0.27 (−0.40 to −0.14) from intention-to-treat analysis. The number needed to treat was 3.70 (95% CI, 2.50–7.14). The proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs 46.7%, p = 0.005).

Conclusions Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.

Classification of evidence This study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV.

Glossary
BPPV=benign paroxysmal positional vertigo; CI=confidence interval; IRR=incidence rate ratio; NNT=number needed to treat; UCLA-DQ=University of California Los Angeles Dizziness Questionnaire

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BPPV reduced 4.5 X by Vitamin D: loading dose then 100,000 monthly - 2015

Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency - 2015
Auris Nasus Larynx, Available online 16 September 2015. doi:10.1016/j.anl.2015.08.009
Hossam Sanyelbhaa Talaata, Sanyelbhaa at yahoo.com , Abdel-Magied Hasan Kabela, 1, Lobna Hamed Khalielb, 2, Ghada Abuhadiedc, 3, Heba Abd El-Rehem Abo El-Nagad, 4, Ahmed Sanyelbhaa Talaate, 5

Objective: Several studies correlated between vitamin D deficiency and the development, and the recurrence of benign positional paroxysmal vertigo (BPPV), but none of them proved that treatment of vitamin D deficiency would reduce the recurrence rate of BPPV. This study aims to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV.

Methods: The inclusion criteria of the study group were: (1) Unilateral, idiopathic, posterior canal BPPV with no history suggestive of secondary BPPV and (2) 25-hydroxyvitamin D3 level ≤10 ng/ml. All subjects enrolled in the current study underwent detailed clinical history, audiovestibular evaluation consisting of pure-tone audiometry, Immittancemetry, Videonystugmography, serum 25-hydroxyvitamin D3 assessment, and Dual-energy X-ray absorptiometry (DXA). Vitamin D therapy was prescribed for the study group. Serum 25-hydroxyvitamin D3 level was evaluated twice, on recruitment into the study group and 3 months after commencing vitamin D therapy. According to the results of the second evaluation of serum 25-hydroxyvitamin D3, the study group was subdivided into two subgroups: Subgroup (I): including 28 subjects who disclosed elevation of serum 25-hydroxyvitamin D3 level; improvement ≥10 ng/ml. Subgroup (II): including 65 patients who disclosed elevation of serum 25-hydroxyvitamin D3 levels <10 ng/ml. The study group was followed up for 18 months in order to observe the recurrence of BPPV.

Results: The differences between both study subgroups (I) & (II) regarding age, sex distribution, and bone mineral density were insignificant. The number of subjects who had recurrence of BPPV in subgroup (I) was 4 (14%) versus 28 subjects (43%) in subgroup (II).
The mean values for recurrent attacks/subject in subgroups (I) & (II) were 0.18, and 0.66 attack/subject respectively; these differences between both subgroups were of high statistical significance (p < 0.01). The Odds Ratio for development of recurrence of BPPV in subjects with severe vitamin D deficiency was 4.54 (95% CI: 1.41–14.58, p < 0.01). The relapse attacks of BPPV affected both ears irrespective of the ear showing the original BPPV attack.

Conclusion: The present study indicates that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.
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BPPV reduced 5X by 50,000 IU of vitamin D - first weekly, then monthly - 2016

Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study
Caspian J Intern Med. 2016 Spring; 7(2): 93–98. PMCID: PMC4913711
Mahboobeh Sheikhzadeh, MSc,1 Yones Lotfi, MD,2,* Abdollah Mousavi, MD,3 Behzad Heidari, MD,4 Mohsen Monadi, MSc,5 and Enayatollah Bakhshi, PhD6

Background: Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV.

Methods: The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels < 20 ng/ml was considered a deficiency. All patients received rehabilitation treatment using Epley's maneuver one time per week for one month. Serum 25-OHD deficient patients were classified as treated and non-treated groups (rehabilitation with or without 50.000 IU cholecalciferol weekly for two months).The results of treatment were compared with vitamin D sufficient group as control. All patients were followed-up for 6 months.

Results: After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period.

Conclusion: This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV.

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Study described at Vitamin D Council