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Articles April 2016 Issue

Extra Vitamin D No Help in Preventing Seniors' Falls

Latest disappointment in hopes for high-dose benefits.

IMAGE THINKSTOCK

If it's important to get enough vitamin D, is getting more even better? Probably not, experts are now cautioning. Hopes that extra doses of the "sunshine vitamin" might benefit a wide range of health conditions have been eclipsed by recent research.

Now a surprising new study reports that high doses of supplemental vitamin D were no more effective than lower doses in improving function in older patients. Higher doses were actually associated with a greater risk of falls. Besides working with calcium to build strong bones, vitamin D had been suggested as a way to build muscle strength in older adults, preventing falls.

But too much of a good thing may be as risky as too little, according to Bess Dawson-Hughes, MD, director of Tufts' HNRCA Bone Metabolism Laboratory and a co-author of the new study, published in JAMA Internal Medicine. "This study points to serum (blood) levels of vitamin D in the range of 21 to 45 ng/ml for fall risk reduction," she explains. "All participants achieved levels of at least 21 ng/ml during the trial, consistent with Institute of Medicine (IOM) recommendations; however, those reaching levels above 45 ng/ml had increased risk of falling. So repletion with the IOM recommended doses should provide the best protection, and going overboard is to be avoided."

The IOM recommends that people ages 70 and older should aim for a daily intake of vitamin D of 800 IU (International Units). Most older people, the IOM advises, do not need routine measurement of their blood levels of vitamin D.

THREE LEVELS: The study was led by Heike Bischoff-Ferrari, MD, DrPh, of University Hospital of Zurich, who is also a visiting scientist at Tufts. She and colleagues recruited 200 people in Switzerland, average age 78, two-thirds of them female, who had experienced low-trauma falls in the previous year. At the start, 58% were vitamin D deficient. Participants were split into three groups and followed for a year. Each group received a different dosage of vitamin D3, the most effective form:

➧ 24,000 IU monthly (the equivalent of the recommended 800 IU daily)

➧ 60,000 IU monthly

➧ 24,000 IU monthly plus a vitamin D product called calcifediol.

The second and third groups were more likely to reach a desirable blood vitamin D level of at least 30 ng/mL. But that improvement didn’t translate into better lower-extremity function or reduced fall risk.

Scores on a battery of physical tests did not vary significantly among the groups at the end of the follow-up period, although the lowest-dose group (equivalent to 800 IU daily) showed more improvement in leg function. That lower-dose group also actually had the lowest incidence of falls, at 48%, compared to two-thirds in the two higher-dose groups. The 60,000 IU and 24,000 IU plus calcifediol groups also averaged more total falls than the lowest-dose participants. Those in the highest-dose group averaged roughly half again as many falls as those getting the lowest dose.

JUST ENOUGH: Why might extra vitamin D be associated with greater risk of falls? Researchers speculated that higher doses might make seniors more active, putting them at greater risk of mishaps. An accompanying editorial suggested instead that too much vitamin D might disrupt muscle activity.

That editorial, by Steven R. Cummings, MD, of California Pacific Medical Center Research Institute, and colleagues, commented, "The vitamin D story seems to be following the familiar pattern observed with antioxidant vitamins," such as vitamin E, beta-carotene and vitamin C. In that pattern, they wrote, initial enthusiasm for supplementation, reinforced by observational studies "showing, essentially, that healthy people have higher vitamin levels," fails to be supported by randomized clinical trials or meta-analyses. (See box)

If you're not getting enough vitamin D from food (as is generally the case) or don't get much sunshine, you might still want to take a supplement. But don't overdo it in hopes that vitamin D is the latest "magic bullet" - that notion is a misfire.

TO LEARN MORE: JAMA Internal Medicine, January 2016 -

http://archinte.jamanetwork.com/article.aspx?articleid=2478897

TO LEARN MORE: New England Journal of Medicine -

http://www.nejm.org/doi/full/10.1056/NEJMoa1500409?query=featured_home

TO LEARN MORE: Seminars in Arthritis and Rheumatism -

http://www.semarthritisrheumatism.com/article/S0049-0172(15)00239-5/abstract

TO LEARN MORE: Journal of Nutrition, December 2015 -

http://jn.nutrition.org/content/145/12/2683

Comments (1)

It is curious to me how we all fall prey to the latest "fad" and then are warned off. Why not wait a while before pushing the "new thing". Until more data becomes available. Or are we the test cases? Vitamin D was recommended to me. Now what do I do? I live in Southern California where there is an abundance of sunshine, however from a skin cancer point of view I stay out of direct sun as much as possible and also wear a good sunscreen. I am sure I will figure this out for myself as I feel I am my best advisor. Soon to be 88, Gwenn Truax

Posted by: Gwenn Truax | October 24, 2016 4:13 PM    Report this comment

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