Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 20, 315-322

Institute of Clinical Osteology Gustav Pommer and Clinic Der Fürstenhof, Bad Pyrmont, Germany.
Osteoporosis International (Impact Factor: 4.17). 02/2009; 20(2):315-22. DOI: 10.1007/s00198-008-0662-7
Source: PubMed

ABSTRACT In 242 community-dwelling seniors, supplementation with either 1000 mg of calcium or 1000 mg of calcium plus vitamin D resulted in a decrease in the number of subjects with first falls of 27% at month 12 and 39% at month 20. Additionally, parameters of muscle function improved significantly.
The efficacy of vitamin D and calcium supplementation on risk of falling in the elderly is discussed controversially. Randomized controlled trials using falls as primary outcome are needed. We investigated long-term effects of calcium and vitamin D on falls and parameters of muscle function in community-dwelling elderly women and men.
Our study population consisted of 242 individuals recruited by advertisements and mailing lists (mean [ +/- SD] age, 77 +/- 4 years). All serum 25-hydroxyvitamin D (25[OH]D) levels were below 78 nmol/l. Individuals received in a double blinded fashion either 1000 mg of calcium or 1000 mg of calcium plus 800 IU of vitamin D per day over a treatment period of 12 months, which was followed by a treatment-free but still blinded observation period of 8 months. Falls were documented using diaries. The study took place in Bad Pyrmont, Germany (latitude 52 degrees ) and Graz, Austria (latitude 46 degrees ).
Compared to calcium mono, supplementation with calcium plus vitamin D resulted in a significant decrease in the number of subjects with first falls of 27% at month 12 (RR = 0.73; CI = 0.54-0.96) and 39% at month 20 (RR = 0.61; CI = 0.34-0.76). Concerning secondary endpoints, we observed significant improvements in quadriceps strength of 8%, a decrease in body sway of 28%, and a decrease in time needed to perform the TUG test of 11%.
Combined calcium and vitamin D supplementation proved superior to calcium alone in reducing the number of falls and improving muscle function in community-dwelling older individuals.

