Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Vitamin D and falls — the dosage conundrum

Nature Reviews Endocrinology volume 12, pages 680–684 (2016)Cite this article

Subjects

Abstract

Falls are a major health problem in elderly individuals. Although intensive physical therapy and management of hazards in the home can reduce falls by 25%, long-term practicality limits their use. Interest in vitamin D as a medical therapy has led to many trials; however, results using daily oral doses of vitamin D have been inconsistent. In the past 5 years, studies on the effect of bolus doses of vitamin D have produced surprising results. Bolus doses of vitamin D, given annually (at a dose of 300,000 IU or 500,000 IU) or monthly (at a dose of 24,000 IU or 60,000 IU) — equivalent to approximate daily doses of 800 IU, 1400 IU and 2,000 IU — result in a significant increase in the number of falls and fractures associated with serum levels of 25-hydroxyvitamin D greater than 40–45 ng/ml (equivalent to 100–112 nmol/l). These unexpected results show increased falls and fractures are adverse events related to vitamin D administration. Until further safety data is available, bolus dosing or daily doses should not exceed 3,000 IU and serum levels of 25-hydroxyvitamin D should not exceed 40–45 ng/ml (equivalent to 100–112 nmol/l) in elderly individuals.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Murad, M. H. et al. Clinical review: the effect of vitamin D on falls: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 96, 2997–3006 (2011).

    Article  CAS  Google Scholar 

  2. Bolland, M. J., Grey, A., Gamble, G. D. & Reid, I. R. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2, 573–580 (2014).

    Article  CAS  Google Scholar 

  3. Bolland, M. J., Grey, A. & Reid, I. R. Differences in overlapping meta-analyses of vitamin D supplements and falls. J. Clin. Endocrinol. Metab. 99, 4265–4272 (2014).

    Article  CAS  Google Scholar 

  4. Sanders, K. M. et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303, 1815–1822 (2010).

    Article  CAS  Google Scholar 

  5. Bischoff-Ferrari, H. A. et al. Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern. Med. 176, 175–183 (2016).

    Article  Google Scholar 

  6. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D (National Academies Press, 2011).

  7. Buchner, D. M. et al. Development of the common data base for the FICSIT trials. J. Am. Geriatr. Soc. 41, 297–308 (1993).

    Article  CAS  Google Scholar 

  8. Morrison, A., Fan, T., Sen, S. S. & Weisenfluh, L. Epidemiology of falls and osteoporotic fractures: a systematic review. Clinicoecon. Outcomes Res. 5, 9–18 (2013).

    PubMed  Google Scholar 

  9. Flicker, L. et al. Serum vitamin D and falls in older women in residential care in Australia. J. Am. Geriatr. Soc. 51, 1533–1538 (2003).

    Article  Google Scholar 

  10. Tinetti, M. E. & Williams, C. S. The effect of falls and fall injuries on functioning in community-dwelling older persons. J. Gerontol. A Biol. Sci. Med. Sci. 53, M112–M119 (1998).

    Article  CAS  Google Scholar 

  11. Close, J. et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353, 93–97 (1999).

    Article  CAS  Google Scholar 

  12. Deshpande, N. et al. Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J. Am. Geriatr. Soc. 56, 615–620 (2008).

    Article  Google Scholar 

  13. Nicklett, E. J. & Taylor, R. J. Racial/ethnic predictors of falls among older adults: the health and retirement study. J. Aging Health 26, 1060–1075 (2014).

    Article  Google Scholar 

  14. WHO. International Classification of Diseases and Related Health Problems. 10th Revision http://www.who.int/classifications/icd/ICD-10_2nd_ed_volume2.pdf (2003),

  15. Owens, P. L., Russo, C. A., Spector, W. & Mutter, R. Emergency department visits for injurious falls among the elderly, 2006. HCUP Statistical Brief #80. Healthcare Cost And Utilization Project http://www.hcup-us.ahrq.gov/reports/statbriefs/sb80.jsp (2009).

