Should Vitamin D Supplements Be Taken to Prevent Falls in the Elderly?

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A daily dose of 4,000 IU of vitamin D is recommended for elders at high risk for falling to improve muscle strength and balance, though there is something that works even better.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for over 400 years that muscle weakness is a common presenting symptom of vitamin D deficiency. Bones aren’t the only organs that respond to vitamin D; muscles do too. But, as we age, our muscles lose vitamin D receptors, perhaps helping to explain the loss in muscle strength as we age.

And indeed, vitamin D status does appear to predict the decline in physical performance as we age, with lower vitamin D levels linked to poorer performance. But, maybe the low vitamin D doesn’t lead to weakness; maybe the weakness leads to low vitamin D. Vitamin D is the sunshine vitamin, and so, if you’re too weak to run around outside, that could explain the correlation with lower levels. To see if it’s cause and effect, you have to put it to the test.

There’s been about a dozen randomized controlled trials: vitamin D supplements versus sugar pills. Put all the studies together, and older men and women do get significant protection from falls with vitamin D, especially among those who start out with relatively low levels, leading the conservative USPSTF, the U.S. Preventive Services Task Force, the official prevention guideline-setting body, and the American Geriatric Society to recommend vitamin D supplementation for those at high risk for falls.

We’re not quite sure of the mechanism, though. Randomized, controlled trials have found that vitamin D boosts global muscle strength, particularly in the quads, which are important for fall prevention—though vitamin D supplements have also been shown to improve balance. So, it may also be a neurological effect, or even a cognitive effect. We’ve known for about 20 years that older men and women who stop walking when a conversation starts are at particularly high risk of falling. Over a six-month timeframe, few of those who could walk and talk at the same time would go on to fall, but 80% of those who stopped when a conversation was initiated ended up falling.

Other high risk groups that should supplement include those who’ve already fallen once, or are unsteady, or on a variety of heart, brain, and blood pressure drugs that can increase fall risk. There’s also a test called “Get-Up-and-Go,” which anyone can do at home. You time how long it takes you “to get up from an armchair, walk 10 feet, turn around, walk back, and sit down.” If it takes you longer than ten seconds, then you may be at high risk.

So, how much vitamin D should you take? It seems to take at least 700 to a thousand units a day. The American Geriatric Society recommends a total of 4,000 a day, though, based on the rationale that this should get about 90% of people up to the target vitamin D blood level of 75 nanomoles per liter. 1,000 should do it for the majority of people, 51%, but they recommend 4,000 to capture 92% of the population. Then, you don’t have to routinely test levels, since you would get most people up there, and it’s considerably below the proposed upper tolerable intake of 10,000 a day. They do not recommend periodic megadoses.

Because it’s hard to get patients to comply with pills, why not just give people one megadose, like 500,000 units, once a year, like when you come in for your flu shot, or something? That way, every year, you can at least guarantee an annual spike in D levels that lasts a few months. It’s unnatural, but certainly convenient (for the doctor, at least). The problem is that it actually increases fall risk—a 30% increase in falls in those first three months of the spike. Similar results were found in other megadose trials. It may be a matter of “too much of a good thing.”

See, “vitamin D may improve physical performance, reduce chronic pain, and improve mood” so much that you start moving around more, and, thereby, increase fall risk. You give people a whopping dose of D, and you get a burst in physical, mental, and social functioning, and it may take time for your motor control to catch up with your improved muscle function. It would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater. You gotta take it slow.

It’s possible, though, that such unnaturally high doses may actually damage the muscles. The evidence they cite in support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D. So, the concern is that such high doses may be over-tenderizing our own muscles, as well. So, yeah, higher D levels are associated with a progressive drop in fracture risk, but too much vitamin D may be harmful.

The bottom line is that vitamin D supplementation appears to help, but the strongest and most consistent evidence for prevention of serious falls is exercise. If you compare the two, yes, taking vitamin D may lower your fall risk, compared to placebo. But, strength and balance training, with or without vitamin D, may be even more powerful.

Please consider volunteering to help out on the site.

Image credit: David J via flickr. Image has been modified.

