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In a clinical trial that explored the effectiveness of exercise training and vitamin D supplementation for reducing falls in older women, neither intervention affected the overall rate of falls, according to an article published online by JAMA Internal Medicine.
Falls are the leading cause of unintentional injuries and fractures in older adults. However, reviews of clinical trials on the role of vitamin D in reducing falls and fractures in community-dwelling older adults and in improving physical functioning have been inconclusive, according to the study background.
Kirsti Uusi-Rasi, Ph.D., of the UKK Institute for Health Promotion Research, Tampere, Finland, and coauthors conducted a two-year randomized clinical trial that included 409 home-dwelling women in Finland (ages 70 to 80). The women were divided into four study groups and their treatments were either: placebo without exercise, vitamin D (800 IU/d) without exercise, placebo and exercise, or vitamin D and exercise. Exercise consisted of supervised group training classes and the focus included balance, weights, agility and strengthening.
Study results indicate that neither vitamin D nor exercise reduced overall falls. Fall rates per 100 person-years were 118.2 (placebo without exercise), 132.1 (vitamin D without exercise), 120.7 (placebo and exercise) and 113.1 (vitamin D and exercise). However, the study found the rate of injurious falls (a secondary outcome) was cut by more than half among exercisers with or without vitamin D.
In other outcomes, vitamin D did help to maintain bone density in the femoral neck (a segment of the femur most likely to break with osteoporosis) and increased tibial trabecular density in the shinbone. Only exercise improved muscle strength and balance, while vitamin D did not enhance the effects of exercise on physical functioning.
"Given the fact that fall risk is multifactorial, exercise may be the most effective and feasible strategy for preventing injurious falls in community-dwelling older adults replete with vitamin D. Herein, vitamin D increased bone density slightly, and exercise improved physical functioning. While neither treatment reduced the rate of falling, injurious falls more than halved among exercisers with or without vitamin D. Our participants were vitamin D replete, with sufficient calcium intake. Future research is needed to elaborate the role of vitamin D to enhance physical functioning in elderly women," the study concludes.
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Professor Kerrie Sanders is from the Institute for Health and Ageing at the Australian Catholic University
The study by Uusi-Rasi and colleagues is well designed with good retention of participants over the 2-year intervention period and good compliance to study medication. The dose of 800 IU/day is consistent with the Australian recommendation for those aged over 70 years.
The unexpected finding was the lack of efficacy of vitamin D reducing the number of falls. Nevertheless those randomised to vitamin D had half the rate of injuries from falls. This is surprising as the study team assessed muscle strength and neuromuscular function using standard ‘easy’ methods such as ‘timed up and up’ (TUG) yet did not report any difference in those treated with vitamin D. More detail of the type of injuries prevented would be useful.
The Finnish women in the current study by Uusi-Rasi and colleagues, had ‘adequate’ vitamin D levels at baseline (65 nmol/L) with only a small number of women likely to be low in vitamin D levels (less than 50nmol/L). Improving vitamin D levels in older adults who are already adequate (50 to 60 nmol/L) does not generally demonstrate benefits. Nevertheless the study demonstrates benefits to bone health with vitamin D supplementation and the exercise program improved physical functioning.
The additional analysis presented in the accompanying editorial by LeBlanc and Chou puts the study results into context. It shows that the balance of evidence continues to support routine supplementation of older adults at risk of falls. The greatest benefit of vitamin D supplementation in reducing falls has consistently been shown in those older adults who are low in vitamin D status before supplementation.
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