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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Am Geriatr Soc. Author manuscript; available in PMC 2010 May 6.
Published in final edited form as:
PMCID: PMC2865134
NIHMSID: NIHMS198050

Vitamin D Supplement Intake in Elderly Fallers

Kathryn A. Kiehn, M.D.,1 Jane Mahoney, M.D.,1 Andrea N Jones, B.S.,1,2 and Karen E. Hansen, M.D.1,2

TO THE EDITOR

Approximately 30% of ambulatory older adults fall yearly [1]; 5% to 10% are seriously injured [2]. Vitamin D deficiency increases body sway and decreases muscle mass and strength, increasing falls risk [3, 4]. Vitamin D supplementation reduces falls by 11% to 22% [5, 6]. To our knowledge, no studies report characteristics of ambulatory fallers associated with meeting the vitamin D recommended adequate intake (RAI). We report patient characteristics associated with vitamin D intake in a falls study.

METHODS

We analyzed data from Safety Assessment for Elders (SAFE), a randomized, controlled study of multifactorial interventions to reduce falls (ClinicalTrials.org identifier NCT00140322). Eligible subjects were adults ages ≥65 years at high falls risk [7]. At baseline and study end, researchers visited subjects’ homes to examine all medication and supplement bottles and record vitamin D intake.

Participants were randomized to receive mailed home safety information or a multifactorial intervention designed to decrease falls risk. In the active arm, subjects with a daily vitamin D intake <800 IU were asked to increase intake to ≥800 IU/day [8]. Participants and their physicians received letters instructing them how to increase vitamin D intake. Participants were called monthly for eleven months to encourage adherence with recommendations.

Study outcomes were the rates and patient characteristics (Table) associated with meeting the age-specific vitamin D RAI of 400 IU (ages 51–70 years or 600 IU (ages ≥71 years) per day [9] at study entry and study end. Subjects with unknown vitamin D intake at baseline (n=18 of 500) were excluded. Forty-five of 482 subjects had missing data at one year; these individuals were similar to the remaining subjects (P > .05, candidate variables).

Table 1
μCharacteristics Associated with Meeting the Vitamin D Recommended Adequate Intake (RAI)* at Baseline

All data were analyzed using Analyze-It software (Leeds, UK) and summarized using the mean ± standard deviation (SD) or percentage points. Continuous study data were parametric, allowing analysis by independent sample t-test. Chi-square tests examined proportions. In all cases, a two-sided P value < .05 determined significant findings.

RESULTS

Vitamin D intake was recorded at baseline (n=482) and study end (n=446) from 500 subjects enrolled. Baseline demographics (Table) included a mean age of 79 ± 8 years and predominance of female (75%), Caucasian (97%) subjects. Participants reported an average of three falls yearly and a mean vitamin D supplement intake of 370 ± 320 IU daily. Only 28% of all subjects met the vitamin D RAI at study entry, increasing to 37% at study end (P = .007).

Five characteristics associated with greater likelihood of meeting the age-specific vitamin D RAI at baseline (Table). Participants meeting the RAI (n=135) were younger (76 ± 8 versus 80 ± 7, P < .001), more likely to be women (87% versus 70%, P = .003), suffer prior fracture (47% versus 37%, P = .05) and take calcium supplements (94% versus 57%, P < .001). Individuals who met the vitamin D RAI had better SF12 physical function scores (41 ± 11 vs. 39 ± 10, P = 0.04).

Subjects with known vitamin D intake at both entry and study end (n=437) increased vitamin D intake during participation (350 ± 300 IU to 410 ± 350 IU daily, P = .009). Two characteristics associated with increased intake. Subjects randomized to active falls interventions (33% versus 17%, P < .001) and those reporting regular exercise (29% versus 20%, P = .04) were statistically more likely to increase vitamin D intake during the one-year study.

DISCUSSION

Vitamin D is a safe, inexpensive strategy to reduce falls and associated medical costs. This study shows older fallers have a low rate of meeting the vitamin D RAI, especially men, older individuals, those without prior fracture and people avoiding calcium supplements. Patients and providers need greater education on the import of vitamin D for prevention of falls and fractures. Written instructions and regular phone follow-up appear to increase vitamin D intake in elderly fallers. This finding, if verified in additional studies, may prove an effective public health strategy to decrease falls in older adults.

References

1. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18:141–158. [PubMed]
2. McClure R, Turner C, Peel N, et al. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev. 2005:CD004441. [PubMed]
3. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res. 2000;15:1113–1118. [PubMed]
4. Snijder MB, van Schoor NM, Pluijm SM, et al. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab. 2006;91:2980–2985. [PubMed]
5. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of Vitamin D on falls: A meta-analysis. JAMA. 2004;291:1999–2006. [PubMed]
6. Cranney A, Horsley T, O’Donnell S, et al. Evidence Report/Technology Assessment No. 158. Rockville: Agency for Healthcare Research and Quality; 2007. Effectiveness and Safety of Vitamin D in Relation to Bone Health. [PubMed]
7. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001;49:664–672. [PubMed]
8. Broe KE, Chen TC, Weinberg J, et al. A higher dose of vitamin d reduces the risk of falls in nursing home residents: A randomized, multiple-dose study. J Am Geriatr Soc. 2007;55:234–239. [PubMed]
9. Institute of Medicine FaNB. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Flouride. Washington, DC: National Academy Press; 1999.