Vitamin D for Fall Prevention

Vitamin D may help prevent falls in the elderly, according to a new analysis published in the British Medical Journal. The study supports earlier findings that vitamin D may improve balance, strength and bone health among older adults.

Vitamin D is found in many dietary sources, such as fish (such as salmon and tuna), fish liver oil and fortified foods (such as milk and cereal). The body also makes vitamin D when the skin is exposed to ultraviolet-B (UVB) rays from sunlight. Vitamin D helps the body maintain normal blood levels of phosphorus and aids in the absorption of calcium, which is important to develop and maintain strong bones. Recent evidence also suggests vitamin D may provide protection from osteoporosis, high blood pressure, cancer and several autoimmune diseases.

The researchers analyzed data from eight studies that tested the effects of vitamin D on fall prevention in 2,426 adults who were at least 65 years old.

The authors found that taking 700-1,000 IU of vitamin D2 or vitamin D3 for two to five months significantly reduced the risk of falls by 19 percent and 26 percent, respectively. The beneficial effects remained after adjusting for age, living environment and calcium supplementation.

However, the dose is higher than the current recommended amount. The recommended amount for people who are 50-70 years old is 400 IU, while 600 IU is recommended for those who are older than 70. Some researchers have questioned whether the current recommended adequate levels are sufficient to meet physiological needs, particularly for people who are no exposed to sunlight regularly. The Institute of Medicine, Food and Nutrition Board recommends an upper limit of 2,000 IU of vitamin D, as higher doses may have toxic effects.

Vitamin D may interact with other agents, particularly digoxin, corticosteroids, stimulant laxatives, thiazide diuretics and herbs or supplements with similar effects. To learn more about potential interactions, please visit Natural Standard's Interactions Checker.

For more information about vitamin D, please visit Natural Standard's Foods, Herbs & Supplements database.

Comments

[Scarlett]

Fall prevention in the over-65 years-of-age population is an essential part of health maintenance. While a tumble down the stairs may result in a bruise or sprain in a younger person, the chances of a fracture are much higher in a senior. Likewise, a broken bone might sideline a 30-year old for a few weeks, but that same injury can have devastating medical consequences for a 70-year old. Treatment might include an extensive hospitalization, surgery or even admission to a rehabilitation facility. It is encouraging to see positive results regarding methods to enhance fall prevention, and hopefully further studies will pinpoint the correct way to utilize vitamin D supplementation.

[Tasha]

After reading this study, I'm curious about how much vitamin D the body produces when you're out in the sun, and how long you need to be exposed to the sun (per day? per week?) to get this benefit. 700 to 1,000 IU per day is a big jump from the current recommended level of 400, but it seems that it would be smart to get at least some of the additional vitamin D needed naturally by being outside, particularly in light of the potential for drug interactions. Seniors typically take so many medications and have so many issues with interactions and side effects already that it seems smart not to introduce more if it's not necessary.

[GC]

Vitamin D for the prevention of falls does make sense since vitamin D aids in the absorption of calcium, so it does help maintain bone structure. A deficiency in vitamin D does increase as you get older, so this study has some relevance. As people age, they naturally have a lower level of vitamin D. On top of that, they’re less likely to be outside, exposed to the sun. These are the people who really need vitamin D the most.

But people who are not elderly should also be aware of their levels of vitamin D, especially those people who live in areas where they may be inside for long stretches of time (ex. living in the Northeast). In these regions, vitamin D deficiency not only reaches the elderly, but also a lot of the population.

[Dave]

So vitamin D protects your bones from the event of a fall. This is great information and should definitely be investigated further. If there is an additional protective effect from vitamin D supplementation at doses higher than what is normally given, then this should be looked in to. Do the same doses for vitamin D2 and D3 have the same effect?

[PL]

Is the amount of vitamin D produced by sun exposure enough to help prevent falls? I was wondering if an elderly person lives in the tropics and is exposed to a lot of sun, does this mean he/she is less likely to be vitamin D deficient?

[Mary]

My mom (who is in her 50s) was vitamin D deficient, so her primary care physician sent her to a bone endocrinologist for further work up. The endocrinologist recommended that she spend 10 minutes per day outside in the sun without sunscreen in hopes that her body would produce more active vitamin D. Ten minutes seems reasonable, even for someone with fair skin who burns easily (like my mother). Patients would just want to be careful if they're taking certain medications that make them more sensitive to the sun, such as ciprofloxacin.