Video credit: Daniel Black.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for over 400 years that muscle weakness is a common presenting symptom of vitamin D deficiency. Bones aren’t the only organs that respond to vitamin D; muscles do too. But, as we age, our muscles lose vitamin D receptors, perhaps helping to explain the loss in muscle strength as we age.

And indeed, vitamin D status does appear to predict the decline in physical performance as we age, with lower vitamin D levels linked to poorer performance. But, maybe the low vitamin D doesn’t lead to weakness; maybe the weakness leads to low vitamin D. Vitamin D is the sunshine vitamin, and so, if you’re too weak to run around outside, that could explain the correlation with lower levels. To see if it’s cause and effect, you have to put it to the test.

There’s been about a dozen randomized controlled trials: vitamin D supplements versus sugar pills. Put all the studies together, and older men and women do get significant protection from falls with vitamin D, especially among those who start out with relatively low levels, leading the conservative USPSTF, the U.S. Preventive Services Task Force, the official prevention guideline-setting body, and the American Geriatric Society to recommend vitamin D supplementation for those at high risk for falls.

We’re not quite sure of the mechanism, though. Randomized, controlled trials have found that vitamin D boosts global muscle strength, particularly in the quads, which are important for fall prevention—though vitamin D supplements have also been shown to improve balance. So, it may also be a neurological effect, or even a cognitive effect. We’ve known for about 20 years that older men and women who stop walking when a conversation starts are at particularly high risk of falling. Over a six-month timeframe, few of those who could walk and talk at the same time would go on to fall, but 80% of those who stopped when a conversation was initiated ended up falling.

Other high risk groups that should supplement include those who’ve already fallen once, or are unsteady, or on a variety of heart, brain, and blood pressure drugs that can increase fall risk. There’s also a test called “Get-Up-and-Go,” which anyone can do at home. You time how long it takes you “to get up from an armchair, walk 10 feet, turn around, walk back, and sit down.” If it takes you longer than ten seconds, then you may be at high risk.

So, how much vitamin D should you take? It seems to take at least 700 to a thousand units a day. The American Geriatric Society recommends a total of 4,000 a day, though, based on the rationale that this should get about 90% of people up to the target vitamin D blood level of 75 nanomoles per liter. 1,000 should do it for the majority of people, 51%, but they recommend 4,000 to capture 92% of the population. Then, you don’t have to routinely test levels, since you would get most people up there, and it’s considerably below the proposed upper tolerable intake of 10,000 a day. They do not recommend periodic megadoses.

Because it’s hard to get patients to comply with pills, why not just give people one megadose, like 500,000 units, once a year, like when you come in for your flu shot, or something? That way, every year, you can at least guarantee an annual spike in D levels that lasts a few months. It’s unnatural, but certainly convenient (for the doctor, at least). The problem is that it actually increases fall risk—a 30% increase in falls in those first three months of the spike. Similar results were found in other megadose trials. It may be a matter of “too much of a good thing.”

See, “vitamin D may improve physical performance, reduce chronic pain, and improve mood” so much that you start moving around more, and, thereby, increase fall risk. You give people a whopping dose of D, and you get a burst in physical, mental, and social functioning, and it may take time for your motor control to catch up with your improved muscle function. It would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater. You gotta take it slow.

It’s possible, though, that such unnaturally high doses may actually damage the muscles. The evidence they cite in support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D. So, the concern is that such high doses may be over-tenderizing our own muscles, as well. So, yeah, higher D levels are associated with a progressive drop in fracture risk, but too much vitamin D may be harmful.

The bottom line is that vitamin D supplementation appears to help, but the strongest and most consistent evidence for prevention of serious falls is exercise. If you compare the two, yes, taking vitamin D may lower your fall risk, compared to placebo. But, strength and balance training, with or without vitamin D, may be even more powerful.

Please consider volunteering to help out on the site.

Image credit: David J via flickr. Image has been modified.

Video credit: Daniel Black.

Doctor's Note

Other studies in which vitamin D supplements have been put to the test in randomized placebo-controlled studies, effectively proving—or disproving!—their efficacy, are featured in videos such as:

That brings up a number of important questions, which I answer in these videos:

Unfortunately, most supplements are useless—or worse. Here are some additional videos on supplements I’ve produced that may be of interest to you:

For more on the benefits of exercise, see Longer Life Within Walking Distance and How Much Should You Exercise?.

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