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Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a 'forgotten step'.
J Intern Med 2015; 277(1):16-44JI

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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(-1) , 1.44 (95% CI 1.17-1.76) for 25OHD <20 ng mL(-1) and 0.95 (95% CI 0.81-1.11) for 25OHD <30 ng mL(-1) .

CONCLUSIONS

Fallers have lower 25OHD concentrations, notably more often <20 ng mL(-1) , than nonfallers. These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls.

Authors+Show Affiliations

Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, Angers University Hospital and UPRES EA 4638, University of Angers, UNAM, Angers, France; Robarts Research Institute, The University of Western Ontario, London, ON, Canada.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

24697944

Citation

Annweiler, C, and O Beauchet. "Questioning Vitamin D Status of Elderly Fallers and Nonfallers: a Meta-analysis to Address a 'forgotten Step'." Journal of Internal Medicine, vol. 277, no. 1, 2015, pp. 16-44.
Annweiler C, Beauchet O. Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a 'forgotten step'. J Intern Med. 2015;277(1):16-44.
Annweiler, C., & Beauchet, O. (2015). Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a 'forgotten step'. Journal of Internal Medicine, 277(1), pp. 16-44. doi:10.1111/joim.12250.
Annweiler C, Beauchet O. Questioning Vitamin D Status of Elderly Fallers and Nonfallers: a Meta-analysis to Address a 'forgotten Step'. J Intern Med. 2015;277(1):16-44. PubMed PMID: 24697944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a 'forgotten step'. AU - Annweiler,C, AU - Beauchet,O, Y1 - 2014/05/23/ PY - 2014/4/5/entrez PY - 2014/4/5/pubmed PY - 2015/2/11/medline KW - accidental falls KW - meta-analysis KW - older adults KW - vitamin D SP - 16 EP - 44 JF - Journal of internal medicine JO - J. Intern. Med. VL - 277 IS - 1 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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(-1) , 1.44 (95% CI 1.17-1.76) for 25OHD <20 ng mL(-1) and 0.95 (95% CI 0.81-1.11) for 25OHD <30 ng mL(-1) . CONCLUSIONS: Fallers have lower 25OHD concentrations, notably more often <20 ng mL(-1) , than nonfallers. These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/24697944/Questioning_vitamin_D_status_of_elderly_fallers_and_nonfallers:_a_meta_analysis_to_address_a_'forgotten_step'_ L2 - https://doi.org/10.1111/joim.12250 DB - PRIME DP - Unbound Medicine ER -