Risk of Frailty reduced 4X by 4,000 IU of vitamin D – RCT April 2022

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The effects of vitamin D supplementation on frailty in older adults at risk for falls

BMC Geriatrics volume 22, Article number: 312 (2022)
Yurun Cai, Amal A. Wanigatunga, Christine M. Mitchell, Jacek K. Urbanek, Edgar R. Miller III, Stephen P. Juraschek, Erin D. Michos, Rita R. Kalyani, David L. Roth, Lawrence J. Appel & Jennifer A. Schrack

Risks if initially had 20-29 ng level of vitamin D

Background
Low serum 25-hydroxyvitamin D [25(OH)D] level is associated with a greater risk of frailty, but the effects of daily vitamin D supplementation on frailty are uncertain. This secondary analysis aimed to examine the effects of vitamin D supplementation on frailty using data from the Study To Understand Fall Reduction and Vitamin D in You (STURDY).

Methods
The STURDY trial, a two-stage Bayesian, response-adaptive, randomized controlled trial, enrolled 688 community-dwelling adults aged ≥ 70 years with a low serum 25(OH)D level (10–29 ng/mL) and elevated fall risk. Participants were initially randomized to 200 IU/d (control dose; n = 339) or a higher dose (1000 IU/d, 2000 IU/d, or 4000 IU/d; n = 349) of vitamin D3. Once the 1000 IU/d was selected as the best higher dose, other higher dose groups were reassigned to the 1000 IU/d group and new enrollees were randomized 1:1 to 1000 IU/d or control group. Data were collected at baseline, 3, 12, and 24 months. Frailty phenotype was based on number of the following conditions: unintentional weight loss, exhaustion, slowness, low activity, and weakness (≥ 3 conditions as frail, 1 or 2 as pre-frail, and 0 as robust). Cox proportional hazard models estimated the risk of developing frailty, or improving or worsening frailty status at follow-up. All models were adjusted for demographics, health conditions, and further stratified by baseline serum 25(OH)D level (insufficiency (20–29 ng/mL) vs. deficiency (10–19 ng/mL)).

Results
Among 687 participants (mean age 77.1 ± 5.4, 44% women) with frailty assessment at baseline, 208 (30%) were robust, 402 (59%) were pre-frail, and 77 (11%) were frail. Overall, there was no significant difference in risk of frailty outcomes comparing the pooled higher doses (PHD; ≥ 1000 IU/d) vs. 200 IU/d. When comparing each higher dose vs. 200 IU/d, the 2000 IU/d group had nearly double the risk of worsening frailty status (HR = 1.89, 95% CI: 1.13–3.16), while the 4000 IU/d group had a lower risk of developing frailty (HR = 0.22, 95% CI: 0.05–0.97). There were no significant associations between vitamin D doses and frailty status in the analyses stratified by baseline serum 25(OH)D level.

Conclusions
High dose vitamin D supplementation did not prevent frailty. Significant subgroup findings might be the results of type 1 error.

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VitaminDWiki pages with FRAILITY in title (16 as of Sept 2022)

This list is automatically updated

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There Is No Magic Pill to Prevent Frailty—You Still Have to Eat Your Vegetables (nope) - Sept 2022

JAMA Open Network
"The Mediterranean diet has been shown to reduce incident frailty, with a pooled odds ratio of 0.44 for individuals who are most adherent to the diet."

• which is half as good as the odds ratio of 0.22 for the Vitamin D study on this page
• They state that Vitamin D does not work based on a study that used only 2,000 IU of vitamin D

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VitamaminDWiki - Falls and Fractures category

• 258 items in FALLS and FRACTURES
• Vitamin D and Calcium cost-effectively reduce falls and fractures – April 2019
• see also Overview Seniors and Vitamin D
  • Overview Fractures and Falls and Vitamin D
  • Overview Fractures and vitamin D
  • Muscles and Vitamin D - many studies

Falls

• Fall prevention - Vitamin D is one of the ways - umbrella review Jan 2024
• Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
• Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
• Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
• Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
  • Note: It took 6 months to get to that level. Most trials last only 3 months
• Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
• Falls reduced by Vitamin D: 13 percent reduction if more than 700 IU – review of 38 trials – Aug 2022

Left hand column section as of Nov 2024

Fracture

• Hip fractures are predicted by 10 factors – low Vitamin D is the biggest – Aug 2023
• Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
• Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
• Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
• 77+ Hip fracture items in VitaminDWiki title   Click here for details examples:
  • Risk of Hip fracture cut in half if Vitamin D was prescribed - Aug 2023
  • Call to action: Vitamin D to prevent of treat hip fracture (50,000 weekly for 8 weeks, then bi-weekly) – Holick July 2020

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See also VitaminDWiki

• 4,000 IU of Vitamin D - many pages