Falling is one of the major causes of debilitation and accelerated death among the elderly. Older as well as recent research indicates that old folks in and out of nursing homes who take regular Vitamin D supplements fall a lot less than those who don’t.
The research literature on injuries and deaths in the elderly due to falling goes way back. In 1985 it was written “Injuries are the sixth leading cause of death in the 75-and-over population, with falls the leading cause of injury-related deaths. Hospitals and residential centers for the elderly have high rates of falls and injuries. With increasing age, patients in nursing homes have a corresponding increase in the proportion of fatal falls.” My own mother fell and very seriously injured herself in her late 80s, contributing to her decline and death at age 93. A 1996 report Epidemiology of hip fractures indicated “There were an estimated 1.66 million hip fractures world-wide in 1990. According to the epidemiologic projections, this worldwide annual number will rise to 6.26 million by the year 2050. This rise will be in great part due to the huge increase in the elderly population of the world.” Over 90% of hip fractures result from falling.
According to the CDC website on hip fractures,
- “In 2004, there were more than 320,000 hospital admissions for hip fractures, a 3% increase from the previous year.
- About one out of five hip fracture patients dies within a year of their injury.
- Most patients with hip fractures are hospitalized for about one week.
- Up to one in four adults who lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury.
- In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.” (Imagine what the cost must be now!)
There is also a long history relating vitamin D to falling and hip fractures. Citing data based on women living in nursing homes in France, in the 1996 paper Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people the author state “We have shown in a 3-year controlled prospective study that the daily use of these supplements (1.2 g of calcium and 800 IU of vitamin D3) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced of 23% (intention-to-treat analysis) the number of hip fractures and other non vertebral fractures.”
Another study report, published in 2008 was entitled A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing Home Residents: A Randomized, Multiple-Dose Study. “PARTICIPANTS: One hundred twenty-four nursing home residents (average age 89). INTERVENTION: Participants were randomly assigned to receive one of four vitamin D supplement doses (200 IU, 400 IU, 600 IU, or 800 IU) or placebo daily for 5 months. MEASUREMENTS: Number of fallers and number of falls assessed using facility incident tracking database. RESULTS: — Participants in the 800 IU group had a 72% lower adjusted-incidence rate ratio of falls than those taking placebo over the 5 months (rate ratio=0.28; 95% confidence interval=0.11-0.75). — CONCLUSION: Nursing home residents in the highest vitamin D group (800 IU) had a lower number of fallers and a lower incidence rate of falls over 5 months than those taking lower doses. Adequate vitamin D supplementation in elderly nursing home residents could reduce the number of falls experienced by this high falls risk group.” A discussion of this study treating its limitations and comparing the results with those of other studies can be found here.
An October 2009 report Extended Physiotherapy and Vitamin D Protect Against Second Hip Fractures appears to describe the latest work on this topic. “Extended physiotherapy significantly reduced the rate of falls among patients with a prior hip fracture, and high-dose vitamin D significantly reduced the rate of hospital readmissions in a study of 173 patients. — A program of extended physiotherapy reduced the fall rate by 25%, compared with standard postfracture physiotherapy; high-dose vitamin D therapy reduced the hospital readmission rate by 39%, compared with a lower dose, the researchers found.” Half of the patients had a severe vitamin D deficiency when they started the study and the mean age of the patients was 84 years. Some patients were given 800 IU of vitamin D, others 2000 IU. “There was no difference in the fall rate for the two vitamin D groups, but high-dose vitamin D did reduce the rate of hospital readmission by 39%, which was significant. There was also a significant 60% reduction in fall-related injuries. “This was mainly driven by a nonsignificant reduction in repeat nonvertebral fractures by 52%,” said Dr. Bischoff-Ferrari of the Centre on Aging and Mobility at the University Hospital Zurich.”
Interestingly, I found one 2007 dissenting study Does Vitamin D Stop Inpatients Falling? A Randomised Controlled Trial. “Objective: to determine whether routine supplementation with vitamin D plus calcium reduces numbers of fallers and falls in a cohort of hospital admissions while they are inpatients. Design: randomised, double-blind, controlled study. Participants: two hundred and five acute admissions > 65 years to a geriatric medical unit. Methods: patients were randomised to intervention of daily vitamin D 800 IU plus calcium 1,200 mg or control group of daily calcium 1,200 mg, until discharge or death. — Results: median age 84 years and a median length of stay = 30 days. — Although there were fewer fallers in the vitamin D cohort, this did not reach statistical significance –Conclusions: in a population of geriatric hospital inpatients, vitamin D did not reduce the number of fallers. Routine supplementation cannot be recommended to reduce falls in this group.” I think the explanation is that the lengths of the hospital stays involved (30 days mean) were too short for the effects of vitamin D to be manifest and too short for many falls to happen (36 of those on vitamin D, 45 for those doing only calcium). The other studies were longer and involved a lot more falls providing statistical significance.
So, it appears that Vitamin D works two ways to prevent fall-related injuries: 1. it reduces the number of falls, probably by a combination of muscle strengthening and improving coordination, and 2. it reduces the number of fractures in those who do fall, via bone strengthening. Of course, preventing falls is only one of an impressive array of benefits due to vitamin D supplementation.