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Vertigo treated by Vitamin D - many studies



Those still dizzy after BPPV treatment were 5.5 X more likely to have low vitamin D – June 2022

Low 25-Hydroxyvitamin D Levels Are Associated With Residual Dizziness After Successful Treatment of Benign Paroxysmal Positional Vertigo
Front Neurol. 2022 Jun 22;13:915239. doi: 10.3389/fneur.2022.915239. eCollection 2022.
Yunqin Wu 1, Kun Han 1, Weiwei Han 2, Zhenyi Fan 1, Min Zhou 1, Xiaoxiong Lu 1, Xiaoxia Liu 1, Li Li 1, Liwen Du 3

Objective: Vitamin D (Vit D) regulates calcium and phosphate metabolism and helps to maintain otolith organ function. Residual dizziness (RD) is one of the most common complications after the successful treatment of benign paroxysmal positional vertigo (BPPV). Various theories have been suggested to explain the cause of RD, and otolith organ disorder is the most evident cause of RD. This study aimed to investigate the association between serum levels of Vit D and the occurrence of RD after the successful treatment of BPPV.

Methods: A prospective study including patients who were diagnosed with de novo posterior semicircular canal-type BPPV (PC-BPPV) was conducted at our institution from May 2017 to May 2019. All the patients underwent canalith repositioning procedures and were followed up. Univariate and multivariate analyses were performed to investigate the relationship between serum 25-hydroxy vitamin D (25(OH)D) levels and RD occurrence after successful BPPV treatment.

Results: In total, 123 patients with PC-BPPV were enrolled, and 41.5% (51/123) experienced RD. The serum level of 25(OH)D was significantly lower in PC-BPPV patients with RD [median 16.2 ng/ml (IQR 12.9-22.1)] than in patients without RD [median 20.5 ng/ml (IQR 16.5-26.5)] (P = 0.001). In multivariate models comparing the prevalence of RD in the insufficient group [25(OH)D ≥ 20 to <30 ng/ml], deficient group [25(OH)D < 20 ng/ml] and normal group [25(OH)D ≥ 30 ng/ml], the 25(OH)D levels in the deficient group were associated with the occurrence of RD (odds ratio = 5.48, 95% confidence interval = 1.08-27.71; P = 0.04).

Conclusion: Low 25(OH)D levels are associated with the development of RD in patients with PC-BPPV after successful treatment. Further efforts to validate and elucidate the mechanism are needed.
 Download the PDF from VitaminDWiki

BPPV substantially reduced if raise Vitamin D levels – Aug 2021

Relation between vitamin D deficiency and benign paroxysmal positional vertigo
Sci Rep. 2021 Aug 19;11(1):16855. doi: 10.1038/s41598-021-96445-x.
Aida Ahmed Abdelmaksoud 1, Dalia Fahim Mohammed Fahim 2, Shamardan Ezzeldin Sayed Bazeed 3, Mohamed Farouk Alemam 4, Zaki Farouk Aref 5
 Download the PDF from VitaminDWiki


Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. To assess the relation between recurrent attacks BPPV and Vitamin D deficiency. A case control study in which 40 patients were clinically diagnosed as posterior canal BPPV, Serum 25(OH) D was measured at 1st visit. Patients were divided into two groups; group A (20 patients) received Vitamin D supplementation in addition to canal repositioning maneuver and group B (20 patients) treated by canal repositioning maneuver only. Follow up of all patients for 6 months, neuro-otological assessment was repeated and recurrent attacks were recorded. Serum vitamin D was repeated after 6 month. This study included 14 males and 26 females age ranged from 35 to 61 years, Average serum of 25 (OH) D at the first visit was (12.4 ± 2 ng/ml) for group A, and (12.2 ± 1.7 ng/ml) for group B, all patients had low serum level of 25(OH) D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. There is a relation between BPPV recurrence and low serum Vitamin D.
Vitamin D intervention - clipped from PDF
Vitamin D status was classifed according to measured 25(OH) D concentration:
less than 10 ng/mL: defcient;
between 11 and 20: insufcient;
For patients with insufciency and defciency serum level and no history of nephrolithiasis,
Vitamin D supplement was given in regimen of cholecalciferol
8000 IU daily for 2 weeks followed by 4000 IU daily for 2 weeks then 8000 IU single dose weekly for 3 months 31

''Note:This dosing schedule did not raise Vitamin D levels very much, much more is needed'


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Vertigo associated with low vitamin D, supplementation reduced relapse (PDF costs $36) - Nov 2021

The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV)
Am J Otolaryngol . 2021 Jun 19;42(6):103134. doi: 10.1016/j.amjoto.2021.103134
Mohamed Mohamed Elmoursy 1, Awad Saad Abbas 2

Background: Benign paroxysmal positional vertigo is characterized as brief episodes of vertigo that are exacerbated by the unexpected act of moving to a current provoking location. It is thought to be an otoconia-related balance disorder. Our objectives were to assess the serum concentrations of vitamin D and calcium (total and ionized) in cases with BPPV, determine if low vitamin D levels were regarded as a cause for BPPV relapse, and determine whether vitamin D supplementation would minimize the risk of BPPV relapse.

