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Evid Based Nurs 11:58 doi:10.1136/ebn.11.2.58
  • Treatment

Short-term vitamin D plus calcium did not prevent falls more than calcium alone in elderly inpatients

E Burleigh

Dr E Burleigh, Victoria Infirmary, Glasgow, UK; Liz.Burleigh{at}sgh.scot.nhs.uk

QUESTION

In elderly hospital inpatients, does vitamin D plus calcium prevent falls more than calcium alone?

METHODS

Design:

randomised controlled trial.

Allocation:

concealed.

Blinding:

blinded (patients, {clinicians, data collectors, data analysts, and outcome assessors}*).

Follow-up period:

until discharge, transfer to another unit, or death (median hospital stay 30 d).

Setting:

an acute geriatric unit in a UK hospital.

Patients:

205 inpatients (median age 84 y, 59% women, 85% had a history of falls) who were ⩾65 years of age and newly transferred or admitted to general assessment or rehabilitation wards. Exclusion criteria included known hypercalcaemia, urolithiasis, renal dialysis therapy, terminal status, bed-bound with a reduced Glasgow Coma Scale, current use of calcium and vitamin D supplements, and designation of “nil by mouth” at admission.

Intervention:

101 patients were allocated to vitamin D (cholecalciferol), 800 IU/day, and calcium carbonate, 1200 mg/day, and 104 patients were allocated to calcium carbonate, 1200 mg/day, until discharge or death.

Outcomes:

number of patients who fell and number of falls; a fall was defined as unintentionally coming to rest on the ground or other lower level except as a result of violence or epileptic seizure. Secondary outcomes included fractures. 166 patients were required to detect a 50% relative reduction from 41% in the number of patients who fell (80% power, α = 0.05).

Patient follow-up:

99% were included in the intention-to-treat analysis.

MAIN RESULTS

During a median hospital stay of 30 days, the vitamin D plus calcium group did not differ from the calcium alone group for number of patients who fell or had fractures (table), or number of falls per patient (mean 1.04 v 1.16, p = 0.44).

Vitamin D plus calcium v calcium alone in elderly hospital inpatients*

CONCLUSION

In elderly inpatients, use of vitamin D plus calcium did not prevent falls or fractures more than calcium alone.

*Information provided by author.

ABSTRACTED FROM

Burleigh E, McColl J, Potter J. Does vitamin D stop inpatients falling? A randomised controlled trial. Age Ageing 2007;36:507–13.

Clinical impact ratings: Elderly care 5/7; General/Internal medicine 6/7

Footnotes

  • Source of funding: Strakan Pharmaceuticals supplied study drugs.

Commentary

The study by Burleigh et al evaluated the impact of vitamin D on falls and nutritional, cognitive, and mobility outcomes. At baseline, participants were compromised in all of these areas, which, independent of vitamin D status, increase risk of falls. In contrast to a recent systematic review,1 Burleigh et al did not find evidence of a benefit with vitamin D. Most experts now agree that 25-hydroxyvitamin D (25-OHD) concentrations between 21 and 29 ng/ml represent vitamin D insufficiency.2 Using this criterion, most patients in the 25% random sample assessed for this outcome were vitamin D insufficient. If falls were a result of musculoskeletal dysfunction from vitamin D insufficiency, then the dose was too low to correct the insufficiency and reduce falls (doses >5000 IU/d are required).3

Burleigh et al did not discuss whether individual care practices and triggers for falls were reviewed and whether elder-friendly environments were created to reduce the risk of injury. For example, people with limited mobility lose up to 5% of muscle mass each day, thereby increasing their fall risk; such muscle mass loss is not correctable with vitamin D.4

Vitamin D insufficiency is widespread. Supplementation makes sense on nutritional grounds alone, as Burleigh et al note, and is widely recommended.3 5 Regardless of the role of vitamin D in fall prevention, adequate levels (recommended daily allowance 600 IU) prevent osteomalacia, a painful bone disease, and may help prevent many cancers.6 The study by Burleigh et al contributes to our understanding of the role of vitamin D in reducing falls, but consideration should also be given to how increased mobility and environmental factors affect fall risk in this compromised population.

References

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