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Vitamin D: Role in postural stability?

Posted on: June 1, 2012   by  John Cannell, MD

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Balance, or postural stability, is important to everyone, from the baby learning to walk to the old woman trying not to fall. Earlier this year, a group from Nepean Hospital in Australia led by Dr. Boersma discovered that vitamin D levels are clearly associated with postural stability.

Boersma D, Demontiero O, Mohtasham Amiri Z, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Duque G. Vitamin D status in relation to postural stability in the elderly. J Nutr Health Aging. 2012 Mar;16(3):270-5.

Using high tech methods, the authors measured a number of factors that have to do with balance, such as postural instability, gait speed, and muscle strength. Unlike some other studies, they found no association with muscle strength, but they did find vitamin D levels have a clear association with both gait speed and postural instability. They also found that the patients with the lowest vitamin D levels were more than twice as likely to have fallen in the last six months.

I was disappointed, as I’m sure the authors were, with the subject’s low vitamin D levels. The authors tested the 145 patients in 2009 and 2010, not ten years ago as in many studies, but still 60% of the subjects had vitamin D levels lower than 20 ng/ml, and 21 % had levels lower than 12 ng/ml. I hoped that after all the publicity about vitamin D, the doctors who care for these patients would have detected and treated their vitamin D deficiencies.

The authors also pointed out that an earlier randomized controlled trial of vitamin D and calcium reduced falls in the elderly by 60%. It’s important to remember that falls are a failure of physical performance. While it is the elderly who usually suffer from falls, the mechanisms that prevent falls are operative in everyone, no matter their age. The researchers also found that 36% of this reduction in falls was due to vitamin D’s effect on balance, both when subjects were still (static balance) and moving (dynamic balance).

Finally, they pointed out that the elderly do not have to have a known neurological disease to account for their lack of balance. Sometimes they do, such as Parkinson’s disease or supranuclear palsy, but often the postural instability is simply rooted in fear of falling. Vitamin D should help that as most studies show vitamin D improves not only balance but reaction time and muscle strength as well.

When the doctors cannot find a neurological condition to account for the balance problems, the doctors call it “primary postural instability.” However, the authors suggest that they may need to change that to postural instability secondary to vitamin D deficiency. A lot of that name changing is going around these days.

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