Questioning vitamin D status of elderly fallers and nonfallers: a meta‐analysis to address a 'forgotten step'. (23rd May 2014)

• Record Type: Journal Article
• Authors: Annweiler, C.; Beauchet, O.
• Is Part Of: Journal of internal medicine. Volume 277:Number 1(2015:Jan.)
• Page Start: 16
• Page End: 44
• Publication Date: 2014-05-23
• Subjects: Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12250
• Languages: English
• ISSNs: 0954-6820

Abstract

<abstract abstract-type="main" id="joim12250-abs-0001"> <title>Abstract</title> <sec id="joim12250-sec-0001" sec-type="section"> <title>Background</title> <p>Previous meta‐analyses to determine the efficacy of vitamin D supplementation to prevent falls in the elderly have shown mixed results. Inconsistencies might depend on the dose of supplements, suggesting that serum 25‐hydroxyvitamin D (25OHD) concentration could influence the risk of falling. Our objective was to systematically review and quantitatively analyse the relationship between serum 25OHD concentration and the occurrence of falls.</p> </sec> <sec id="joim12250-sec-0002" sec-type="section"> <title>Methods</title> <p>A Medline search was conducted in December 2013, with no date limit, using the Medical Subject Heading terms 'Vitamin D' OR 'Ergocalciferols' OR 'Vitamin D deficiency' combined with 'Accidental Falls' OR 'Gait disorders, neurologic' OR 'Gait apraxia' OR 'Gait' OR 'Recurrent Falls' OR 'Falling'. Fixed and random‐effects meta‐analyses were performed to determine the following: (i) the effect size of the difference in 25OHD concentration between fallers and nonfallers and (ii) the risk of falling according to serum 25OHD concentration.</p> </sec> <sec id="joim12250-sec-0003" sec-type="section"> <title>Results</title> <p>Of the 659 retrieved studies, 18 observational studies – including ten cross‐sectional and eight cohort studies – met the selection criteria. All were of good quality. The number of participants ranged from 80 to 2957 (44–100% women); 11.0% to 69.3% were fallers. Serum 25OHD concentrations were 0.33 × SD lower in fallers compared to nonfallers [pooled effect size 0.33; 95% confidence interval (CI) 0.18–0.47]. The risk of falls was inversely associated with serum 25OHD concentration [summary odds ratio (OR) 0.97; 95% CI 0.96–0.99]. The association between falls and hypovitaminosis D varied according to the definition used; the summary OR for falls was 1.23 (95% CI 0.94–1.60) for 25OHD <10 ng mL<sup>−1</sup>, 1.44 (95% CI 1.17–1.76) for 25OHD <20 ng mL<sup>−1</sup> and 0.95 (95% CI 0.81–1.11) for 25OHD <30 ng mL<sup>−1</sup>.</p> </sec> <sec id="joim12250-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Fallers have lower 25OHD concentrations, notably more often <20 ng mL<sup>−1</sup>, than nonfallers. These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls.</p> </sec> </abstract>