Abstract
Summary
Three hundred eighty-seven home-dwelling older women were divided into quartiles based on mean serum 25-hydroxyvitamin D (S-25(OH)D) levels. The rates of falls and fallers were about 40% lower in the highest S-25(OH)D quartile compared to the lowest despite no differences in physical functioning, suggesting that S-25(OH)D levels may modulate individual fall risk.
Introduction
Vitamin D supplementation of 800 IU did not reduce falls in our previous 2-year vitamin D and exercise RCT in 70–80 year old women. Given large individual variation in individual responses, we assessed here effects of S-25(OH)D levels on fall incidence.
Methods
Irrespective of original group allocation, data from 387 women were explored in quartiles by mean S-25(OH)D levels over 6–24 months; means (SD) were 59.3 (7.2), 74.5 (3.3), 85.7 (3.5), and 105.3 (10.9) nmol/L. Falls were recorded monthly with diaries. Physical functioning and bone density were assessed annually. Negative binomial regression was used to assess incidence rate ratios (IRRs) for falls and Cox-regression to assess hazard ratios (HR) for fallers. Generalized linear models were used to test between-quartile differences in physical functioning and bone density with the lowest quartile as reference.
Results
There were 37% fewer falls in the highest quartile, while the two middle quartiles did not differ from reference. The respective IRRs (95% CI) for falls were 0.63 (0.44 to 0.90), 0.78 (0.55 to 1.10), and 0.87 (0.62 to 1.22), indicating lower falls incidence with increasing mean S-25(OH)D levels. There were 42% fewer fallers (HR 0.58; 040 to 0.83) in the highest quartile compared to reference. Physical functioning did not differ between quartiles.
Conclusions
Falls and faller rates were about 40% lower in the highest S-25(OH)D quartile despite similar physical functioning in all quartiles. Prevalent S-25(OH)D levels may influence individual fall risk. Individual responses to vitamin D treatment should be considered in falls prevention.
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References
Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E, Slomian J, Petermans J, Reginster JY, Bruyere O (2014) The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 99:4336–4345
Minshull C, Biant LC, Ralston SH, Gleeson N (2016) A systematic review of the role of vitamin D on neuromuscular remodelling following exercise and injury. Calcif Tissue Int 98:426–437
Shab-Bidar S, Bours SP, Geusens PP, van der Velde RY, Janssen MJ, van den Bergh JP (2013) Suboptimal effect of different vitamin D3 supplementations and doses adapted to baseline serum 25(OH)D on achieved 25(OH)D levels in patients with a recent fracture: a prospective observational study. Eur J Endocrinol 169:597–604
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine S (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930
Halfon M, Phan O, Teta D (2015) Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty. Biomed Res Int 2015:953241
Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stähelin HB, Theiler R, Dawson-Hughes B (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367:40–49
Binkley N, Lappe J, Singh RJ, Khosla S, Krueger D, Drezner MK, Blank RD (2015) Can vitamin D metabolite measurements facilitate a “treat-to-target” paradigm to guide vitamin D supplementation? Osteoporos Int 26:1655–1660
Autier P, Gandini S, Mullie P (2012) A systematic review: influence of vitamin D supplementation on serum 25-hydroxyvitamin D concentration. J Clin Endocrinol Metab 97:2606–2613
Marcelli C, Chavoix C, Dargent-Molina P (2015) Beneficial effects of vitamin D on falls and fractures: is cognition rather than bone or muscle behind these benefits? Osteoporos Int 26:1–10
Stockton KA, Mengersen K, Paratz JD, Kandiah D, Bennell KL (2011) Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int 22:859–871
Rosendahl-Riise H, Spielau U, Ranhoff AH, Gudbrandsen OA, Dierkes J (2017) Vitamin D supplementation and its influence on muscle strength and mobility in community-dwelling older persons: a systematic review and meta-analysis. J Hum Nutr Diet 30:3–15
Bolland MJ, Grey A, Gamble GD, Reid IR (2014) Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2:573–580
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692
Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, Sievanen H (2015) Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med 175:703–711
Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, Sievanen H (2017) A 2-year follow-up after a 2-year RCT with vitamin D and exercise: effects on falls, injurious falls and physical functioning among older women. J Gerontol A Biol Sci Med Sci 72:1239–1245
Uusi-Rasi K, Kannus P, Karinkanta S, Pasanen M, Patil R, Lamberg-Allardt C, Sievanen H (2012) Study protocol for prevention of falls: a randomized controlled trial of effects of vitamin D and exercise on falls prevention. BMC Geriatr 12:12
Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc 53:1618–1622
Schwenk M, Lauenroth A, Stock C, Moreno RR, Oster P, McHugh G, Todd C, Hauer K (2012) Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol 12:50
