Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis.
Kalyani, Rita Rastogi MD, MHS *; Stein, Brady MD, MHS +; Valiyil, Ritu MD, MHS ++; Manno, Rebecca MD, MHS ++; Maynard, Janet W. MD, MHS ++; Crews, Deidra C. MD, ScM [S]
Journal of the American Geriatrics Society.
58(7):1299-1310, July 2010.
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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.
(C) 2010 by the American Geriatrics Society