Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial

TLDR

The study aimed to determine whether vitamin D supplementation reduces falls and fractures among older residential‑care residents who are not classically vitamin‑D deficient. A 2‑year, double‑blind, placebo‑controlled randomized trial enrolled 625 residents (mean age 83.4) across 149 Australian facilities, giving vitamin D (10 000 IU weekly then 1 000 IU daily) plus 600 mg calcium daily, with falls and fractures prospectively recorded. Intention‑to‑treat analysis showed a 27 % reduction in fall incidence (IRR 0.73, 95 % CI 0.57‑0.95) and a non‑significant 31 % reduction in fractures (OR 0.69, 95 % CI 0.40‑1.18), with greater compliance yielding a 37 % fall reduction (IRR 0.63, 95 % CI 0.48‑0.82) and a 30 % fracture reduction (OR 0.68, 95 % CI 0.38‑1.22).

Abstract

To determine whether vitamin D supplementation can reduce the incidence of falls and fractures in older people in residential care who are not classically vitamin D deficient.Randomized, placebo-controlled double-blind, trial of 2 years' duration.Multicenter study in 60 hostels (assisted living facilities) and 89 nursing homes across Australia.Six hundred twenty-five residents (mean age 83.4) with serum 25-hydroxyvitamin D levels between 25 and 90 nmol/L.Vitamin D supplementation (ergocalciferol, initially 10,000 IU given once weekly and then 1,000 IU daily) or placebo for 2 years. All subjects received 600 mg of elemental calcium daily as calcium carbonate.Falls and fractures recorded prospectively in study diaries by care staff.The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, the incident rate ratio for falling was 0.73 (95% confidence interval (CI)=0.57-0.95). The odds ratio for ever falling was 0.82 (95% CI=0.59-1.12) and for ever fracturing was 0.69 (95% CI=0.40-1.18). An a priori subgroup analysis of subjects who took at least half the prescribed capsules (n=540), demonstrated an incident rate ratio for falls of 0.63 (95% CI=0.48-0.82), an odds ratio (OR) for ever falling of 0.70 (95% CI=0.50-0.99), and an OR for ever fracturing of 0.68 (95% CI=0.38-1.22).Older people in residential care can reduce their incidence of falls if they take a vitamin D supplement for 2 years even if they are not initially classically vitamin D deficient.