This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (277)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Quality of Care  • Evidence-Based Medicine  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis

Heike A. Bischoff-Ferrari, MD, MPH; Bess Dawson-Hughes, MD; Walter C. Willett, MD, DrPH; Hannes B. Staehelin, MD; Marlet G. Bazemore, MD; Robert Y. Zee, MD; John B. Wong, MD

JAMA. 2004;291:1999-2006.

Context  Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established.

Objective  To assess the effectiveness of vitamin D in preventing an older person from falling.

Data Sources  MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical experts, bibliographies, and abstracts. Search terms included trial terms: randomized-controlled trial or controlled-clinical trial or random-allocation or double-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vitamin D/aa[analogs & derivates] or ergocalciferol or vitamin D/bl[blood]; and with accidental falls or falls, and humans.

Study Selection  We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were excluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis.

Data Extraction  Independent extraction by 3 authors using predefined data fields including study quality indicators.

Data Synthesis  Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval [CI], 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 person from falling. The inclusion of 5 additional studies, involving 10 001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men.

Conclusions  Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered.

Author Affiliations: Divisions of Aging (Dr Bischoff-Ferrari) and Rheumatology, Immunology, and Allergy, the Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center (Dr Bischoff-Ferrari), Center for Cardiovascular Disease Prevention, Division of Preventive Medicine (Dr Zee), and Brigham and Women's Hospital, Harvard Medical School, and Department of Nutrition (Dr Willett), Harvard School of Public Health, Harvard University; Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, (Dr Dawson-Hughes); and Department of Medicine, Division of Clinical Decision Making, Tufts-New England Medical Center, Boston, Mass (Dr Wong); Department of Geriatrics, University Hospital Basel, Basel, Switzerland (Dr Staehelin); and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Bazemore).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women's Health Initiative Dietary Modification Trial
McTiernan et al.
Am. J. Clin. Nutr. 2009;89:1864-1876.
ABSTRACT | FULL TEXT  

Methodology and Baseline Characteristics for the Sarcopenia and Hip Fracture Study: A 5-Year Prospective Study
Fiatarone Singh et al.
J Gerontol A Biol Sci Med Sci 2009;64A:568-574.
ABSTRACT | FULL TEXT  

Recurrent and Injurious Falls in the Year Following Hip Fracture: A Prospective Study of Incidence and Risk Factors From the Sarcopenia and Hip Fracture Study
Lloyd et al.
J Gerontol A Biol Sci Med Sci 2009;64A:599-609.
ABSTRACT | FULL TEXT  

Vitamin D Beyond Bones in Chronic Obstructive Pulmonary Disease: Time to Act
Janssens et al.
Am. J. Respir. Crit. Care Med. 2009;179:630-636.
ABSTRACT | FULL TEXT  

Reporting of systematic reviews of micronutrients and health: a critical appraisal
Chung et al.
Am. J. Clin. Nutr. 2009;89:1099-1113.
ABSTRACT | FULL TEXT  

Implications of a New Definition of Vitamin D Deficiency in a Multiracial US Adolescent Population: The National Health and Nutrition Examination Survey III
Saintonge et al.
Pediatrics 2009;123:797-803.
ABSTRACT | FULL TEXT  

Postoperative Management of Hip Fractures: Recent inaugural IBMS BoneKEy Online Forum focused on pharmacological and non-pharmacological approaches to managing patients post-hip fracture
Andrews
IBMS BoneKEy 2009;6:55-62.
FULL TEXT  

New Therapies for Osteoporosis
Hegge et al.
Journal of Pharmacy Practice 2009;22:53-64.
ABSTRACT  

Vitamin D Status and Its Relationship to Body Fat, Final Height, and Peak Bone Mass in Young Women
Kremer et al.
J. Clin. Endocrinol. Metab. 2009;94:67-73.
ABSTRACT | FULL TEXT  

Clinical subsequent fractures cluster in time after first fractures
van Geel et al.
Ann Rheum Dis 2009;68:99-102.
ABSTRACT | FULL TEXT  

Vitamin D Deficiency: An Important, Common, and Easily Treatable Cardiovascular Risk Factor?
Lee et al.
J Am Coll Cardiol 2008;52:1949-1956.
ABSTRACT | FULL TEXT  

Fracture Prevention in Frail Older Adults: Why, When and How
Colon-Emeric
IBMS BoneKEy 2008;5:426-435.
ABSTRACT | FULL TEXT  

Vitamin D and Human Health: Lessons from Vitamin D Receptor Null Mice
Bouillon et al.
Endocr. Rev. 2008;29:726-776.
ABSTRACT | FULL TEXT  

