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Vitamin D supplements prevent falls, fractures

12/22/2009 - Articles

Vitamin D supplements prevent falls, fractures

By: Susan Aldridge, medical journalist, PhD

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Vitamin D is essential for bone health and its deficiency may contribute to falls and fractures among the elderly.  For the skin of older people has a four-fold reduced ability to produce vitamin D and the elderly may also avoid sun exposure (essential for vitamin D production), particularly if they are institutionalised.

Falls and fractures can have serious implications in terms of functional disability and loss of independence.  The role of vitamin D in preventing falls and fractures was a key topic in the recent Nestlé Nutrition Institute sponsored symposium ‘Nutrition and Functionality’ which took place at the IAGG World Congress of Gerontology and Geriatrics in Paris, recently.

Professor Heike Bischoff-Ferrari of the University of Zurich highlighted the benefits of vitamin D supplementation for older people (it is hard to get sufficient vitamin D from even a healthy diet).  She presented a recent meta-analysis of clinical trials on how vitamin D supplementation can reduce non-vertebral fractures, including hip fractures.  This is an important issue, because previous studies have given conflicting results, leaving physicians unsure as to whether or not they should be recommending vitamin D, and in what dose, to their elderly patients. The new analysis looked at how the dose of vitamin D might influence the benefits it confers.

At the highest doses of vitamin D, of more than 400 IU/day, there was a 20% reduction in non-vertebral fractures of all kinds, and an 18% reduction in hip fractures.  Benefit was found for all sub-groups, whether they were community dwelling or in institutions. Moreover, the benefits of vitamin D in reducing fractures were independent of whether or not calcium supplements were being taken (some previous studies have suggested that vitamin D is only effective with calcium supplements). Bischoff-Ferrari also pointed out that vitamin D deficiency is common in hip fracture patients, with 50% having severe vitamin D deficiency and less than 5% reaching the minimal vitamin D levels required for prevention of non-vertebral fractures.

In conclusion, higher doses of vitamin D may be required to reduce fractures, including hip fractures,1 in the elderly. Doses between 482 and 770 IU/day would be in the right range.  Earlier initiation of vitamin D supplementation and longer duration of use may also produce better protection.  Bischoff-Ferrari said that their research did not support the use of lower-dose vitamin D with, or without, calcium, to prevent falls and fractures among the elderly.

Source:

Bischoff-Ferrari H, Willett W et al Prevention of nonvertebral fractures with oral vitamin D and dose dependency Archives of Internal Medicine 2009;169:551-561 

 

Created on: 09/30/2009
Reviewed on: 12/22/2009

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