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Keywords:

  • vitamin D;
  • falls;
  • elderly;
  • randomized controlled trials;
  • systematic review

OBJECTIVES: To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults.

DESIGN: Systematic review and meta-analysis.

SETTING: MEDLINE, CINAHL, Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies.

PARTICIPANTS: Older adults (aged ≥60) who participated in randomized controlled trials that both investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition.

MEASUREMENTS: Two authors independently extracted data, including study characteristics, quality assessment, and outcomes. The I2 statistic was used to assess heterogeneity in a random-effects model.

RESULTS: Of 1,679 potentially relevant articles, 10 met inclusion criteria. In pooled analysis, vitamin D therapy (200–1,000 IU) resulted in 14% (relative risk (RR)=0.86, 95% confidence interval (CI)=0.79–0.93; I2=7%) fewer falls than calcium or placebo (number needed to treat =15). The following subgroups had significantly fewer falls: community-dwelling (aged <80), adjunctive calcium supplementation, no history of fractures or falls, duration longer than 6 months, cholecalciferol, and dose of 800 IU or greater. Meta-regression demonstrated no linear association between vitamin D dose or duration and treatment effect. Post hoc analysis including seven additional studies (17 total) without explicit fall definitions yielded smaller benefit (RR=0.92, 95% CI=0.87–0.98) and more heterogeneity (I2=36%) but found significant intergroup differences favoring adjunctive calcium over none (P=.001).

CONCLUSION: Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit.