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Is fall prevention by vitamin D mediated by a change in postural or dynamic balance?

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Abstract

Introduction

The objectives were:(1) to validate a quantitative balance assessment method for fall risk prediction; (2) to investigate whether the effect of vitamin D and calcium on the risk of falling is mediated through postural or dynamic balance, as assessed by this method.

Materials and methods

A secondary analysis of a double blind randomized controlled trial was employed, which included 64 institutionalized elderly women with complete balance assessment (age range: 65–97; mean 25–hydroxyvitamin D levels: 16.4 ng/ml (SD ±9.9). Participants received 1,200 mg calcium plus 800 IU cholecalciferol (n=33) or 1,200 mg calcium (n=31) per day over a 3-month treatment period. Using an electronic device attached to the lower back of the participant, balance was assessed as the degree of trunk angular displacement and angular velocity during a postural task (standing on two legs, eyes open, for 20 s) and a dynamic task (get up from a standard height chair with arm rests, sit down and then stand up again and remain standing).

Results

It was found that both postural and dynamic balance independently and significantly predicted the rate of falling within the 3-month follow-up. Vitamin D plus calcium reduced the rate of falls by 60% [relative risk (RR)=0.40; 95% CI: 0.17, 0.94] if compared with calcium alone. Once postural and dynamic balance were added to the regression analysis, they both attenuated the effect of vitamin D plus calcium on the rate of falls. For postural balance, the RR changed by 22% from 0.40 to 0.62 if angular displacement was added to the model, and by 9% from 0.40 to 0.49 if angular velocity was added. For dynamic balance, it changed by 1% from 0.40 to 0.41 if angular displacement was added, and by 14% from 0.40 to 0.54 if angular velocity was added.

Discussion

Thus, balance assessment using trunk angular displacement is a valid method for the prediction of falls in older women. Of the observed 60% reduction in the rate of falls by vitamin D plus calcium supplementation compared with calcium alone, up to 22% of the treatment effect was explained by a change in postural balance and up to 14% by dynamic balance.

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Acknowledgements

The authors are indebted to John Orav (Department of Biostatistics, Harvard School of Public Health, Boston, USA) for his statistical advice and to Stephen M. Ferrari (independent) for his insights and assistance in the preparation of this manuscript. We are grateful to the nurses of the Geriatric Departments for their great commitment in recording the falls of our patients. This study was supported by the following: the International Foundation for the Promotion of Nutrition Research and Nutrition Education (ISFE), the Swiss Orthopedic Society, the Swiss Foundation for Nutrition Research (SFEFS), and Strathmann AG, Germany.

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Authors and Affiliations

  1. Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland

    H. A. Bischoff-Ferrari

  2. Division of Rheumatology, Immunology and Allergy, The Robert B. Brigham Arthritis and Musculoskeletal Clinical Research Center, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    H. A. Bischoff-Ferrari

  3. Department of Orthopedic Surgery, University Basel, Basel, Switzerland

    H. A. Bischoff-Ferrari & W. Dick

  4. Department of Geriatrics, Felix Platter Spital, Basel, Switzerland

    M. Conzelmann

  5. Deptartment of Geriatrics, University of Basel, Basel, Switzerland

    H. B. Stähelin

  6. Department of ORL, University Hospital, Basel, Switzerland

    M. G. Carpenter, A. L. Adkin & J. H. J. Allum

  7. Department of Neuroscience, Karolinska Institute, Stockholm, Sweden

    M. G. Carpenter

  8. Department of Physical Education and Kinesiology, Brock University, St Catherines, Canada

    A. L. Adkin

  9. Department of Rheumatology, Triemli StadtSpital, Zurich, Switzerland

    R. Theiler

  10. Institute for Clinical Osteology, Bad Pyrmont, Germany

    M. Pfeifer

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  1. H. A. Bischoff-Ferrari
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  2. M. Conzelmann
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  3. H. B. Stähelin
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  4. W. Dick
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  6. A. L. Adkin
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  7. R. Theiler
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  9. J. H. J. Allum
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Correspondence to H. A. Bischoff-Ferrari.

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Bischoff-Ferrari, H.A., Conzelmann, M., Stähelin, H.B. et al. Is fall prevention by vitamin D mediated by a change in postural or dynamic balance?. Osteoporos Int 17, 656–663 (2006). https://doi.org/10.1007/s00198-005-0030-9

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  • DOI: https://doi.org/10.1007/s00198-005-0030-9

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