Elderly Fall Prevention:
Exercise vs. Vitamin D

The U.S. Preventive Services Task Force appears to be a bit behind the literature on fall prevention and vitamin D supplementation. Just as vitamin D supplementation has been recently debunked as an effective strategy for treating hypertension (see “Vitamin D Supplements Do Not Appear to Lower Blood Pressure,” in this issue), it now appears to be ineffective for fall prevention, in particular among older women. 

Exercise, rather than vitamin D supplementation, may be key to preventing injurious falls in older women, the latest study from JAMA Internal Medicine suggests.

About 400 older, home-dwelling women in Finland who'd fallen at least once within the previous year were randomized to four groups: vitamin D supplementation (800 IU/day) plus exercise, placebo plus exercise, vitamin D without exercise, and placebo without exercise. The exercise intervention involved group classes and at-home activities, with a focus on strength-training, balance, and agility.

At two years, neither vitamin D nor exercise reduced the overall rate of falls. However, the rate of injurious falls was significantly lower in the two exercise groups (roughly 6 per 100 person-years) than in the non-exercising groups (13 per 100).

And last April, vitamin D supplementation was shown to fail to reduce the risk for falls in older adults of both genders. Nearly 30,000 older adults participated in 20 randomized trials that looked at the effect of vitamin D supplementation—with or without calcium—on the risk for falls. Vitamin D supplementation did not reduce the incidence of falls by 15% or more (the pre-specified threshold for clinical relevance). Calcium also had no effect.

The authors do not see the point of recommending vitamin D for fall prevention. They write, “In pooled analyses, supplementation with vitamin D, with or without calcium, does not reduce falls by 15% or more. Future trials with similar designs are unlikely to alter these conclusions. At present, there is little justification for prescribing vitamin D supplements to prevent falls.”

JAMA Int. Med., March 2015, published online doi:10.1001/jamainternmed.2015.0225, http://archinte.jamanetwork.com/article.aspx?articleid=2204033

The Lancet: Diabetes and Endocrinology, 2014, Vol. 2, No. 7, pp. 578-580, published online April 2014, http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70068-3/abstract

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