Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 58; no. 7; pp. 1299 - 1310
• Main Authors: Kalyani, Rita Rastogi, Stein, Brady, Valiyil, Ritu, Manno, Rebecca, Maynard, Janet W., Crews, Deidra C.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-07-2010; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Accidental Falls - prevention & control; Aged; Aged, 80 and over; Bibliographies; Biological and medical sciences; Dietary Supplements; elderly; Falls; Female; General aspects; Humans; Male; Medical sciences; Miscellaneous; Older people; Prevention and actions; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; randomized controlled trials; Systematic review; Vitamin D; Vitamin D - therapeutic use; Vitamins - therapeutic use; Human; Statistical analysis; Evidence-based practice; Controlled therapeutic trial; Systematic review; Review; randomized controlled trials; Evidence-based medicine; Metaanalysis; Prevention; Gerontology; Randomization; Treatment; falls; Vitamin D; Clinical trial; Fall; Elderly; Bibliographic review; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2010.02949.x

OBJECTIVES: To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults.
DESIGN: Systematic review and meta‐analysis.
SETTING: MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies.
PARTICIPANTS: Older adults (aged ≥60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition.
MEASUREMENTS: Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I2 statistic was used to assess heterogeneity in a random‐effects model.
RESULTS: Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200–1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79–0.93; I2=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community‐dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta‐regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87–0.98) and more heterogeneity (I2=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001).
CONCLUSION: Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.