Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehab 7:50-63

Department of Internal Medicine and Geriatrics, Angers University Hospital, Angers University Memory Center, UPRES EA 2646, University of Angers, UNAM, Angers, France.
Journal of NeuroEngineering and Rehabilitation (Impact Factor: 2.74). 10/2010; 7(1):50. DOI: 10.1186/1743-0003-7-50
Source: PubMed


Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults.

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    • "Approximately one-third of the population over the age of 65 falls each year, rising to over 50% by the age of 80 [5, 7–10]. Falls and fall-related injuries are a major cause of disability and personal and professional impairment [3, 6–8]. According to the leading Swiss Accident Insurance provider (SUVA), the prevalence of falls in Switzerland is approximately 295,000 cases per year: 55,000 at work, 140,000 during leisure time, and 100,000 at home [11]. "
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    ABSTRACT: Principals: Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. Methods: Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. Results: Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). Conclusion: Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.
    The Scientific World Journal 03/2014; 2014:256519. DOI:10.1155/2014/256519 · 1.73 Impact Factor
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    • "There are many factors affecting fall-risk for older individuals , and although these may be different for inside and outside falls [10], strength and balance remain two important physical fall-risk factors. A recently published overview of the literature supports an assertion that age-related changes in postural reactions may be related to vitamin D statusmediated through either central nervous system integration or antigravity muscles as the effectors in postural responses [11]. Despite changes in vitamin D across the seasons [8], muscle strength in the quadriceps muscles has been shown to remain stable [12]. "
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    ABSTRACT: Introduction. Low serum vitamin D levels are associated with increased postural sway. Vitamin D varies seasonally. This study investigates whether postural sway varies seasonally and is associated with serum vitamin D and falls. Methods. In a longitudinal observational study, eighty-eight independently mobile community-dwelling older adults (69.7 ± 7.6 years) were evaluated on five occasions over one year, measuring postural sway (force platform), vitamin D levels, fall incidence, and causes and adverse outcomes. Mixed-methods Poisson regression was used to determine associations between measures. Results. Postural sway did not vary over the year. Vitamin D levels varied seasonally (P < 0.001), peaking in summer. Incidence of falls (P = 0.01) and injurious falls (P = 0.02) were lower in spring, with the highest fall rate at the end of autumn. Postural sway was not related to vitamin D (P = 0.87) or fall rates, but it was associated with fall injuries (IRR 1.59 (CI 1.14 to 2.24, P = 0.007). Conclusions. Postural sway remained stable across the year while vitamin D varied seasonally. Participants with high values for postural sway demonstrated higher rates of injurious falls. This study provides important evidence for clinicians and researchers providing interventions measuring balance outcomes across seasons.
    Journal of aging research 10/2013; 2013(1):751310. DOI:10.1155/2013/751310
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    • "However, the direct effect of vitamin D on the neuromuscular system in aged individuals has yet to be evaluated. Some postulate that the effect of vitamin D on muscle may be due to parathormone and not to a direct action of vitamin D on muscle (Annweiler et al., 2010). This mechanism needs to be addressed, but it is still conceivable that use of VDR ligands may present more benefit in the treatment of osteoporosis than originally thought by acting on both bone and muscle. "
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    ABSTRACT: Nuclear receptors are ligand-activated transcription factors and include the receptors for steroid hormones, lipophilic vitamins, sterols, and bile acids. These receptors serve as targets for development of myriad drugs that target a range of disorders. Classically defined ligands that bind to the ligand-binding domain of nuclear receptors, whether they are endogenous or synthetic, either activate receptor activity (agonists) or block activation (antagonists) and due to the ability to alter activity of the receptors are often termed receptor "modulators." The complex pharmacology of nuclear receptors has provided a class of ligands distinct from these simple modulators where ligands display agonist/partial agonist/antagonist function in a tissue or gene selective manner. This class of ligands is defined as selective modulators. Here, we review the development and pharmacology of a range of selective nuclear receptor modulators.
    Pharmacological reviews 02/2013; 65(2):710-78. DOI:10.1124/pr.112.006833 · 17.10 Impact Factor
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