From the Guidelines
Vitamin D plays a limited role in the management of elderly patients, primarily in preventing fractures, but not falls, in those with vitamin D deficiency or insufficiency.
Role of Vitamin D in Elderly Patients
- Fracture prevention: Vitamin D supplementation has been shown to reduce the risk of non-vertebral fractures by 20% and hip fractures by 18% in elderly patients with adequate doses (482-770 IU/day or 12.0-19.25 μg/day) and achieved blood 25(OH)D levels of at least 30 to 40 ng/ml 1.
- Fall prevention: However, the USPSTF recommends against vitamin D supplementation for the prevention of falls in community-dwelling older adults not known to have vitamin D deficiency or insufficiency, as it has been found to have no benefit in preventing falls 1.
- Muscle performance: Vitamin D has been shown to improve muscle performance and reduce the risk of falling in community-dwelling and institutionalized elderly, but this effect is not sufficient to recommend supplementation for fall prevention alone 1.
Clinical Considerations
- Patient population: The USPSTF recommendations apply to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures, and do not apply to persons with osteoporosis or vitamin D deficiency 1.
- Potential harms: Vitamin D supplementation has been associated with a small to moderate risk of harms, including renal stones, and costs are relatively low 1.
From the Research
Role of Vitamin D in Elderly Patients
- Vitamin D deficiency is common among community-dwelling elderly in developed countries at higher latitudes and very common among institutionalized elderly, geriatric patients, and patients with hip fractures 2.
- Vitamin D deficiency is an established risk factor for osteoporosis, falls, and fractures 2, 3.
- Clinical trials have demonstrated that 800 IU (20 microg) per day of vitamin D in combination with 1200 mg calcium effectively reduces the risk of falls and fractures in institutionalized patients 2.
- Vitamin D supplementation should be combined with calcium to reduce fractures in the older population 4.
- The goal for adequate Vitamin D status should be to reach a serum level of 25(OH)D >50 nmol/l 4.
Vitamin D Deficiency and Related Disorders
- Vitamin D insufficiency is related to a number of other disorders frequently observed among the elderly, such as breast, prostate, and colon cancers, type 2 diabetes, and cardiovascular disorders including hypertension 2.
- Vitamin D deficiency (< 20 ng/ml) increases parathyroid hormone levels and thus promotes bone loss and the risk of fracture 3.
- Severe vitamin D deficiency (< 10 ng/ml) may also lead to reversible muscle weakness resulting in an increased risk of falling 3.
- Vitamin D supplementation decreases the risk of progression to T2D from prediabetes among those who are Vitamin D deficient 4.
Management of Vitamin D Deficiency
- Supplementation with vitamin D is the best option either pharmacologically or through food fortification 4.
- Daily low-dose vitamin D regimens reduce the risk of falling, especially in the elderly, compared with infrequent, large bolus doses that may increase it 4.
- A bolus dose of over 24,000 IU/month should be avoided due to the increased risk of falls and fractures 3.
- Treatment goals should focus on avoiding 25(OH)D serum levels <30 nmol/l, with a goal to reach levels >50 nmol/l 4.