Table 2.
Meta-analyses of studies on vitamin D supplementation and falls
| Author, year | Intervention | Target population, duration and baseline 25(OH)D | Outcome: falls |
|---|---|---|---|
|
Bischoff-Ferrari et al. (2009) [92] 7 RCTs N = 1921 |
Vit D ± calcium | Individuals aged 65 years and older with a minimum follow-up of 3 months | Pooled RR 0.81 (95% CI 0.71–0.92) with Vit D 700 to 1000 IU daily ± calcium |
| Pooled RR 0.77 (95% CI 0.65–0.90) in those with achieved 25(OH)D ≥ 60 nmol/L | |||
|
Murad et al. (2011) [93] 26 RCTs N = 45,782 |
Vit D ± calcium |
78% women, mean age 76 years, high risk of falling (15–69%, median 50%); duration: 3–62 months (median 12 months) Included both Vit D-deplete and -replete individuals, with info on Vit D status |
OR 0.86 (95% CI 0.71–0.92) |
| Effect more prominent in vit D-deficient patients at baseline and in studies in which calcium was co-administered with vit D | |||
| Gillepsie et al. (2012) [74] | Vit D |
Most community-dwelling older people 7 RCTs; N = 9324 |
RR 1.00 (95% CI 0.90–1.11)—no reduction of the rate of falls |
| 13 RCTs; N = 26,747 | RR 0.96 (95% CI 0.89–1.03)—no reduction of risk of falls | ||
|
In those with low vit D level at baseline: 2 RCTs; N = 260 3 RCTs; N = 562 |
RR 0.57 (95% CI 0.37–0.89) for rate of falls RR 0.65 (95% CI 0.46–0.91) for number of fallers |
||
|
LeBlanc et al. (2015) [75] 11 RCTs N = 5682 |
Vit D | 11 RCTs; N = 5682 | RR 0.89 (95% CI 0.82–0.97) |
| Low vit D levels (90% of population < 75 nmol/L): 7 RCTs; N = 2118 | RR 0.85 (95% CI 0.73–0.98) in bold | ||
| Not low vit D levels or not reported: 4 RCTs; N = 3564 | RR 0.89 (95% CI 0.83–1.04 not in bold since not significant | ||
|
Wu et al. (2017) [94] 26 RCTs N = 32,686 |
Vit D (ranged from 200 to 1000 IU/day in 11/26 RCTs dosage was 800 IU/day, 6 RCTs used a total dosage ranging from 300,000 IU/36 months to 600,000 IU/6 months) ± calcium |
Mean age ± SD of participants in these studies varied from 67 ± 2 to 92 ± 6 years Duration: 1–60 months |
OR for experiencing at least one fall, 0.87 (95% CI 0.80–0.94) with combined vit D + calcium |
|
Guirguis-Blake et al. (2018) [95] 7 RCTs n = 7531 |
Vit D ± calcium Vit D (700 IU or 800 IU daily, 150 000 IU every 3 months or 500 000 IU annually) 2 trials administered 1 μg of 1-hydroxycholecalciferol daily or 0.25 μg of calcitriol twice daily |
Mean age: 71–77 years Vit D for 9 months up to 5 years Excluded studies on Vit D deplete Baseline mean serum 25(OH)D levels ranging from 65.9 to 79.4 nmol/L |
Vit D did not prevent falls Annual high-dose cholecalciferol (500,000 IU) showed an increase in falls, people experiencing a fall, and injurious falls; Calcitriol showed a reduction in falls and people experiencing a fall |
|
Bolland et al. (2018) [59] 37 RCTs N = 34,144 |
Vit D alone in the majority of RCTs with daily dose mostly < 1000 IU/day | Unselected populations of community-dwelling women aged 65 years or older | OR 0·97 (95% CI 0·93–1·02) |
| Duration ≤ 1 year for the majority of studies | Results were similar in RCTs of high-dose versus low-dose vit D and in sub-group analyses of RCTs using doses greater than 800 IU per day | ||
| Only 6% (4 studies) 25OHD < 25 nmol/L | Comment by Bishoff-Ferrari (2019): considering 11 trials testing 800–1000 IU Vit D daily, with more than 50% adherence, and excluding large annual dosing trials, we see a significant falls’ reduction (RR = 0.88) | ||
| Non standardized lab measurements | |||
| Excluded trials with Vit D and calcium supplementation | |||
|
Thanapluetiwong et al. (2020) [63] 47 RCTs N = 58,424 |
Vit D ± calcium 37 trials with vit D3 7 trials with vit D2 1 trial with vit D2 and vit D3 2 trials with vit D analogues |
Populations were mainly elderly women with age less than 80 years |
RR 0.948 (95% CI 0.914–0.984) By sub-group analyses, only Vit D with calcium supplement significantly reduce fall incidence, RR 0.881 (95% CI 0.821–0.945) Vit D3 supplement decreased incidence of fall but this occurred only when vit D3 was combined to calcium |
|
Ling et al. (2021) [96] 31 RCTs N = 57,867 |
Vit D alone, daily or intermittent doses of 400–60 000 IU 21 RCTs, n = 51,984 |
Only trials enrolling adults (age ≥ 18) |
RR 1.00 (95% CI 0.95–1.05) Subgroup analyses showed that with baseline of serum 25OHD < 50 nmol/L fall risk was reduced RR 0.77 (95% CI 0.61–0.98) |
|
Vit D (daily doses of 700–1000 IU) plus calcium (daily doses of 1000–1200 mg) 10 RCTs, n = 5883 |
RR 0.88 (95% CI 0.80–0.97) | ||
|
Kong et al. (2022) [66] 32 RCTs N = 104,363 |
Median daily dose of Vit D: 800 IU | Most studies included women (75% of participant; range 15–100%) | Pooled RR 0.91 (95% CI 0.85–0.98) with daily Vit D dose of 800–1000 IU |
| 21 RCTs, N = 36,793 with falls as outcomes | No reduction in studies with < 800 or > 1000 IU/day | ||
| 8 studies: < 800 IU/day | Median age was 72 years (range 53–85) | ||
| 15 studies: 800–1000 IU/day, and | Median follow-up duration: 24 months (range 9–120) | Daily administration of Vit D associated with reduced risk of falls, while intermittent dose was not | |
| 9 studies: > 1000 IU/day | |||
| 26 studies reported daily administration, while 6 reported intermittent administration | Patients with vit D deficiency showed a significant risk reduction of falls with Vit D supplementation |
RCT randomized controlled trial, 25(OH)D 25-hydroxyvitamin D, Vit D vitamin D, RR relative risk, OR odds ratio
Bold: statistically significant differences