[CD]

It is very interesting to see all of this new info on vitamin D, including the increasing doses. Let's also not forget that vitamin D is also being looked at for depression, and that there may be a possible link between low levels of D and depression. Additionally, you need to be aware of your D levels and where you reside. It is known that people who live in the northeastern part of the U.S. have notoriously lower levels due to the weather conditions. Getting out early in the morning (6-7AM), unprotected, will get you off to a good start and help your body absorb the rays that are not as harmful as exposure to them later in the day.

[EH]

The fact that vitamin D is associated with fall prevention isn’t something surprising to a lot of us, given its well-known effect in aiding our body’s absorption of calcium. What we should have found interesting after reading this new study is the dosage amount of vitamin D that was needed to bring such an effect.

Since the Dietary Reference Intake (DRI) for vitamin D (400 IU daily) was established in 1997, new data presented in different clinical studies have become available concerning its wide range of health outcomes, but no new recommendation has yet been set up. Along with the previous findings, hopefully this study would lead to more rigorous research in reestablishing the current recommended intake of vitamin D.

[Celia]

Fall prevention is such a simple and important part of keeping the elderly population healthy. I agree with some other comments that discuss the ability to get vitamin D from the sun rather than supplements. It is best to get a regular small amount of sunlight to help the body naturally produce vitamin D, but it is also important to take into consideration that cloud cover, glass and sunscreen over SPF 8 reduce UV rays enough to prevent the synthesis of vitamin D. There are also times of the year in certain areas, such as November through February anywhere between Northern California and Boston, when UV energy is insufficient for vitamin D synthesis.

In addition to the Natural Standard monograph on vitamin D, the National Institutes of Health provide a very informative fact sheet: http://ods.od.nih.gov/factsheets/vitamind.asp#h3.

[T.b.]

Let's not forget vitamin B-12 also for maintaining a healthy body and coordination. Elderly people and vegans often have deficient levels of vitamin B-12. I am still in my 20s, and I can say I get a lot of sun exposure, yet I find my self swaying and tripping on myself. Verdict from the doctor and herbalist: cobalamine deficient.

[Adam]

Vitamin D2 and D3 are not equally effective compounds. The scientific name for vitamin D2 is ergocalciferol, and that of D3 is cholecalciferol. Oftentimes, those are the names listed as ingredients, so it is important to be able to recognize them. Ergocalciferol is not absorbed well in the body, so taking those supplements will not provide you with as much vitamin D. You will get much more vitamin D from cholecalciferol. In addition, the two compounds affect parathyroid hormone levels differently (levels increase in the setting of vitamin D deficiency). Ergocalciferol failed to restore normal levels, while cholecalciferol succeeded according to a few studies. The next time you buy a vitamin D supplement or multi-vitamin, make sure it says cholecalciferol on the bottle!

http://www.easy-immune-health.com/Vitamin-D3.html

[KC]

PL raises a pretty interesting topic. I wonder if there have been any studies regarding the amount of sun exposure to certain populations compared to the number of falls in people of the same or different population. I would think a study of this nature should not be that difficult to do, although many factors would be involved in determining if the sun itself was an important factor in terms of falls. For instance, there could be more falls in Florida, but it may not be because of the sun, but simply because of the large population density of the elderly. But I do think a study of this nature would be quite interesting.

[Kevin]

The primary roles of vitamins have been known for a long time, but as research continues, we are finding more and more supplemental functions of these vitamins. What we initially found to promote the absorption of calcium now seems to have effects on the brain by improving balance and preventing falls. I am glad this research is still being done because obviously our knowledge of what these substances do in our bodies is incomplete.

Vitamin D is also said to be preventative for different types of cancer, type 1 diabetes and heart disease:
http://www.ajcn.org/cgi/content/abstract/79/3/362

[karina gordin]

According to the new analysis published in the British Medical Journal on vitamin D and fall prevention in the elderly, the researchers noted that taking 700-1,000IU of vitamin D2 or vitamin D3 for 2-5 months significantly reduced the risk of falls, respectively by 19% and 26%.

