DNC News


Falling for Vitamin D:

Subject: Vitamin D deficiency increases falls in elderly populations. Supplementation may be helpful for muscle weakness


Bottom line: Elderly people need to take more vitamin D


Vitamin D has been in the news over the last year. A few months ago I wrote reviewing research that links Vitamin D, multiple sclerosis, rheumatoid arthritis and diabetes. Two new studies have come out pointing to vitamin D deficiency increasing the frequency of falls in the elderly.


It's well known that vitamin D is needed for strong bones; without enough D, the body can't adequately absorb the calcium crucial to bone density. It's also well known that older people don't get enough D in their diets. The recommended amount for people 71 and older is 600 International Units daily. But the only food that meets a substantial portion of that need is vitamin D-fortified milk, with 100 units per cup. And few people drink even 1 or 2 cups of milk at day, let alone 6.


What's less well known is that vitamin D is also crucial to proper muscle function. As D is metabolized, or broken down, in the body, the compounds it forms directly enhance the maturation of muscle cells and muscle function. Unfortunately, large numbers of people in their 70s and older may have unnecessary muscle weakness attributable to vitamin D shortfalls that makes them tire easily, unable to function as well as possible, and more prone to falls. The weakness occurs predominantly in the legs, often manifested as a feeling of heaviness in the limbs and difficulty climbing stairs or getting up from a chair. But compromised handgrip strength has been seen, too.


Fortunately, vitamin D supplementation can reverse the problem. Several studies have reported that vitamin D supplementation improves muscle strength in elderly deficient populations. [1] [2] [3] In other studies, people given vitamin D (and calcium) were able to dress themselves more quickly and do better in other activities of daily living. [4] Still other research has shown that supplementation with D reduces body sway, reducing the chances of falling and breaking a bone.


In December of 2003 newspapers reported the results of an Australian study. Vitamin D was the unexpected risk factor contributing to falls and hip fractures in the elderly.


Researchers in Australia found that being severely deficient increased the risk of falls and that supplements reduced their number. The study of over 1500 women, led by Leon Flicker of the University of Western Australia in Perth , also found that severe vitamin D deficiency is surprisingly common, even in Australia .


Vitamin D is produced in the skin when it is exposed to sunlight, so the assumption had been that deficiency would not be a problem in sunny countries. But the new study found that almost half of elderly women in high-level residential care, though not bedridden, were severely deficient.


Furthermore, a fifth of elderly women who were healthy enough to live in low-level residential care were also severely deficient. Both groups of women had an average age of 84 years.


The deficient women had blood levels so low that the same levels in a growing child would cause bone abnormalities such as rickets, says research team member Caryl Nowson, of Deakin University in Melbourne .


Women in the study who were less severely vitamin D deficient were less likely to fall, with a doubling of vitamin D levels reducing their risk by 20 per cent. That association existed even when other risk factors, such as the use of sedatives, were taken into account. [5]


An unpublished study by the same team shows that supplements reduced the number of falls and the number of breaks caused. The supplements only need to be given every few months because the body can store vitamin D.

At the end of April, 2004, an American study was published on this same issue. The Journal of the American Medical Association published what is called a Meta-Analysis of the studies done on Vitamin D. No new data were generated. Dr. Bischoff-Ferrari, from Harvard Medical School in Boston , and colleagues analyzed old data from ten previous studies that looked at the association of Vitmin D and falls in elderly populations. Five of the studies were included in the main analysis, while the remaining five were used to verify the results, according to the report published in the Journal of the American Medical Association.


The analysis indicates that a daily vitamin D dose of 800 units reduces the incidence of falls in people aged 65 and older by 22 percent. [6]


About one-third of all persons 65 and older fall at least once a year, leading to 1.6 million emergency room treatments and 388,000 hospitalizations, government figures show. Falls are a leading cause of death and disability in old people. When a person in their eighties breaks a hip, there is a 30 percent chance they will die within a month. Falls cause 11,600 deaths a year in the US , most of them in people 75 and older who suffer hip fractures, the federal government estimates.


Reuters quotes Dr Bischoff-Ferrari as saying that, “Previous studies have shown vitamin D reduces the number of fractures caused by falls because it strengthens bones.” She makes it sound almost as if the earlier studies were news to her: "The new insight that we try to show in this study is that vitamin D reduces the risk of falling by affecting muscle strength favorably," she said.


The five studies analyzed in the report compared the incidence of falls in more than 1,200 older people who took either a vitamin D supplement, calcium or a placebo, under carefully controlled conditions.


The 800-unit-a-day recommendation in this JAMA study comes from the observation that the frequency of falls was not reduced in people who took 400 units a day of vitamin D, she said. Apparently they didn't have data on higher doses either.


A vitamin supplement is advisable because "in the United States , you can get some vitamin D through milk or supplemented orange juice, but not enough," Bischoff-Ferrari said. "Ideally, it should be taken in combination with a calcium supplement."


Dr. Michael Holick, director of the Boston University Vitamin D Laboratory, called the 800-unit-a-day recommendation conservative. Conservative meaning as in “Not Enough”


"We think that everybody needs 1,000 units a day," Holick said. "The problem is that there are good controlled studies for 800 units a day but not for 1,000 units a day." Dr. Holick may still be a moderate. Nowson and his colleagues in Australia perhaps are Liberal when they suggest that, “In cases of established vitamin D deficiency, supplementation with 3000-5000 IU per day for at least 1 month is required to replete body stores.” [7]



This is quite a change in suggested doses. Multivitamins rarely offer more than 400 IU per day. Expect to see some much higher doses of Vitamin D showing up on the shelves soon. We are already looking at a product that contains 2,000 IU per capsule. Vitamin D is stored in the body and one thought with these higher dose pills is to take a course of D several times a year but not necessarily daily.


[1] Z Rheumatol. 2000;59 Suppl 1:39-41. Relationship between muscle strength and vitamin D metabolites: are there therapeutic possibilities in the elderly? Bischoff HA, Stahelin HB, Tyndall A, Theiler R.

[2] Arch Phys Med Rehabil. 1999 Jan;80(1):54-8 Muscle strength in the elderly: its relation to vitamin D metabolites. Bischoff HA, Stahelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P, Tyndall A, Theiler R.

[3] J Gerontol A Biol Sci Med Sci. 2002 Jan;57(1):M7-11. Relation between vitamin D, physical performance, and disability in elderly persons. Zamboni M, Zoico E, Tosoni P, Zivelonghi A, Bortolani A, Maggi S, Di Francesco V, Bosello O

[4] Osteoporos Int. 2003 Jul;14(7):577-82. Epub 2003 Jul 11.   Prevalence of hypovitaminosis D in elderly women in Italy : clinical consequences and risk factors. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S.

[5] J Am Geriatr Soc. 2003 Nov;51(11):1533-8. Serum vitamin D and falls in older women in residential care in Australia . Flicker L,

[6] JAMA. 2004 Apr 28;291(16):1999-2006. Effect of Vitamin D on falls: a meta-analysis.

Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB.

[7] Aust Fam Physician. 2004 Mar;33(3):133-8. Vitamin D in Australia . Issues and recommendations. Nowson CA , Diamond TH, Pasco JA, Mason RS, Sambrook PN, Eisman JA


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