Questioning vitamin D status of elderly fallers and non-fallers:
a meta-analysis to address a ‘forgotten step’
Journal of Internal Medicine. DOI: 10.1111/joim.12250
Cedric Annweiler 1,2,* and Olivier Beauchet 1,3
Previous meta-analyses to determine the efficacy of vitamin D supplementation to prevent falls in the elderly have shown mixed results. Inconsistencies might depend on the dose of supplements, suggesting that serum 25-hydroxyvitamin D (25OHD) concentration could influence the risk of falling. Our objective was to systematically review and quantitatively analyse the relationship between serum 25OHD concentration and the occurrence of falls.
A Medline search was conducted in December 2013, with no date limit, using the Medical Subject Heading terms ‘Vitamin D’ OR ‘Ergocalciferols’ OR ‘Vitamin D deficiency’ combined with ‘Accidental Falls’ OR ‘Gait disorders, neurologic’ OR ‘Gait apraxia’ OR ‘Gait’ OR ‘Recurrent Falls’ OR ‘Falling’. Fixed and random-effects meta-analyses were performed to determine (i) the effect size of the difference in 25OHD concentration between fallers and non-fallers and (ii) the risk of falling according to serum 25OHD concentration.
Of the 659 retrieved studies, 18 observational studies – including ten cross-sectional and eight cohort studies – met the selection criteria. All were of good quality. The number of participants ranged from 80–2957 (44–100% women); 11.0% to 69.3% were fallers. Serum 25OHD concentrations were 0.33 x SD lower in fallers compared to non-fallers [pooled effect size 0.33; 95% confidence interval (CI) 0.18–0.47]. The risk of falls was inversely associated with serum 25OHD concentration [summary odds ratio (OR) 0.97; 95% CI 0.96–0.99]. The association between falls and hypovitaminosis D varied according to the definition used; the summary OR for falls was 1.23 (95% CI 0.94–1.60) for 25OHD <10 ng/mL, 1.44 (95% CI 1.17–1.76) for 25OHD <20 ng/mL and 0.95 (95% CI 0.81–1.11) for 25OHD <30 ng/mL.
Fallers have lower 25OHD concentrations, notably more often <20 ng/mL, than non-fallers.
These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls.
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