Vitamin D supplementation improves neuromuscular function in older people who fall

Vitamin D supplementation improves neuromuscular function in olderpe ople who fall

 

1. 1.    Jugdeep K. Dhesi ¹ ,
2. 2.    Stephen H. D. Jackson ² ,
3. 3.    Lindsay M. Bearne ³ ,
4. 4.    Caje Moniz ⁴ ,
5. 5.    Michael V. Hurley ³ ,
6. 6.    Cameron G. Swift ² and
7. 7.    Theresa J. Allain ⁵

+ Author Affiliations

1. 1.     ¹Elderly Day Hospital, Thomas Guy House, Guys Hospital, St Thomas Street, London SE1, UK
2. 2.     ²Clinical Age Research Unit, Department of Health Care of the Elderly, New Medical School, King’s College Hospital, Bessemer Road, London SE5 9PJ, UK
3. 3.     ³Physiotherapy Rehabilitation Unit, East Dulwich Hospital, East Dulwich Grove, East Dulwich, London, UK
4. 4.     ⁴Clinical Biochemistry, King’s College Hospital, Guy’s, King’s and St Thomas’ School of Medicine, Bessemer Road, London SE5 9PJ, UK
5. 5.     ⁵Care of the Elderly, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
6. Address correspondence to: J. Dhesi. Fax: (+44) 20 7188 2096. Email: jugdeep.dhesi@gsst.nhs.uk

     Received May 13, 2003.

     Revision received July 8, 2004.

     Accepted July 8, 2004.

Abstract

Background: vitamin D supplementation reduces the incidence of fractures in older adults. This may be partly mediated by effects of vitamin D on neuromuscular function.

Objective: to determine the effects of vitamin D supplementation on aspects of neuromuscular function known to be risk factors for falls and fractures.

Design: randomised, double-blind, placebo-controlled study.

Setting: falls clinic taking referrals from general practitioners and accident and emergency department.

Subjects: 139 ambulatory subjects (≥65 years) with a history of falls and 25-hydroxyvitamin D (25OHD) ≤12 μg/l.

Intervention: patients were randomised to receive a single intramuscular injection of 600,000 i.u. ergocalciferol or placebo.

Outcome measures: assessments including biochemistry, postural sway, choice reaction time (CRT), aggregate functional performance time (AFPT), and quadriceps strength were carried out at baseline and 6 months post-intervention.

Results: baseline characteristics were comparable between both groups. 25OHD in the treatment group increased significantly at 6 months. AFPT deteriorated in the control group and improved in the intervention group, representing a significant difference between groups (+6.6 s versus –2.0 s, t = 2.80, P < 0.05). Similar changes were observed for CRT (−0.06 s versus +0.41 s, t = −2.52, P < 0.01) and postural sway (+0.0025 versus −0.0138, t = 2.35, P < 0.02). There was no significant difference in muscle strength change between groups (−10 N versus −2 N, t = −1.26, ns). A significant correlation between change in AFPT and change in 25OHD levels was observed (r = 0.19, P = 0.03). There was no significant difference in the number of falls (0.39 versus 0.24, t = 1.08, P = 0.28) or fallers (14 versus 11, P = 0.52) between two groups.

Conclusions: vitamin D supplementation, in fallers with vitamin D insufficiency, has a significant beneficial effect on functional performance, reaction time and balance, but not muscle strength. This suggests that vitamin D supplementation improves neuromuscular or neuroprotective function, which may in part explain the mechanism whereby vitamin D reduces falls and fractures.

Key words

     vitamin D

muscle

accidental falls

aged

25-hydroxyvitamin D3

elderly

Age and Ageing Vol. 33 No. 6 © British Geriatrics Society 2004; all rights reserved

http://ageing.oxfordjournals.org/content/33/6/589.short

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