Results: Sixty cases with BPPV were included in the study; 53 cases had posterior canal BPPV, while seven had lateral canal BPPV. Canalithiasis was the most common type of BPPV pathology. Forty cases had abnormally low levels of vitamin D. There was a statistically significant positive correlation between the mean vitamin D assay for all cases with BPPV and serum calcium. There was statistically significant difference in comparing the relapse of BPPV for group that receive vitamin D after one year follow up.

Conclusion: Abnormal vitamin D levels were linked with the incident and relapse of BPPV.
Correction of low vitamin D levels was linked with the reduction of the relapse of BPPV

BPPV somewhat reduced by just 800 IU of Vitamin D + Calcium - RCT Aug 2020

Prevention of Benign Paroxysmal Positional Vertigo with Vit D Supplementation: A Randomized Trial
DOI: https://doi.org/10.1212/WNL.0000000000010343
Overview and some details on Medscape no placebo, just a control group

  • "The dislodgment of particles in the ears called otoconia is thought to initiate these attacks."
  • "The number of recurrences per one-person year was 0.83 in the intervention group and 1.10 in the observation group. This yielded an incidence rate ratio (IRR) of 0.76 and a reduction in the annual recurrence rate of 0.27 with supplementation. The preventive effect was even more pronounced among patients with decreased serum vitamin D of less than 20 ng/mL at baseline."
  • "Among treated patients, serum vitamin D levels increased from 13.3 ng/mL at baseline to 24.4 ng/mL at 2 months and 24.2 ng/mL at 1 year."
    • Note by VitaminDWiki - clearly the RCT should have used larger doses (to get > 30 ng)

BPPV has many risk factors, low Vitamin D is one of them – Meta-analysis Aug 2020

Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis
Review J Neurol. 2020 Aug 24. doi: 10.1007/s00415-020-10175-0
Jinbao Chen 1, Senlin Zhang 2, Kai Cui 2, Chuxuan Liu 3
 Download the PDF from sci-hub via VitaminDWiki

Background and purpose: Benign paroxysmal positional vertigo is one of the most common vestibular diseases, especially in the elderly. Although the treatment of BPPV is relatively successful, many patients suffer recurrence after treatment. Therefore, identifying potential risk factors for BPPV recurrence may help improve treatment outcome and patient prognosis. However, some related risk factors for BPPV recurrence are relatively controversial and poorly studied. This meta-analysis aims to identify potential risk factors associated with BPPV recurrence, thereby reducing the recurrence rate of BPPV and improving the prognosis of patients.

Methods: This meta-analysis was conducted through systematically searching PubMed, Embase, and the Cochrane Library for eligible English original studies published up to June 2020. All search results were reviewed based on our inclusion and exclusion criteria. We calculated the pooled odds ratios (ORs) or the mean differences (MDs) with their corresponding 95% confidence intervals (CIs) to evaluate the effects of included risk factors on BPPV recurrence.

Results: A total of 14 studies involving 3060 BPPV patients published between 2010 and 2019 were finally included, including six prospective studies and eight retrospective studies, with a NOS score ranged from 6 to 9. Our pooled results of this meta-analysis suggested that the recurrence of BPPV was closely related to

  • female gender (OR = 1.42; 95% CI 1.17-1.74; P = 0.0004),
  • hypertension (OR = 2.61; 95% CI 1.22-5.59; P = 0.01),
  • diabetes mellitus (OR = 2.62; 95% CI 1.25-5.48; P = 0.01),
  • hyperlipidemia (OR = 1.60; 95% CI 1.23-2.09; P = 0.0006),
  • osteoporosis (OR = 1.72; 95% CI 1.03-2.88; P = 0.04) and
  • vitamin D deficiency (MD = - 3.29; 95% CI - 5.32 to - 1.26; P = 0.001).

