Medium doses of daily vitamin D decrease falls and higher doses of daily vitamin D3 increase falls: A randomized clinical trial.
J Steroid Biochem Mol Biol. 2017 Oct;173:317-322. doi: 10.1016/j.jsbmb.2017.03.015. Epub 2017 Mar 18.
Smith LM1, Gallagher JC2, Suiter C3.
1 Biostatistics, Public Health Department, U. Nebraska Medical Center, Omaha, NE 68198, US.
2 Endocrinology, Creighton University Medical School, Omaha, NE 68131, US. jcg at creighton.edu.
3 Endocrinology, Creighton University Medical School, Omaha, NE 68131, US
- When people get enough vitamin D they feel better, they move around more, and as a result for seniors who might fall, they fall more.
- <800 IU - no benefit compared to placebo
- 1,000 - 3,000 IU slight improvement in muscle speed, so less likely to fall
- >4000 IU caucasians felt better, moves around more
- note: increased fall rate not statistically significant
- Note: No increase in rate of falls for blacks with 4,000-4,800 as blacks need more to feel the benefit
- Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
- Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
- Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
- Higher quality of life associated with higher levels of vitamin D
- Some drugs change potency when Vitamin D is increased (increase in a hormone)
Falls are a serious health problem in the aging population. Because low levels of vitamin D have been associated with increased fall rates, many trials have been performed with vitamin D; two meta-analyses showed either a small effect or no effect of vitamin D on falls. We conducted a study of the effect of vitamin D on serum 25 hydroxyvitamin D (25OHD) and data on falls was collected as a secondary outcome. In a 12-month double blind randomized placebo trial, elderly women, mean age 66 years, were randomized to one of seven daily oral doses of vitamin D or placebo. The main inclusion criterion for study was a baseline serum 25OHD<20ng/ml (50nmol/L).
A history of falls was collected at baseline and fall events were collected every 3 months. Results showed that the effect of vitamin D on falls followed a U-shaped curve whether analyzed by dose or serum 25OHD levels. There was no decrease in falls on low vitamin D doses 400, 800 IU, a significant decrease on medium doses 1600, 2400,3200 IU (p=0.020) and no decrease on high doses 4000, 4800 IU compared to placebo (p=0.55).
When compared to 12-month serum 25OHD quintiles, the faller rate was 60% in the lowest quintile <25ng/ml (<50nmol/L), 21% in the low middle quintile 32-38ng/ml (80-95nmo/L), 72% in the high middle quintile 38-46ng/ml (95-115nmo/L) and 45% in the highest quintile 46-66ng/ml (115-165nmol/L). In the subgroup with a fall history, fall rates were 68% on low dose, 27% on medium doses and 100% on higher doses. Fall rates on high doses were increased compared to medium doses (Odds Ratio 5.6.95% CI: 2.1-14.8). In summary, the maximum decrease in falls corresponds to a 12- month serum 25OHD of 32-38ng/ml (80-95nmol/L) and faller rates increase as serum 25OHD exceed 40-45ng/ml (100-112.5nmol/L). The Tolerable upper limit (TUL) recently increased in 2010 from 2000 to 4000 IU/day may need to be reduced in elderly women especially in those with a fall history.
PMID: 28323044 PMCID: PMC5595629 [Available on 2018-10-01] DOI: 10.1016/j.jsbmb.2017.03.015