Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial

Authors

  • Leon Flicker MBBS, PhD,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Robert J. MacInnis BSc, G Dip Epi Biostat,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Mark S. Stein MBBS, PhD,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Sam C. Scherer MB, BS,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Kate E. Mead B App Sc,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Caryl A. Nowson PhD,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Jenny Thomas RN,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • Chris Lowndes RN,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • John L. Hopper PhD,

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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  • John D. Wark MBBS, PhD

    1. From the *School of Medicine and Pharmacology, University of Western Australia, Perth, AustraliaCancer Epidemiology Center, Cancer Council Victoria, Melbourne, AustraliaSchool of Population Health, §Department of Medicine, Center for Genetic Epidemiology, University of Melbourne, Melbourne, AustraliaDepartment of Diabetes and Endocrinology, #Bone and Mineral Service, Royal Melbourne Hospital, Melbourne, Australia**Royal Freemasons' Homes of Victoria, Stonnington, Australia††School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
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Errata

This article is corrected by:

  1. Errata: Erratum Volume 60, Issue 8, 1599, Article first published online: 13 August 2012

Address correspondence to Leon Flicker, Professor of Geriatric Medicine, University of Western Australia, Royal Perth Hospital, Box X2213 GPO, Perth WA 6001, Australia. E-mail: leonflic@cyllene.uwa.edu.au

Abstract

Objectives: To determine whether vitamin D supplementation can reduce the incidence of falls and fractures in older people in residential care who are not classically vitamin D deficient.

Design: Randomized, placebo-controlled double-blind, trial of 2 years' duration.

Setting: Multicenter study in 60 hostels (assisted living facilities) and 89 nursing homes across Australia.

Participants: Six hundred twenty-five residents (mean age 83.4) with serum 25-hydroxyvitamin D levels between 25 and 90 nmol/L.

Intervention: Vitamin D supplementation (ergocalciferol, initially 10,000 IU given once weekly and then 1,000 IU daily) or placebo for 2 years. All subjects received 600 mg of elemental calcium daily as calcium carbonate.

Measurements: Falls and fractures recorded prospectively in study diaries by care staff.

Results: The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, the incident rate ratio for falling was 0.73 (95% confidence interval (CI)=0.57–0.95). The odds ratio for ever falling was 0.82 (95% CI=0.59–1.12) and for ever fracturing was 0.69 (95% CI=0.40–1.18). An a priori subgroup analysis of subjects who took at least half the prescribed capsules (n=540), demonstrated an incident rate ratio for falls of 0.63 (95% CI=0.48–0.82), an odds ratio (OR) for ever falling of 0.70 (95% CI=0.50–0.99), and an OR for ever fracturing of 0.68 (95% CI=0.38–1.22).

Conclusion: Older people in residential care can reduce their incidence of falls if they take a vitamin D supplement for 2 years even if they are not initially classically vitamin D deficient.

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