Conclusion: This meta-analysis indicated that female gender, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency were risk factors for BPPV recurrence. However, the effects of other potential risk factors including advanced age, migraine, head trauma, and Menière's disease on BPPV recurrence need further investigations. Furthermore, most studies included in this meta-analysis were performed in Asia, so our results cannot easily be extended to the whole world population. Therefore, more large-scale prospective studies in different countries are required to further investigate these risk factors.

BPPV 2X more likely if low Vitamin D - meta-analysis of 18 studies Jan 2020

Association Between Serum Vitamin D Levels and Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis of Observational Studies
Eur Arch Otorhinolaryngol, 277 (1), 169-177 Jan 2020, PMID: 31630244 DOI: 10.1007/s00405-019-05694-0
Baiyuan Yang 1, Yongxia Lu 2, Dongmei Xing 3, Wei Zhong 1, Qing Tang 1, Jingyu Liu 2, Xinglong Yang 4

Objective: Benign paroxysmal positional vertigo (BPPV) was the most common neuro-otological disorder manifests as recurrent positional vertigo, but its risk factors are elusive. Recent studies suggest that decreased Vitamin D level may be a risk factor, but the literature is inconsistent.

Methods: The databases PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and Embase were systematically searched for studies on the association between BPPV and serum Vitamin D levels published up to June 2019. Data from eligible studies were meta-analyzed using Stata 12.0.

Results: A total of 18 studies were included in the analysis. Serum Vitamin D levels were significantly lower in individuals with BPPV than in controls (WMD - 2.46, 95% CI - 3.79 to - 1.12, p < 0.001). Subgroup analysis by geographical area showed that vitamin D level was significantly lower in BPPV than in controls in China (WMD - 3.27, 95% CI - 4.12 to - 2.43, p < 0.001), but not outside China (WMD - 0.90, 95% CI - 4.36 to 2.56, p = 0.611). Vitamin D levels were significantly lower in recurrent than non-recurrent BPPV across all countries in the sample (WMD 2.59, 95% CI 0.35-4.82, p = 0.023). Vitamin D deficiency emerged as an independent risk factor of BPPV (OR 1.998, 95% CI 1.400-2.851, p < 0.001).

Conclusion: The available evidence suggests that BPPV is associated with decreased levels of serum Vitamin D, and vitamin D deficiency was an independent risk factor for BPPV.

BPPV eliminated by Vitamin D – April 2019

Vitamin D deficiency and benign paroxysmal positioning vertigo
Journal of Hearing, Balance, and Communication doi.org/10.1080/21695717.2019.1590988
Pedro Jorge Matos Carneiro de Sousa, Diogo Manuel Abreu Pereira, Pedro Carneiro Melo Pereira de Magalhães, Delfim Rui da Silva Duarte & Nuno Maria Trigueiros da Silva Cunha
 Download the PDF from Sci-Hub via VitaminDWiki
Treatment group - NO Vertigo

Objectives: Benign paroxysmal positioning vertigo (BPPV) has significant recurrence rates, mainly in older patients. The etiopathology of recurrent BPPV is possibly related to low serum vitamin D levels. Finding a therapeutic weapon will help with these complicated cases, reducing disability, falling risk and also health care costs.

Study design: Clinical trial: one-year duration.

Setting: Ten patients with diagnosis of BPPV made by history and physical examination and at least two episodes of documented BPPV in the previous two years and chronic complaints of dizziness. Neurologic and other otological diseases were excluded for these patients.

Subjects and methods: Vitamin D was evaluated by measuring serum 25-hydroxyvitamin D (25-OHD). Levels below 20 ng/mL were considered deficiency and levels between 20 and 30 ng/mL were considered insufficiency. Half of the patients (treatment group) started a treatment with cholecalciferol while the remaining patients were the control group. All of the patients were reevaluated every three months.

Results: All patients of the treatment group did not have any subsequent episode of positional vertigo, dizziness complaints or nystagmus evoked by provocative manoeuvers. At reevaluations, the mean value of serum 25-OHD for the treatment group had increased noticeably. It was also significantly higher than the mean value of control group. All patients of control group had positional vertigo episodes, as well as positional nystagmus at office reevaluations.

Conclusion: These results support the need to systematically measure and correct vitamin D levels in patients with recurrent BPPV.

BPPV Meta-analysis found no association with low vitamin D in the blood- Oct 2018

Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis
https://doi.org/10.1007/s00405-018-5146-6 7 studies

Conclusion: "Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV."

VitaminDWiki: Meta-analysis seems to ignore the possibility that there is an OK level of vitamin D in the blood, and that Vitamin D is not getting to the cells of the ear due to poor gene activation.

