Should Vitamin D Supplements Be Taken to Prevent Falls in the Elderly?

[Music] we’ve known for over 400 years that muscle weakness was a common presenting symptom of vitamin D deficiency bones aren’t the only organs that respond to vitamin D muscles due to but as we age our muscles lose vitamin D receptors perhaps helping to explain the loss in muscle strength as we age and indeed vitamin D status does appear to predict the decline in physical performance as we age with lower vitamin D levels linked to poorer performance but maybe the vitamin D didn’t lead to weakness may be the weakness led to low vitamin D vitamin D is the sunshine vitamin and so if you’re too weak to run around outside that could explain the correlation with lower levels to see if it’s cause and effect you have to put it to the test there’s been about a dozen randomized control trials vitamin D supplements versus sugar pills put all the studies together and older men and women do get significant protection from Falls with vitamin D especially among those who start out with relatively low levels leading the conservative USPSTF the US Preventive Services Task Force the official prevention guidelines setting body and the American geriatric society to recommend vitamin D supplementation for those at high risk for Falls we’re not quite sure the mechanism though randomized controlled trials have found that vitamin D boosts global muscle strength particularly in the quads which are important for fall prevention though vitamin D supplements have also been shown to improve balance so it may also be a neurological effect or even a cognitive effect we’ve known for about 20 years that older men and women who stopped walking when a conversation starts or at particularly high risk of falling over a six-month timeframe few of those who could walk and talk at the same time would go on to fall but 80% of those who stopped when a conversation is initiated ended up falling other high-risk groups that should supplement include those who’ve already fallen once or are unsteady or on a variety of heart brain and blood pressure drugs that can increase fall risk there’s also a test called get-up-and-go which anyone can do at home your time how long it takes you to get up from an armchair walk 10 feet turn around walk back and sit down if it takes you a longer than 10 seconds then you may be at high risk so how much vitamin D should you take seems to take at least seven hundred to a thousand units a day the American geriatric Society recommends a total of four thousand a day though based on the rationale that this should get about 90 percent of people up to the target vitamin D blood level of 75 minimal per liter a thousand should do it for the majority of people 51 percent but they recommend four thousand to capture 92 percent of the population then you don’t have to routinely test levels since you would get most people up there and it’s considerably below the proposed upper tolerable intake of 10,000 a day they do not recommend periodic mega-doses because it’s hard to get patients to comply with pills why not just give people one mega dose like five hundred thousand units once a year like when you come in for your flu shot or something so every year you can at least guarantee everyone gets an annual spike in D levels that lasts a few months it’s unnatural but certainly convenient for the doctor at least the problem is that it actually increases fall risk 30% increase in Falls in those first three months of the spike similar results were found in other mega dose trials it may be a matter of too much of a good thing C vitamin D may improve physical performance reduce chronic pain and improve mood so much that you start moving around more and thereby increase fall risk you give people a whopping dose of deme you get a burst in physical mental and social functioning and make take time for your motor control to catch up with your improved muscle function it would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater you gotta take it slow it’s possible though that such unnaturally high doses may actually damage the muscles the evidence they cite and support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D so the concern is that such high doses may be over tenderizing our own muscles as well so yeah higher D levels are associated with a progressive drop in fracture risk but too much vitamin D may be harmful the bottom line is that vitamin D supplementation appears to help but the strongest and most consistent evidence for prevention of serious Falls is exercise if you compare the two yes taking vitamin D may lower your fall risk compared to placebo but strength and balance training with or without vitamin D may be even more powerful [Music]

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