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Available from: Astrid Fahrleitner-Pammer, Sep 28, 2015
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    • "37.7 ± 9.1 (0) 37.8 ± 10.8 (10) 32.5 (10) * 3.25 (10) at 12 months Islam et al. 2010 [22] 35.0 ± 9.4) (0) 37.1 ±12.1 (10) 31.6 (10) 3.16 (10) at 12 months Karkkaine et al. 2010 [23] 49.2 ± 17.7 (0) 50.1 ± 18.8 (20) 23.7 (20) 1.27 (20) at 36 months Nelson et al. 2009 [24] 61.9 ± 22.6 (0) 62.1 ± 24.0 (20) 25.5 (20) 1.28 (20) at 12 months Pfeifer et al. 2009 [25] 54 ± 18 (0) 55 ± 18 (20) 26 (20) 1.3 (20) at 12 months Pignotti et al. 2010 [26] 52.9 ± 21.4 (0) 46.7 ± 14.0 (10) 6.9 (10) 0.69 (10) At 3 months Smith et al. 2009 [27] 36 ± 17 (0) 44 ± 18 (10) 15 (10) 1.5 (10) at 6 months Talwar et al. 2007 [28] 43.2 ± 16.8 (0) 46.9 ± 20.6 (20) 29.6 (20) 1.48 (20) at 3 months Viljakainen et al. 2006 [29] 52.2 ± 19.9 (0) 46.0 ± 14.3 (5) 46.5 ± 10.2 (10) 44.1 ± 13.5 (20) 10.9 (5) 21.4 (10) 35.1 (20) 2.18 (5) 2.14 (10) 1.76 (20) at 12 weeks Bonjour et al. 2013 [30] 16.2 ± 0.6 (0) 19.2 ± 1.2 (10) 20.2 (10) 2.02 (10) at 8 weeks * as reported by authors. "
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    ABSTRACT: There is controversy surrounding the designation of vitamin D adequacy as defined by circulating levels of the metabolite 25-hydroxyvitamin D (25(OH)D). Depending on the cutoff level chosen, dietary intakes of vitamin D may or may not provide sufficient impact upon vitamin D status measured as improvement in serum levels of 25(OH)D. We sought to examine whether modest daily doses (5–20 μg) as found in fortified foods or multivitamin supplements had a measureable impact on vitamin D status, defined as moving from below to above 50 nmol/L, or from less than 30 nmol/L to above 30 nmol/L. Published literature was searched for relevant articles describing randomized controlled trials. Exclusion criteria were: studies not involving humans; review articles; studies lacking blood level data pre- and post-treatment; no control group; bolus treatments (weekly, monthly, yearly); vitamin D <5 μg or >20 μg; baseline 25(OH)D ≥75 nmol/L; subjects not defined as healthy; studies <8 weeks; and age <19 years. Of the 127 studies retrieved, 18 publications with 25 separate comparisons met criteria. The mean rate constant, defined as change in 25(OH)D in nmol/L per μg vitamin D administered, was calculated as 2.19 ± 0.97 nmol/L per μg. There was a significant negative correlation (r = −0.65, p = 0.0004) between rate constant and administered dose. To determine impact of the dose reflecting the Estimated Average Requirement (EAR) of 10 μg administered in nine studies (10 comparisons), in every case mean 25(OH)D status rose either from “insufficient” (30–50 nmol/L) to “sufficient” (>50 nmol/L) or from “deficient” (<30 nmol/L) to “insufficient” (>30 but <50 nmol/L). Our study shows that when baseline levels of groups were <75 nmol/L, for every microgram of vitamin D provided, 25(OH)D levels can be raised by 2 nmol/L; and further, when groups were deficient or insufficient in vitamin D, there was significant value in providing additional 10 μg per day of vitamin D.
    Nutrients 04/2015; 7(4):2311-2323. DOI:10.3390/nu7042311 · 3.27 Impact Factor
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    • "Most importantly, these benefits translated in a reduction in falls in some of the same trials [48–50]. In three recent double-blind RCTs supplementation with 800 IU vitamin D3 resulted in a 4-11% gain in lower extremity strength or function [48, 50], and an up to 28% improvement in body sway [48, 49] in older adults aged 65 and older within 2 to 12 months of treatment. Extending to trials among individuals with a lower risk of vitamin D deficiency and including open design trials, a recent meta-analysis by Stockton identified 17 RCTs that tested any form of vitamin D treatment and documented a muscle strength related endpoint. "
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    ABSTRACT: Besides its well-known effect on bone metabolism, recent researches suggest that vitamin D may also play a role in the muscular, immune, endocrine, and central nervous systems. Double-blind RCTs support vitamin D supplementation at a dose of 800 IU per day for the prevention of falls and fractures in the senior population. Ecological, case-control and cohort studies have suggested that high vitamin D levels were associated with a reduced risk of autoimmune diseases, type 2 diabetes, cardio-vascular diseases and cancer but large clinical trials are lacking today to provide solid evidence of a vitamin D benefit beyond bone health. At last, the optimal dose, route of administration, dosing interval and duration of vitamin D supplementation at a specific target dose beyond the prevention of vitamin D deficiency need to be further investigated.
    09/2014; 72(1):32. DOI:10.1186/2049-3258-72-32
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    • "Moreover, the effect of vitamin D administration on physical performance, falls, and muscle strength has been widely investigated. Short-and long-term studies collectively demonstrate a relationship between vitamin D status and fall prevention and improvement in muscle strength in community-dwelling older individuals receiving a long-term supplementation with calcium and vitamin D [90] [91] [92] (Table 1). Nevertheless, data are still conflicting [74, 81, 93–95]. "
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    ABSTRACT: The skin synthesis of vitamin D represents the first step of a metabolic pathway whose features have been extensively studied and clarified in the last decades. In particular, the production of active and inactive forms of the hormone and the actions of the corresponding enzymes have offered new insights into the knowledge of vitamin D metabolism. Additionally, the description of the different organs and tissues expressing the vitamin D receptor and its possible functions, as well as its genetic determinants, have allowed focusing on the interrelationship between vitamin D and many physiological and pathological functions. In this context, many studies reported the association between vitamin D and adipose tissue metabolism, as well as the possible role of the hormone in obesity, weight, and fat mass distribution. Finally, many reports focused on the vitamin D-related effects on skeletal muscle, particularly on the mechanisms by which vitamin D could directly affect muscle mass and strength. This paper is mainly aimed to review vitamin D metabolism and its relationship with obesity and skeletal muscle function.
    International Journal of Endocrinology 08/2014; 2014:841248. DOI:10.1155/2014/841248 · 1.95 Impact Factor
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