Just 4,000 IU of vitamin D was not enough to halt senior falls – July 2023

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The association of vitamin D supplementation and serum vitamin D levels with physical activity in older adults: Results from a randomized trial

J of American Geriatrics Society https://doi.org/10.1111/jgs.18290 PDF is behind a paywall ($15 to rent)
Jennifer A. Schrack PhD, MS, Yurun Cai PhD, Jacek K. Urbanek PhD, Amal A. Wanigatunga PhD, MPH, Christine M. Mitchell ScM …

Background
To assess whether vitamin D3 supplementation attenuates the decline in daily physical activity in low-functioning adults at risk for falls.

Methods
Secondary data analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You), a response-adaptive randomized clinical trial. Participants included 571 adults aged 70 years and older with baseline serum 25(OH)D levels of 10–29 ng/mL and elevated fall risk, who wore a wrist accelerometer at baseline and at least one follow-up visit and were randomized to receive: 200 IU/day (control), 1000, 2000, or 4000 IU/day of vitamin D3. Objective physical activity quantities and patterns (total daily activity counts, active minutes/day, and activity fragmentation) were measured for 7-days, 24-h/day, in the free-living environment using the Actigraph GT9x over up to 24-months of follow-up.

Results
In adjusted models, physical activity quantities declined (p < 0.001) and became more fragmented, or “broken up”, (p = 0.017) over time. Supplementation with vitamin D3 did not attenuate this decline.
Changes in physical activity were more rapid among those with baseline serum 25(OH)D <20 ng/mL compared to those with baseline 25(OH)D levels of 20–29 ng/mL (time*baseline 25(OH)D, p < 0.05).

Conclusion
In low-functioning older adults with serum 25(OH)D levels 10–29 ng/mL, vitamin D3 supplementation of 1000 IU/day or higher did not attenuate declines in physical activity compared with 200 IU/day. Those with baseline 25(OH)D <20 ng/mL showed accelerated declines in physical activity. Alternative interventions to supplementation are needed to curb declines in physical activity in older adults with low serum 25(OH)D.