This made me consider the differences between vitamin D2 and D3, and why if D3 reduces the risk of falls more successfully than D2, physicians are still writing prescriptions for D2, rather than the superior counterpart. Could it be money? I can't be sure, but one thing I do know is that the differences between D2 and D3 are remarkable, and patients should be informed about what their doctors are recommending, insurance companies are wiling to pay for, and pharmacists are providing.

Firstly, vitamin D absorption is very much affected by which type of vitamin D is being administered. Research backs this claim by stating that “D2 (ergocalciferol) has lower bioactivity, poorer stability, and shorter duration of action, resulting in approximately 33% lower potencycompared with vitamin D3.” [From ‘The Value of Vitamin D3 over Vitamin D2 in Older Persons’ Barbara J. Zarowitz PharmD, FCCP, BCPS, CGP, FASCP.]

Most over the over-the-counter vitamin D supplements and ALL prescription vitamin D supplements contain vitamin D2, which is the synthetic counterpart. Vitamin D2 is used to fortify foods, added to some vitamin D supplements and is the basis for all prescription vitamin D. “Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification.” [From ‘The case against ergocalciferol (vitamin D2) as a vitamin supplement’. Houghton LA, Vieth R.]

I had the privilege of sitting in on a lecture offered by Dr. Holick, and he stated that "...Vitamin D2 is only about 20-40% as effective as cholecalciferol …” Of course, if it were simply a matter of poor bio-availability, then administering more vit. D2 might demonstrate a better outcome; but unfortunately, such is not the case. D2 just doesn't carry out the job it's programmed to do. Specifically, a consequence of vitamin D deficiency is an overactive parathyroid gland, altering calcium metabolism. When good-quality vitamin D is replenished, the parathyroid hormone is lowered back to normal levels. It must be noted that in a few studies, the parathyroid hormone was not reduced to normal levels with the administration of vitamin D2, while with D3 administration the levels decreased back to normal.

I recommend just skipping the prescription and buying a food-based vit D3 supplement (cholecalciferol).

[Bill]

When I first glanced at this article, my initial thought was "how does vitamin D prevent falls?" I knew that vitamin D could reduce the incidence of fractures in the event of a fall, but was not aware of the benefit of vitamin D in the prevention of a fall. After reading this article, it became apparent to me that vitamin D not only strengthens bones, but it also has an important role in muscle strength.

There are vitamin D receptors in human muscle tissue, which when given vitamin D supplementation, can improve strength, function and balance. It is great that a simple vitamin D supplement can do much more than promote bone health.

[Hazel]

It is important to evaluate elderly patients’ medication lists because many medications have the potential to make the elderly fall, so avoiding this initially would be best. It is also important to encourage alternative therapy to patients, especially patients who are older and are taking multiple medications for their multiple health conditions, before initiating drug therapy. This could avoid unnecessary drug-drug interactions and further complications.

[Ali]

Thankfully, I am not at the age where I need to worry as much about fall prevention, but I found this article interesting because I am interested in dietary issues. I was happy to learn that two of my favorite foods (salmon and mushrooms) are high in vitamin D.

[tea]

It seems that vitamin D is more important than calcium for preventing falls; although calcium may be helpful in maintaining stronger bones. Therefore, to maintain healthy bones and prevent falls and fractures as you age, make sure to consume adequate amounts of vitamin D and calcium each day.

[Mo]

A lot of the reading I’ve done regarding vitamin D seems to imply that vitamin D intake above the current recommended amount has greater rates of efficacy in improving bone health and strength, especially in areas where the population doesn’t get much sun exposure. The current recommendations are probably outdated because there is a lot of information out there emphasizing the importance of vitamin D and its benefits and the fact that many people are deficient. I recently discussed this topic with a friend since his dad started taking 1,200 IU/day of vitamin D, and he was researching what amount is considered “too much.” He let me know that most of the research he had done cautioned against an intake above 2,000 IU/day, but also stated that cases of reported vitamin D toxicity were associated with even much higher levels of intake

[Jacob]

Having parents and grandparents who are in this age group, I am always looking for ways to keep them healthier. Falling has increasingly become a major concern of mine, and now that I can suggest something for them that can decrease their chance of falls, I will have one less worry about them. It is interesting to know the differences between the two different forms of vitamin D. When I do suggest that my family take vitamin D supplements to prevent falls, I will make sure they get products containing cholecalciferol.