Calcium Carbonate crystals in ear decrease in elderly with low Vit D - April 2018

A Relationship Between Blood Levels of Otolin-1 and Vitamin D

  • "There was a negative correlation between vitamin D and otolin-1 levels of subjects over 70 (r = -0.36, p = 0.036)."
  • CONCLUSION: "Our results demonstrate a relationship between vitamin D and otolin-1. The majority of our subjects had abnormally low vitamin D levels, but only those over 70 years of age showed a negative correlation with high otolin-1 levels. We postulate that a seasonal drop in vitamin D may not be sufficient for otoconia fragmentation and ultimately iBPPV, rather, chronically low vitamin D maybe required to induce otoconia degeneration."
    DOI: 10.1097/MAO.0000000000001747

BPPV 23X more likely if vitamin D deficient - Oct 2012

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo - Oct 2012
J Neurol. 2012 Oct 25.
Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y.
Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea.

Previous studies have demonstrated an association of osteopenia/osteoporosis with idiopathic benign paroxysmal positional vertigo (BPPV). Since vitamin D takes part in the regulation of calcium and phosphorus found in the body and plays an important role in maintaining proper bone structure, decreased bone mineral density in patients with BPPV may be related to decreased serum vitamin D. We measured the serum levels of 25-hydroxyvitamin D in 100 patients (63 women and 37 men, mean age ± SD = 61.8 ± 11.6) with idiopathic BPPV and compared the data with those of 192 controls (101 women and 91 men, mean age ± SD = 60.3 ± 11.3) who had lived in the same community without dizziness or imbalance during the preceding year. The selection of the controls and acquisition of clinical information were done using the data from the Fourth Korean National Health and Nutrition Examination Survey, 2008.
The serum level of 25-hydroxyvitamin D was lower in the patients with BPPV than in the controls (mean ± SD = 14.4 ± 8.4 versus 19.1 ± 6.8 ng/ml, p = 0.001). Furthermore, patients with BPPV showed a higher prevalence of decreased serum vitamin D (<20 ng/ml, 80.0 vs. 60.1 %, p < 0.001) than the controls.

Multiple logistic regression analyses adjusted for age, sex, body mass index, hypertension, diabetes, proteinuria, regular exercise and the existence of decreased bone mineral density demonstrated that vitamin D insufficiency (10-20 ng/ml) and deficiency (<10 ng/ml) were associated with BPPV with the odds ratios of 3.8 (95 % confidence interval = 1.51-9.38, p = 0.004) and 23.0 (95 % confidence interval = 6.88-77.05, p < 0.001). Our study demonstrated an association between idiopathic BPPV and decreased serum vitamin D. Decreased serum vitamin D may be a risk factor of BPPV.

PMID: 23096068

VitaminDWiki comment: Perhaps additional possible suspects are low Magnesium and low Vitamin K2

BPPV reduced 5 X by 50,000 IU of vitamin D every 2 weeks - 2016

The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: A case-control study.
Caspian J Intern Med. 2016 Summer;7(3):173-177.
Sheikhzadeh M1, Lotfi Y1, Mousavi A2, Heidari B3, Bakhshi E4.


Trial lasted only 8 weeks
Can anticipate much better results if the trial had lasted for 12-16 weeks
Note: Since the average got to 34 ng, we can anticipate that about 40% < 30 ng level of vitamin D
Typically little benefit from vitamin D if < 30 ng

 Download the PDF from VitaminDWiki

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a condition with recurrent attacks in a significant proportion of patients. The present case- control study was conducted to assess the influence of serum vitamin D normalization on recurrent attacks of vitamin D deficient patients.

METHODS: Diagnosis of BPPV was made based on history and clinical examination and exclusion of other conditions. Serum 25-hydroxy vitamin D (25-OHD) was measured using ELISA method and a levels of < 20 ng/ml was considered a deficiency of vitamin D. Inclusion criteria were as follows: history of recurrent attacks and serum 25-OHD<20.ng/ml. While the patients with history of trauma, surgery and chronic systemic diseases were excluded. The patients were classified into two groups: treatment and control, intermittently. Both groups received Epley rehabilitation therapy one session per week for 4 weeks but the treatment group received an additional supplement of 50.000 IU of vitamin D (cholecalciferol) weekly for two months to achieve serum 25-OHD ≥ 30 ng/ml and the study patients were followed-up for 6 months.

