High-dose vitamin D does not prevent falls among older adult
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A randomized trial found that, compared with a lower dose, higher doses of vitamin D supplementation did not reduce falls in older persons at high risk for falls. In addition, several analyses raised safety concerns about vitamin D3 doses of 1000 IU/d or higher. The findings are published in Annals of Internal Medicine.

Vitamin D supplementation may prevent falls in older persons, but evidence is inconsistent, possibly because of dosage differences.

This study aimed to compare the effects of 4 doses of vitamin D3 supplements on falls in the setting of 2 community-based research units.

There were 688 participants, aged 70 years and older, with elevated fall risk and a serum 25-hydroxyvitamin D [25-(OH)D] level of 25 to 72.5 nmol/L.

200 (control), 1000, 2000, or 4000 IU of vitamin D3 per day were analyzed. During the dose-finding stage, participants were randomly assigned to 1 of the 4 vitamin D3 doses, and the best noncontrol dose for preventing falls was determined. After dose finding, participants previously assigned to receive noncontrol doses received the best dose, and new enrollees were randomly assigned to receive 200 IU/d or the best dose.

Results:
-- During the dose-finding stage, the primary outcome rates were higher for the 2000- and 4000-IU/d doses than for the 1000-IU/d dose, which was selected as the best dose.

-- In the confirmatory stage, event rates were not significantly different between participants with experience receiving the best dose (events and observation time limited to the period they were receiving 1000 IU/d; n = 308) and those randomly assigned to receive 200 IU/d (n = 339).

-- Analysis of falls with adverse outcomes suggested greater risk in the experience-with-best-dose group versus the 200-IU/d group.

Conclusively, in older persons with elevated fall risk and low serum 25-(OH)D levels, vitamin D3 supplementation at doses of 1000 IU/d or higher did not prevent falls compared with 200 IU/d. Several analyses raised safety concerns about vitamin D3 doses of 1000 IU/d or higher.

Source: https://www.acpjournals.org/doi/10.7326/M20-3812
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