Age and Ageing Vol. 33 No. 6 © British Geriatrics Society 2004; all rights reserved
Research Paper |
Vitamin D supplementation improves neuromuscular function in older people who fall
1 Elderly Day Hospital, Thomas Guy House, Guys Hospital, St Thomas Street, London SE1, UK
2 Clinical Age Research Unit, Department of Health Care of the Elderly, New Medical School, King's College Hospital, Bessemer Road, London SE5 9PJ, UK
3 Physiotherapy Rehabilitation Unit, East Dulwich Hospital, East Dulwich Grove, East Dulwich, London, UK
4 Clinical Biochemistry, King's College Hospital, Guy's, King's and St Thomas' School of Medicine, Bessemer Road, London SE5 9PJ, UK
5 Care of the Elderly, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
Address correspondence to: J. Dhesi. Fax: (+44) 20 7188 2096. Email: jugdeep.dhesi{at}gsst.nhs.uk
Abstract
Background: vitamin D supplementation reduces the incidence of fractures in older adults. This may be partly mediated by effects of vitamin D on neuromuscular function.
Objective: to determine the effects of vitamin D supplementation on aspects of neuromuscular function known to be risk factors for falls and fractures.
Design: randomised, double-blind, placebo-controlled study.
Setting: falls clinic taking referrals from general practitioners and accident and emergency department.
Subjects: 139 ambulatory subjects (
65 years) with a history of falls and 25-hydroxyvitamin D (25OHD) 
12 µg/l.
Intervention: patients were randomised to receive a single intramuscular injection of 600,000 i.u. ergocalciferol or placebo.
Outcome measures: assessments including biochemistry, postural sway, choice reaction time (CRT), aggregate functional performance time (AFPT), and quadriceps strength were carried out at baseline and 6 months post-intervention.
Results: baseline characteristics were comparable between both groups. 25OHD in the treatment group increased significantly at 6 months. AFPT deteriorated in the control group and improved in the intervention group, representing a significant difference between groups (+6.6 s versus –2.0 s, t = 2.80, P < 0.05). Similar changes were observed for CRT (–0.06 s versus +0.41 s, t = –2.52, P < 0.01) and postural sway (+0.0025 versus –0.0138, t = 2.35, P < 0.02). There was no significant difference in muscle strength change between groups (–10 N versus –2 N, t = –1.26, ns). A significant correlation between change in AFPT and change in 25OHD levels was observed (r = 0.19, P = 0.03). There was no significant difference in the number of falls (0.39 versus 0.24, t = 1.08, P = 0.28) or fallers (14 versus 11, P = 0.52) between two groups.
Conclusions: vitamin D supplementation, in fallers with vitamin D insufficiency, has a significant beneficial effect on functional performance, reaction time and balance, but not muscle strength. This suggests that vitamin D supplementation improves neuromuscular or neuroprotective function, which may in part explain the mechanism whereby vitamin D reduces falls and fractures.
Keywords: vitamin D, muscle, accidental falls, aged, 25-hydroxyvitamin D3, elderly
Received May 13, 2003; Revision received July 8, 2004. accepted in revised form July 8, 2004.
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