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Study References

1. Pojednic RM, Ceglia L. The emerging biomolecular role of vitamin D in skeletal muscle. Exerc Sport Sci Rev. 2014;42(2):76-81. doi:10.1249/JES.0000000000000013
2. Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80(3):752-758.
3. Wicherts IS, van Schoor NM, Boeke AJ, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;92(6):2058-2065.
4. Birrell F, Francis RM. Invited commentary: physical activity and vitamin D. Am J Epidemiol. 2008;168:587-589.
5. Klenk J, Rapp K, Denkinger M, et al. Objectively measured physical activity and vitamin D status in older people from Germany. J Epidemiol Community Health. 2015;69:388-392.
6. Manini TM, Everhart JE, Patel KV, et al. Activity energy expenditure and mobility limitation in older adults: differential associations by sex. Am J Epidemiol. 2009;169(12):1507-1516. doi:10.1093/aje/kwp069
7. Pfeifer M, Begerow B, Minne HW. Vitamin D and muscle function. Osteoporos Int. 2002;13(3):187-194. doi:10.1007/s001980200012
8. Scragg R Jr, CAC. Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the third National Health and nutrition examination survey. Am J Epidemiol. 2008;168(6):91-586. doi:10.1093/aje/kwn163
9. Bell NH, Godsen RN, Henry DP, Shary J, Epstein S. The effects of muscle-building exercise on vitamin D and mineral metabolism. J Bone Miner Res Off J Am Soc Bone Miner Res. 1988;3(4):369-373. doi:10.1002/jbmr.5650030402
10. Scott D, Blizzard L, Fell J, Ding C, Winzenberg T, Jones G. A prospective study of the associations between 25-hydroxy-vitamin D, sarcopenia progression and physical activity in older adults. Clin Endocrinol. 2010;73(5):581-587. doi:10.1111/j.1365-2265.2010.03858.x
11. Schrack JA, Cooper R, Koster A, et al. Assessing daily physical activity in older adults: unraveling the complexity of monitors, measures, and methods. J Gerontol A Biol Sci Med Sci. 2016;71(8):1039-1048.
12. Wanner M, Richard A, Martin B, Linseisen J, Rohrmann S. Associations between objective and self-reported physical activity and vitamin D serum levels in the US population. Cancer Causes Control. 2015;26(6):881-891. doi:10.1007/s10552-015-0563-y
13. Ginde AA, Blatchford P, Breese K, et al. High-dose monthly vitamin D for prevention of acute respiratory infection in older long-term care residents: a randomized clinical trial. J Am Geriatr Soc. 2017;65(3):496-503. doi:10.1111/jgs.14679
14. Sanders KM, Stuart AL, Williamson EJ, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303(18):1815-1822. doi:10.1001/jama.2010.594
15. Schrack JA, Kuo PL, Wanigatunga AA, et al. Active-to-sedentary behavior transitions, fatigability, and physical functioning in older adults. J Gerontol A Biol Sci Med Sci. 2018;24:560-567. doi:10.1093/gerona/gly243
16. Wanigatunga AA, Di J, Zipunnikov V, et al. Association of Total Daily Physical Activity and Fragmented Physical Activity with Mortality in older adults. JAMA Netw Open. 2019;2(10):e1912352. doi:10.1001/jamanetworkopen.2019.12352
17. Appel LJ, Michos ED, Mitchell CM, et al. The effects of four doses of vitamin D supplements on falls in older adults: a response-adaptive, randomized clinical trial. Ann Intern Med. 2021;174(2):145-156. doi:10.7326/M20-3812
18. Michos ED, Mitchell CM, Miller ER, et al. Rationale and design of the study to understand fall reduction and vitamin D in you (STURDY): a randomized clinical trial of vitamin D supplement doses for the prevention of falls in older adults. Contemp Clin Trials. 2018;73:111-122. doi:10.1016/j.cct.2018.08.004
19. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-1930. doi:10.1210/jc.2011-0385
20. Choi L, Ward SC, Schnelle JF, Buchowski MS. Assessment of wear/nonwear time classification algorithms for triaxial accelerometer. Med Sci Sports Exerc. 2012;44(10):2009-2016. doi:10.1249/MSS.0b013e318258cb36
21. Wanigatunga AA, Wang H, An Y, et al. Association between brain volumes and patterns of physical activity in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2021;76(8):1504-1511. doi:10.1093/gerona/glaa294
22. Schrack JA, Zipunnikov V, Goldsmith J, et al. Assessing the “physical cliff”: detailed quantification of age-related differences in daily patterns of physical activity. J Gerontol A Biol Sci Med Sci. 2013;69:973-979. doi:10.1093/gerona/glt199
23. Koster A, Shiroma EJ, Caserotti P, et al. Comparison of sedentary estimates between activPAL and hip- and wrist-worn ActiGraph. Med Sci Sports Exerc. 2016;48(8):1514-1522. doi:10.1249/MSS.0000000000000924
24. Herrick KA, Storandt RJ, Afful J, et al. Vitamin D status in the United States, 2011-2014. Am J Clin Nutr. 2019;110(1):150-157. doi:10.1093/ajcn/nqz037
25. Kahwati LC, LeBlanc E, Weber RP, et al. Screening for vitamin D deficiency in adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2021;325(14):1443. doi:10.1001/jama.2020.26498
26. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for vitamin D deficiency in adults: US preventive services task force recommendation statement. JAMA. 2021;325:1436. doi:10.1001/jama.2021.3069
27. Pludowski P, Holick MF, Pilz S, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev. 2013;12(10):976-989. doi:10.1016/j.autrev.2013.02.004
28. Guralnik JM, Sternberg AL, Mitchell CM, et al. STURDY Collaborative Research Group. Effects of vitamin D on physical function: results from the STURDY trial. J Gerontol A Biol Sci Med Sci. 2022;77(8):1585-1592. doi:10.1093/gerona/glab379
29. Wanigatunga AA, Cai Y, Urbanek JK, Mitchell CM, et al. Objectively measured patterns of daily physical activity and phenotypic frailty. J Gerontol A Biol Sci Med Sci. 2022;77(9):1882-1889. doi:10.1093/gerona/glab278

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VitaminDWiki – Falls and Fractures category contains

• 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