Nutrients, Endpoints, and the Problem of Proof
Heaney
J. Nutr. 2008;138:1591-1595.
FULL TEXT  

Vitamin D in Health and Disease
Heaney
CJASN 2008;3:1535-1541.
ABSTRACT | FULL TEXT  

Serum 25-Hydroxyvitamin D Concentrations and Risk for Hip Fractures
Cauley et al.
ANN INTERN MED 2008;149:242-250.
ABSTRACT | FULL TEXT  

The Risk of Fracture Following Hospitalization in Older Women and Men
Gardner et al.
Arch Intern Med 2008;168:1671-1677.
ABSTRACT | FULL TEXT  

Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health
Cranney et al.
Am. J. Clin. Nutr. 2008;88:513S-519S.
ABSTRACT | FULL TEXT  

Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality
Dobnig et al.
Arch Intern Med 2008;168:1340-1349.
ABSTRACT | FULL TEXT  

Review: calcium supplementation, with or without vitamin D, prevents osteoporotic fractures in older people
Jamal and Emanoilidis
Evid. Based Med. 2008;13:53-53.
FULL TEXT  

Short-term vitamin D plus calcium did not prevent falls more than calcium alone in elderly inpatients
Earthy and Silv
Evid. Based Nurs. 2008;11:58-58.
FULL TEXT  

Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients
Li et al.
Nephrol Dial Transplant 2008;23:1396-1400.
ABSTRACT | FULL TEXT  

The Evolution of Unintentional Injury Mortality Among Elderly in Europe
Petridou et al.
J Aging Health 2008;20:159-182.
ABSTRACT  

Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis
MacLean et al.
ANN INTERN MED 2008;148:197-213.
ABSTRACT | FULL TEXT  

Effects of Ergocalciferol Added to Calcium on the Risk of Falls in Elderly High-Risk Women
Prince et al.
Arch Intern Med 2008;168:103-108.
ABSTRACT | FULL TEXT  

Vitamin D supplementation has minor effects on parathyroid hormone and bone turnover markers in vitamin D deficient bedridden older patients
Bjorkman et al.
Age Ageing 2008;37:25-31.
ABSTRACT | FULL TEXT  

Association of Serum Vitamin D Levels With Inflammatory Response Following Hip Fracture: The Baltimore Hip Studies
Miller et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2007;62:1402-1406.
ABSTRACT | FULL TEXT  

Vitamin D Supplementation and Total Mortality: A Meta-analysis of Randomized Controlled Trials
Autier and Gandini
Arch Intern Med 2007;167:1730-1737.
ABSTRACT | FULL TEXT  

Safety of vitamin D3 in adults with multiple sclerosis
Kimball et al.
Am. J. Clin. Nutr. 2007;86:645-651.
ABSTRACT | FULL TEXT  

Does vitamin D stop inpatients falling? A randomised controlled trial
Burleigh et al.
Age Ageing 2007;36:507-513.
ABSTRACT | FULL TEXT  

Assessment of non-vertebral fracture risk in postmenopausal women
Roux et al.
Ann Rheum Dis 2007;66:931-935.
ABSTRACT | FULL TEXT  

Vitamin D and Rehabilitation: Improving Functional Outcomes
Shinchuk and Holick
Nutr Clin Pract 2007;22:297-304.
ABSTRACT | FULL TEXT  

Not enough vitamin D: Health consequences for Canadians
Schwalfenberg
cfp 2007;53:841-854.
ABSTRACT | FULL TEXT  

Association Between Vitamin D Status and Physical Performance: The InCHIANTI Study
Houston et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2007;62:440-446.
ABSTRACT | FULL TEXT  

Need for Additional Calcium to Reduce the Risk of Hip Fracture with Vitamin D Supplementation: Evidence from a Comparative Metaanalysis of Randomized Controlled Trials
Boonen et al.
J. Clin. Endocrinol. Metab. 2007;92:1415-1423.
ABSTRACT | FULL TEXT  

The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta-analysis
Jackson et al.
QJM 2007;100:185-192.
ABSTRACT | FULL TEXT  

Bone health
Heaney
Am. J. Clin. Nutr. 2007;85:300S-303S.
ABSTRACT | FULL TEXT  

Validation of a 4-Item Score Predicting Hip Fracture and Mortality Risk Among Elderly Women
Albertsson et al.
Ann Fam Med 2007;5:48-56.
ABSTRACT | FULL TEXT  

A 55-Year-Old Woman With Osteopenia
Cummings
JAMA 2006;296:2601-2610.
ABSTRACT | FULL TEXT  

Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial
Zermansky et al.
Age Ageing 2006;35:586-591.
ABSTRACT | FULL TEXT  