RESULTS: Twenty-seven patients were allocated to each group. At baseline, serum 25-OHD was similar (10.7±2.3 vs 11.41±1.9, P=0.23). At month 2, serum 25-OHD in the treatment group increased significantly to ≥ 30 ng/ ml, whereas serum 25-OHD in the control group remained unchanged (34.2±3.3 vs 10.6 10.6±2.2 ng/ml, P=0.001). During the follow-up period, attacks of BPPV in the treatment group decreased significantly compared with the control group (14.8% vs 96.3% OR= 0.18, P=0.001).

CONCLUSION: The findings of this study indicate that the normalization of serum vitamin D significantly reduces BPPV recurrences.

PMID: 27757201 PMCID: PMC5062174

BPPV 2.1 X more likely if low vitamin D - Dec 2017

Note: the 2012 study looked at benign paroxysmal positional vertigo
Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo Dec 2017
10.1080/00016489.2017.1416168     PDF from Sci-Hub via VitaminDWiki

BPPV much more common with low vitamin D - Oct 2016

Serum vitamin D and recurrent benign paroxysmal positional vertigo.
Laryngoscope Investig Otolaryngol. 2016 Oct 20;1(6):150-153. doi: 10.1002/lio2.35. eCollection 2016 Dec.
Rhim GI1.

OBJECTIVES: The objective of the present study was to examine the effects of serum 25-hydroxyvitamin D concentrations on patients diagnosed with benign paroxysmal positional vertigo (BPPV) on BPPV recurrence.

STUDY DESIGN: Case series.

METHODS: A retrospective review of 232 patients diagnosed with BPPV visiting the clinic between June 2014 and June 2015 was performed. All patients underwent a complete otolaryngological, audiologic, and neurologic evaluation. The appropriate particle-repositioning maneuver was performed depending on the type of BPPV. The patients were divided into the recurrence group and the nonrecurrence group. Age, gender, follow-up period, type of BPPV, and vitamin D concentrations in the two groups were compared and analyzed through binary logistic regression analyses.

RESULTS: The average follow-up period after treatment was 10.2 months. Forty-one (17.7%) of 232 patients suffered a recurrence during the follow-up period. The mean vitamin D concentration of 191 patients who did not suffer any recurrence was 16.63 ng/mL, whereas that of 41 patients who suffered a recurrence was 13.64 ng/mL. This difference in vitamin D concentrations was statistically significant (P < 0.019). The patients' age, gender, follow-up period, and type of BPPV had no statistically significant impact.

CONCLUSION: Vitamin D is assumed to affect BPPV as a recurrence factor independent of age, gender, follow-up period, and type of BPPV.


PMID: 28894811 PMCID: PMC5510269 DOI: 10.1002/lio2.35
 Download the PDF from VitaminDWiki

Possible reasons for association - clipped from PDF
"The authors (of another study) presented two mechanisms of the relationships between BPPV and osteopenia or osteopenia

  • First, the decrease of estrogen in reducing the natural regulators of bone mass might disturb the internal structure of the otoconia and/or their interconnection and attachment to the gelatinous matrix.
  • Second, an increase of calcium resorption might generate increased concentration of free calcium in the endolymph and reduce its capacity to dissolve the dislodged otoconia."

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Created by admin. Last Modification: Tuesday July 12, 2022 11:25:31 GMT-0000 by admin. (Version 56)

Attached files

ID Name Comment Uploaded Size Downloads
18085 BPPV sci-hub.pdf admin 12 Jul, 2022 11:23 677.13 Kb 128
18084 Benign Paroxysmal Positional Vertigo - 5X still dizzy if low Vitamin D.pdf PDF 2022 admin 12 Jul, 2022 11:15 286.78 Kb 137
16118 BPPV table.jpg admin 21 Aug, 2021 12:48 16.49 Kb 1401
16117 BPPV.jpg admin 21 Aug, 2021 12:47 31.49 Kb 1503
16116 benign paroxysmal positional vertigo.pdf PDF 2021 admin 21 Aug, 2021 12:47 834.05 Kb 356
14217 Vertigo meta-analysis sci-hub.pdf PDF 2020 admin 26 Aug, 2020 14:31 3.15 Mb 741
11919 Control group.jpg admin 08 May, 2019 13:52 20.99 Kb 6647
11918 Vertigo treatment.jpg admin 08 May, 2019 13:51 19.21 Kb 7101
11917 Vertigo 2019.pdf PDF 2019 admin 08 May, 2019 13:51 554.11 Kb 959
9008 BPPV 50,000 IU.pdf admin 24 Dec, 2017 13:02 193.19 Kb 1068
9007 BPPV Oct 2016.pdf admin 24 Dec, 2017 12:43 82.43 Kb 1290