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Senior health: Vitamin D and fall prevention

Posted on: January 11, 2013   by  John Cannell, MD

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Falls are common among older people. Seniors living in long-term care facilities are particularly prone to fall. Seniors in such facilities also suffer from more serious consequences, such as fractures, which further expose seniors to surgery and its complications such as pulmonary embolism, infection, and physical deterioration.

Falls are also very costly. They result in more injuries, longer hospital stays, and more lawsuits. They cost more than $4,000 in excess charges per hospitalization.

Drs Gilbert Chua and Roger Wong, of the University of British Columbia, recently did a needed meta-analysis of falls and vitamin D dosing schedules. They looked at daily dosing versus monthly or quarter year dosing. They wanted to know if huge monthly or three month “Stoss” doses that physicians use in Europe, Australia, and New Zealand, are effective or as good as daily dosing?

Chua GT, Wong RY. Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors. Can Geriatr J. 2011 Dec;14(4):93-9.

Drs Chua and Wong analyzed 79 studies to find 28 studies with four randomized controlled trials on falls and vitamin D that met their selection criteria. They found that daily dosing reduced falls 16% more than Stoss dosing. The authors concluded,

“As far as we know, this is the first systematic review that takes dosing regimen of vitamin D into account in fall prevention among LTC seniors. We found that intermittent supratherapeutic doses could possibly undermine the effectiveness of vitamin D in fall prevention. In this systematic review of four double-blinded, randomized, controlled trials, vitamin D at all doses was found to be effective in reducing rate of falls, with statistical significance, by 28%. Exclusion of the study using 100,000 IU quarterly was found to have a further increase of effectiveness by 16%.”

I believe the same thing is true with flu and cold prevention. A high monthly dose of 100,000 IU/month did not prevent flus and colds.

A closer look: “Vitamin D no match for common cold.” Posted on October 4, 2012 by John Cannell, MD

However, a daily dose of 4,000 IU/day did.

New study says vitamin D fights respiratory infections, reduces need for antibiotics. Posted on December 22, 2012 by John Cannell, MD

Vitamin D needs to be taken every day, not once a month or even once a week. When we were evolving, we got vitamin D every day. I advise that you do the same.

12 Responses to Senior health: Vitamin D and fall prevention

  1. hlahore@gmail.com

    “Vitamin D needs to be taken every day, . . . . ”

    That might be right, but . . .

    Animals, through evolution, have learned to survive/thrive in conditions of varying resources: calories, water, heat, sunshine (vitamin D), etc.

    Animals have evolved to store up a resource when it is available, and then draws on that store during times of famine/drought/cold/lack of sunshine.

    The half life of vitamin D stores is measured in weeks, not days.

    When the body is getting lots of vitamin D (near the equator) the half life is 8 weeks.

    Details at http://is.gd/halflifeD

    Possible Hypothesis can be proposed which include:

    – Your vitamin D levels should vary (so as to simulate vitamin D variation with season, overcast)

    – For light skinned people supplementation on a weekly/monthly basis is better than daily vitamin D.

    By the way: some of these ideas come from Talib’s recent book: Antifragile, which is a best seller in both the finance and health categories. The book has a huge number of excellent ideas. The thesis of the book extremely briefly is: Systems (not necessarily individuals) thrive on variations in the environment, but become fragile and can fail when there is a lack of variation.

    Personal note: I take vitamin D once every 5 days in the summer, once every 4 days in the winter, and more frequently when there is a need.

  2. Rita and Misty

    @hlahore….

    May I ask your dosage in winter and summer, as well as your 25(OH)D level?

    Thanks,

    Rita 🙂

  3. hlahore@gmail.com

    50,000 IU every 4 days in winter and every 5 days in summer. Also doing ALL of the things to increase the response (cofactors, almonds, Omega-3, ) last blood test was 120 ng. Feeling like 10 years younger than my actual age of 66. Details on increasing the vitamin D response are at http://is.gd/2xvitd

  4. Rita and Misty

    @hlahore,

    Thank you for your reply…and especially grateful that you shared your last blood test of 120 ng/ml….

    Although I talk a good talk, I was getting a little concerned with my recent reading of 104 ng/ml….now I can stop worrying….