[Frieda]

This story gives me one more reason to encourage my parents to eat more salmon and tuna. Since they live in the Midwest, I know they do not get enough sun exposure to prevent falls. I already encourage fish for the healthy fats, and now I can add vitamin D to the list.

[tina]

Vitamin D was recently in the news regarding its use as a treatment or prevention strategy for the H1N1 flu. Researchers found that people who were most likely to die from the flu also had Vitamin D deficiency, so people are proposing that vitamin D supplementation can prevent the flu. It makes me think about the proposed mechanism of these effects. Is it just that people who are vitamin D deficient are also deficient in other vitamins and minerals and are therefore less healthy and more likely to get sick?

[JS]

I know a pharmacist that recommended taking Nordic Naturals Omega 3D. Apparently, this is a really good product, although I have yet to find it. I think I have to go to a Whole Foods or a GNC to find it because I haven't seen it at the big-chain pharmacies, like CVS or Walgreens.

From what I was told, they have this in capsule form and liquid form. The pharmacist told me that he uses the liquid form because it's more concentrated, and he only has to take that once a day instead of several times like with the capsule.

I asked about the taste, and he said it was pretty good, and it had a lemon flavor. With the good things I've heard about omega-3's, maybe this is a product that can be very beneficial, as it also has vitamin D in it.

[Grace Caulfield]

This is very important, especially because more and more people are finding that they have low levels of vitamin D to begin with. I think people have shied away from taking vitamin D as a supplement because it is a fat-soluble vitamin. People need to know it’s an important part of their diet, especially if they already have low levels.

[Jenny]

Vitamin D is not only good for patients with osteoarthritis/osteoporosis, but it's also helpful for patients with seizures. I’ve been working in an epilepsy clinic, and we strongly recommend patients to take vitamin D supplements to prevent falling. Patients with seizures have a high risk of falling, in addition, most of anti-seizure medications interfere with absorption of vitamin D via liver.

Vitamin D is fat-soluble vitamin that is mainly metabolized by the liver, and most anti-seizure medications induce liver enzymes so that they can metabolize vitamin D faster. It’s good to encourage any seizure patients to have enough vitamin D or any fat-soluble vitamin intake (vit A, vit E, and vit K).

[DF]

As for how much sun exposure is needed to produce adequate levels of vitamin D, a 2007 study by K. Binkley suggests that even ample exposure may not be enough for some people. Among 93 young adults in Honolulu, Hawaii, who reported being outside with no sunscreen for an average of three hours per day, 51 percent had low blood levels of vitamin D. Amazing! This is one more argument for regular supplementation with vitamin D, especially by elderly people seeking to prevent falls.

[alexa]

It’s been pretty well-known that vitamin D is important and necessary for adequate bone health, and better bone health usually means fewer falls, especially for the elderly.

It’s probably a good idea for most elderly patients to take additional forms calcium and vitamin D since most people don’t obtain enough from their diets and supplementation has been shown to have many health benefits. However, when recommending this, it is important to keep in mind other medications one may be on because of possible interactions.

[Luba]

There is a great paper discussing the use of vitamin D for fall prevention in the elderly. (Pfeifer M., Begerow B., Minne H.W., Suppan K., Fahrleitner-Pammer A., Dobnig H. Effects of a Long-Term Vitamin D and Calcium Supplementation on Falls and Parameters of Muscle Function in Community-Dwelling Older Individuals. Osteoporos Int (2009) 20:315-322.)

The majority of the elderly population living in the Northern Hemisphere is vitamin D deficient. Likewise, the majority of the elderly population, women in particular, are a greater risk for osteoporosis. Vitamin D and calcium supplementation are essential for health maintenance in the elderly.

[rsamd]

Falls in the elderly population are a HUGE issue. I have worked for a short amount of time in nursing homes, and while there are certain methods to prevent falls (walkers, bed rails, one-on-one physical therapy), there are still a large percentage of individuals who experience falls. This is possibly due to the medications they are on, which can be highly sedating and also lead to less muscle control.

Vitamin D supplementation is actually a big thing in these nursing homes, so it’s good to see that it’s becoming a recommendation for all older individuals and not just those living in a skilled nursing facility or assisted living home. It’s also good to remember the drug interactions, as the drugs seen are commonly used in the older population.