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Neither vitamin D nor exercise affect overall fall rates among older women

But vitamin preserves femoral neck density while exercise halves serious fall rate

Caroline White

Tuesday, 24 March 2015

Neither vitamin D nor exercise made any difference to overall fall rates among older women, reveal the results of a Finnish clinical trial* published online in JAMA Internal Medicine.

Falls are the leading cause of unintentional injuries and fractures in older adults. But reviews of clinical trial data on the role of vitamin D in curbing falls and fractures in older adults living independently and in improving physical functioning have been inconclusive.

In a bid to explore the effectiveness of exercise training and vitamin D supplementation for reducing falls in older women, the researchers carried out a two year randomised controlled trial involving 409 Finnish women aged 70 to 80 and still living at home.

The women, none of whom was vitamin D deficient, were divided into one of four treatment arms: placebo without exercise; vitamin D (800 IU/day) without exercise; placebo and exercise; or vitamin D and exercise.

Exercise consisted of supervised group training classes, focusing on balance, weights, agility and muscle strengthening. All the women had adequate calcium intake.

The results showed that neither vitamin D nor exercise reduced the overall fall rate. Fall rates per 100 person-years were 118.2 in the placebo without exercise group, 132.1 in the vitamin D without exercise group, 120.7 in the placebo and exercise group, and 113.1 in the vitamin D and exercise group.

But the rate of falls resulting in injury was cut by more than half among those who exercised—with or without vitamin D.

And 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 shin bone.

But 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. Future research is needed to elaborate the role of vitamin D to enhance physical functioning in elderly women,” the authors concludes.

In a linked commentary**, Dr Erin LeBlanc, of Kaiser Permanente Northwest, and Dr Roger Chou, of Oregon Health & Science University, in Portland, Oregon, caution: “This trial reminds us that although vitamin D is known as the sunshine vitamin and higher levels are associated with better health in observational studies, more research is needed to understand the effectiveness of vitamin D supplementation on clinical outcomes.”

Given its low cost and low risk, vitamin D should remain in the physician’s armamentarium for fall prevention, at least until more data are available, they add.

“Taking a person’s vitamin D status into account may be a useful clinical consideration. As more high-quality [randomised clinical trials] release their findings, we need to be ready to re-evaluate the role that vitamin D has in maintaining health. However, [this study] reminds us that the strongest and most consistent evidence for prevention of serious falls is exercise, which has multiple other health benefits,” they conclude.

* Kirsti Uusi-Rasi, et al. Exercise and Vitamin D in Fall Prevention Among Older Women. JAMA Intern Med. Published online March 23, 2015. doi:10.1001/jamainternmed.2015.0225

** Erin S. LeBlanc, Roger Chou. Vitamin D and Falls — Fitting New Data With Current Guidelines. JAMA Intern Med. Published online March 23, 2015. doi:10.1001/jamainternmed.2015.0248

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