    AGREE with you that higher 25(OH)D levels makes you feel (and look) at least 10 years younger….It’s been a long time since I’ve felt this good. 🙂

  5. kenmerrimanmd

    recently met with the primary care doc who oversees the nursing home where I am suppose to be the “orthopedic consultant” he is a non believer re the vit D thing and compares it to Vit E which he feels has been 100% debunked ( although I am not so sure)

    It looks like I may have a bit of a difficult time getting him to go along with my plans for ramping up the vitD levels of the residents and staff at this ECF

    re hlahore’s formula of taking vit D sounds pretty reasonable BUT with most of my patients if it gets any more complicated than once per day I am pretty much losing them in fact it is hard enough to get the to go along with once per day

    agree that the human body probably was made to cycle through times of more and times of less

  6. Rita and Misty

    @Ken,

    I’m certain you are already aware of the below….It (always) baffles me how willfully ignorant some docs choose to be regarding Vitamin D…..

    http://www.ncbi.nlm.nih.gov/pubmed/20440692

    http://www.endo-society.org/media/press/2012/Vitamin-D-Deficiency-Linked-to-Higher-Mortality-in-Female-Nursing-Home-Residents.cfm

  7. kenmerrimanmd

    thanks fro the heads up I was not really aware of the above as I am kind of an old cave man orthopedic surgeon who is trying to get smarter about this stuff in spite of many around me dissing me off for my concern// life is so cruel!!

  8. Rita and Misty

    @Ken…very funny….HAAA! 🙂

    I’m pretty certain you know a thing (or two) about Vitamin D…just a wild hunch on my part!

    But it is amazing how many relatively young(er) physicians choose to be ignorant regarding Vitamin D…my elderly uncle’s primary care physician is a mere 40 years of age, yet his mind is (almost) inflexible….

    Perhaps it takes years of life experience to open one’s mind….(This is too heavy a thought for me at 3:30 p.m. ET.)

    Life isn’t cruel, though….Life is wonderful (IMO) 🙂

  9. Brant Cebulla

    I haven’t looked at any research, but I am guessing that the word ‘vitamin’ in ‘vitamin D’ creates a bit of a stigma against its use in the treatment or prevention of illnesses in clinical practice. Ken, it sounds like you have this experience.

    If I knew nothing of evidence-based medicine and I were a patient with say, cystic fibrosis or multiple sclerosis, I can imagine taking offense to the suggestion of taking vitamin D: “I have a serious illness that needs a serious effective drug, not some silly vitamin.”

    This is also why I’m a proponent of practitioners being aware of evidence-based medicine. While I’m not suggesting they follow it rigorously, it’s important they are aware enough to ask the question, “What does the evidence show for vitamin D?” Asking this question takes the terms “believer” and “non-believer” out of the equation.

    I think researchers interested in vitamin D should start looking a little into effective ways to communicate vitamin D awareness to the public and patients and fighting the vitamin stigma. We know lack of sun exposure/vitamin D is a huge risk factor for MS. Can we do anything about it? I have seen little effort in public health (outside a few organizations including the Council) to confront this issue.

  10. Rita and Misty

    From my perch, I would have to say that there is still (tons of) stigma associated with recommending sun exposure…and furthermore, in a (very) well respected CT MS clinic, 40 ng/ml is currently viewed as the 25(OH)D level needed to treat MS….

    Public Health doctors I know are cautionary when speaking of Vitamin D, even if they personally choose to keep their 25(OH)D levels at the higher end of optimal (range being 30ng/ml—100ng/ml)….They say society moves forward in small increments and that any radical thought will hinder Vitamin D progress over all….I’m certain there is some concern that to speak forcefully on Vitamin D may halt an otherwise promising career flat in its tracks….

    I am grateful for the courageous individuals I know who are willing to stretch the limits within the medical community….those willing to be accountable and responsible for necessary change.

    And, I am always grateful for the Vitamin D Council—an excellent source of information!

  11. dew@richardshunter.com

    “Vitamin D needs to be taken every day, not once a month or even once a week. When we were evolving, we got vitamin D every day. I advise that you do the same.”

    More corrrectly, what you should have said is:

    Vitamin D needs to be taken every day, not once a month or even once a week. When we were created by God, we were designed to get vitamin D every day. I advise that you do the same.

    Your science on Vitamin D is very sound. Your assumptions as to why, are flawed. Please don’t confuse the two.

  12. hlahore@gmail.com

    Taking a supplement once every 5 days, or once a week is far easier to remember than daily. Just mark your calendar, then remove the mark or cross it out the instant you take the supplement. Thus: 1) you do not have to remember when to take it or 2) remember if you have taken it.

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