Outila TA, Karkkainen MU, Lamberg-Allardt CJ (2001) Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 74:206–210
Uusi-Rasi K, Rauhio A, Kannus P, Pasanen M, Kukkonen-Harjula K, Fogelholm M, Sievanen H (2010) Three-month weight reduction does not compromise bone strength in obese premenopausal women. Bone 46:1286–1293
Sievanen H, Koskue V, Rauhio A, Kannus P, Heinonen A, Vuori I (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13:871–882
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94
Podsiadlo D, Richardson S (1991) The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148
Husu P, Suni J, Pasanen M, Miilunpalo S (2007) Health-related fitness tests as predictors of difficulties in long-distance walking among high-functioning older adults. Aging Clin Exp Res 19:444–450
De Leo D, Diekstra RF, Lonnqvist J et al (1998) LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behav Med 24:17–27
Aalto A-M, Aro AR, Hakonen A, Lönnqvist J (2009) LEIPAD mittari vanhenevan väestön elämänlaadun kuvaajana: Mittarin validointi. Gerontologia 3:187–196
Pfeifer M, Begerow B, Minne HW (2002) Vitamin D and muscle function. Osteoporos Int 13:187–194
Bischoff-Ferrari HA (2012) Relevance of vitamin D in muscle health. Rev Endocr Metab Disord 13:71–77
Ceglia L, Niramitmahapanya S, da Silva Morais M, Rivas DA, Harris SS, Bischoff-Ferrari H, Fielding RA, Dawson-Hughes B (2013) A randomized study on the effect of vitamin D(3) supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98:E1927–E1935
Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL (2018) Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services task force. JAMA 319:1705–1716
Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, Dick W, Willett WC, Egli A (2016) Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med 176:175–183
Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC (2010) Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303:1815–1822
Smith LM, Gallagher JC, Suiter C (2017) 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 173:317–322
Gallagher JC, Sai A, Templin T 2nd, Smith L (2012) Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann Intern Med 156:425–437
Rizzoli R, Boonen S, Brandi ML, Bruyere O, Cooper C, Kanis JA, Kaufman JM, Ringe JD, Weryha G, Reginster JY (2013) Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin 29:305–313
Karinkanta S, Piirtola M, Sievanen H, Uusi-Rasi K, Kannus P (2010) Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 6:396–407
Sohl E, de Jongh RT, Heijboer AC, Swart KMA, Brouwer-Brolsma EM, Enneman AW, de Groot CPGM, van der Velde N, Dhonukshe-Rutten RAM, Lips P, van Schoor NM (2013) Vitamin D status is associated with physical performance: the results of three independent cohorts. Osteoporos Int 24:187–196
Weyland PG, Grant WB, Howie-Esquivel J (2014) Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill's criteria for causality. Nutrients 6:3403–3430
Wicherts IS, van Schoor NM, Boeke AJ, Visser M, Deeg DJ, Smit J, Knol DL, Lips P (2007) Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92:2058–2065
Hansen KE, Johnson RE, Chambers KR, Johnson MG, Lemon CC, Vo TN, Marvdashti S (2015) Treatment of vitamin D insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern Med 175:1612–1621
Jaaskelainen T, Itkonen ST, Lundqvist A et al (2017) The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr 105:1512–1520
Zhao LJ, Zhou Y, Bu F, Travers-Gustafson D, Ye A, Xu X, Hamm L, Gorsage DM, Fang X, Deng HW, Recker RR, Lappe JM (2012) Factors predicting vitamin D response variation in non-Hispanic white postmenopausal women. J Clin Endocrinol Metab 97:2699–2705
Pourshahidi LK (2015) Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc 74:115–124
Hossein-nezhad A, Holick MF (2013) Vitamin D for health: a global perspective. Mayo Clin Proc 88:720–755
Nelson ML, Blum JM, Hollis BW, Rosen C, Sullivan SS (2009) Supplements of 20 microg/d cholecalciferol optimized serum 25-hydroxyvitamin D concentrations in 80% of premenopausal women in winter. J Nutr 139:540–546
Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB (2015) Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev 16:341–349
Viljakainen HT, Palssa A, Karkkainen M, Jakobsen J, Lamberg-Allardt C (2006) How much vitamin D3 do the elderly need? J Am Coll Nutr 25:429–435
Kalyani RR, Stein B, Valiyil R, Manno R, Maynard JW, Crews DC (2010) Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc 58:1299–1310
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This work was supported by grants from the Academy of Finland.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study. The study protocol was approved by the institutional ethics committee of the Tampere University Hospital, Tampere, Finland. This study was conducted in accordance with the principles of the Declaration of Helsinki.
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Uusi-Rasi, K., Patil, R., Karinkanta, S. et al. Serum 25-hydroxyvitamin D levels and incident falls in older women. Osteoporos Int 30, 93–101 (2019). https://doi.org/10.1007/s00198-018-4705-4
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DOI: https://doi.org/10.1007/s00198-018-4705-4