Nutrition, chronic disease, and the problem of proof.
Heaney
Am. J. Clin. Nutr. 2006;84:471-472.
FULL TEXT  

Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission.
Visser et al.
Am. J. Clin. Nutr. 2006;84:616-622.
ABSTRACT | FULL TEXT  

Vitamin D Status in Relation to One-Year Risk of Recurrent Falling in Older Men and Women
Snijder et al.
J. Clin. Endocrinol. Metab. 2006;91:2980-2985.
ABSTRACT | FULL TEXT  

Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes
Bischoff-Ferrari et al.
Am. J. Clin. Nutr. 2006;84:18-28.
ABSTRACT | FULL TEXT  

The effect of undernutrition in the development of frailty in older persons.
Bischoff et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2006;61:585-589.
FULL TEXT  

The myth of the female athlete triad
DiPietro and Stachenfeld
Br. J. Sports. Med. 2006;40:490-493.
FULL TEXT  

Calcium and vitamin D in the prevention of osteoporotic fractures
Francis et al.
QJM 2006;99:355-363.
FULL TEXT  

Diagnosis, Screening, Prevention, and Treatment of Osteoporosis
Mauck and Clarke
Mayo Clin Proc. 2006;81:662-672.
ABSTRACT | FULL TEXT  

Primary vitamin D deficiency in adults
DTB 2006;44:25-29.
ABSTRACT | FULL TEXT  

High Prevalence of Vitamin D Inadequacy and Implications for Health
Holick
Mayo Clin Proc. 2006;81:353-373.
ABSTRACT | FULL TEXT  

Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial.
Bischoff-Ferrari et al.
Arch Intern Med 2006;166:424-430.
ABSTRACT | FULL TEXT  

Calcium plus Vitamin D Supplementation and the Risk of Fractures
Jackson et al.
NEJM 2006;354:669-683.
ABSTRACT | FULL TEXT  

Risk of Osteoporotic Fracture in Elderly Patients Taking Warfarin: Results From the National Registry of Atrial Fibrillation 2
Gage et al.
Arch Intern Med 2006;166:241-246.
ABSTRACT | FULL TEXT  

Sato Shines a Light on Sunshine
Dawson-Hughes
IBMS BoneKEy 2005;2:39-41.
FULL TEXT  

Vitamin D inadequacy among post-menopausal women: a systematic review
Gaugris et al.
QJM 2005;98:667-676.
ABSTRACT | FULL TEXT  

Postmenopausal Osteoporosis
Rosen
NEJM 2005;353:595-603.
FULL TEXT  

The Prevention of Hip Fracture With Risedronate and Ergocalciferol Plus Calcium Supplementation in Elderly Women With Alzheimer Disease: A Randomized Controlled Trial
Sato et al.
Arch Intern Med 2005;165:1737-1742.
ABSTRACT | FULL TEXT  

Update in General Internal Medicine
Sheffield and Larson
ANN INTERN MED 2005;143:212-221.
FULL TEXT  

Screening for Osteoporosis
Raisz
NEJM 2005;353:164-171.
FULL TEXT  

To D or Not to D
Heaney
IBMS BoneKEy 2005;2:28-31.
FULL TEXT  

Prevalence of Vitamin D Inadequacy among Postmenopausal North American Women Receiving Osteoporosis Therapy
Holick et al.
J. Clin. Endocrinol. Metab. 2005;90:3215-3224.
ABSTRACT | FULL TEXT  

Fracture Prevention With Vitamin D Supplementation: A Meta-analysis of Randomized Controlled Trials
Bischoff-Ferrari et al.
JAMA 2005;293:2257-2264.
ABSTRACT | FULL TEXT  

Osteoporosis: the role of micronutrients
Nieves
Am. J. Clin. Nutr. 2005;81:1232S-1239S.
ABSTRACT | FULL TEXT  

Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care
Porthouse et al.
BMJ 2005;330:1003.
ABSTRACT | FULL TEXT  

The Role of Vitamin D in Fracture Prevention
Dawson-Hughes
IBMS BoneKEy 2005;2:6-10.
FULL TEXT  

Vitamin D Repletion in Patients with Primary Hyperparathyroidism and Coexistent Vitamin D Insufficiency
Grey et al.
J. Clin. Endocrinol. Metab. 2005;90:2122-2126.
ABSTRACT | FULL TEXT  

Review: prophylactic use of vitamin D reduces falls in older persons
Johnson
Evid. Based Med. 2004;9:169-169.
FULL TEXT  

Review: prophylactic use of vitamin D reduces falls in older people
Monaghan
Evid. Based Nurs. 2004;7:119-119.
FULL TEXT  

Vitamin D for Preventing Falls in Elders?
JWatch General 2004;2004:3-3.
FULL TEXT