  16. Stevens, J. A., Corso, P. S., Finkelstein, E. A. & Miller, T. R. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 12, 290–295 (2006).

    Article  CAS  Google Scholar 

  17. Nyberg, L., Gustafson, Y., Berggren, D., Brännström, B. & Bucht, G. Falls leading to femoral neck fractures in lucid older people. J. Am. Geriatr. Soc. 44, 156–160 (1996).

    Article  CAS  Google Scholar 

  18. Donald, I. P. & Bulpitt, C. J. The prognosis of falls in elderly people living at home. Age Ageing 28, 121–125 (1999).

    Article  CAS  Google Scholar 

  19. Lozano, R. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095–2128 (2012).

    Article  Google Scholar 

  20. Kannus, P., Sievänen, H., Palvane, M., Järvinen, T. & Parkkari, J. Prevention of falls and consequent injuries in elderly people. Lancet 366, 1885–1893 (2005).

    Article  Google Scholar 

  21. Michael, Y. L. et al. Interventions to prevent falls in older adults: An updated systematic review (Agency for Healthcare Research and Quality (US), 2010).

    Google Scholar 

  22. Snijder, M. B. et al. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J. Clin. Endocrinol. Metab. 91, 2980–2985 (2006).

    Article  CAS  Google Scholar 

  23. Faulkner, K. A. et al. Higher 1.25-dihydroxyvitamin D3 concentrations associated with lower fall rates in older community-dwelling women. Osteoporos. Int. 17, 1318–1328 (2006).

    Article  CAS  Google Scholar 

  24. Sambrook, P. N. et al. Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population. J. Clin. Endocrinol. Metab. 89, 1572–1576 (2004).

    Article  CAS  Google Scholar 

  25. Hansen, K. E. et al. Treatment of vitamin D insufficiency in postmenopausal women: a randomized clinical trial. JAMA Intern. Med. 175, 1612–1621 (2015).

    Article  Google Scholar 

  26. Uusi-Rasi, K. et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern. Med. 175, 703–711 (2015).

    Article  Google Scholar 

  27. Smith, H. et al. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women — a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 46, 1852–1857 (2007).

    Article  CAS  Google Scholar 

  28. Gallagher, J. C., Yousefian, S. & Smith, L. Falls are increased on recommended doses of vitamin D in elderly women [poster abstract]. Presented at the ASBMR 2015 Annual Meeting (2015).

  29. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for prevention of falls and their consequences. J. Am. Geriatr. Soc. 62, 147–152 (2014).

  30. Gallagher, J. C., Fowler, S. E., Detter, J. R. & Sherman, S. S. Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J. Clin. Endocrinol. Metab. 86, 3618–3628 (2001).

    Article  CAS  Google Scholar 

  31. Dukas, L. et al. Alfacalcidol reduces the number of fallers in a community-dwelling elderly population with a minimum calcium intake of more than 500 mg daily. J. Am. Geriatr. Soc. 52, 230–236 (2004).

    Article  Google Scholar 

  32. US National Library of Science. ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT02166333?term=STURDY&rank=1 (2016).

Download references

Acknowledgements

J.C.G. conducted a dose-ranging trial on vitamin D that was supported by the National Institute on Aging (Grant number RO1-AG28168) and the Office of Dietary Supplements.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Bone Metabolism Unit, Creighton University School of Medicine, 601 North 30th Street, Omaha, 68131, Nebraska, USA

    J. Christopher Gallagher

Authors
  1. J. Christopher Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Christopher Gallagher.

Ethics declarations

Competing interests

J.C.G. was on the Advisory Board of, and has received honoraria from, Teva.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gallagher, J. Vitamin D and falls — the dosage conundrum. Nat Rev Endocrinol 12, 680–684 (2016). https://doi.org/10.1038/nrendo.2016.123

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrendo.2016.123

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing