Vitamin D and Number of Falls in a Long-Term Care Facility

Robert B. Raffa, Frank Breve, Robert Taylor Jr., Joseph V. Pergolizzi Jr.

Mid Atlantic PharmaTech Consultants, LLC, Ventnor City, NJ, USA.
Temple University School of Pharmacy, Philadelphia, PA, USA.
NEMA Research Inc., Naples FL, USA.
Temple University School of Medicine, Temple University, Philadelphia, PA, USA, The Johns Hopkins University School of Medicine, Baltimore, MD and Georgetown University School of Medicine, Washington DC, USA.

DOI: 10.4236/pp.2012.34061                

Abstract

Falls represent a significant contribution to the morbidity and mortality of the elderly population. Because vitamin D is important in bone physiology, the use of vitamin D to restore deficient bone and ameliorate the effects of bone fractures due to falls has become a common practice in recent years. Following introduction of widespread use, reports began to emerge that vitamin D not only aided in repair of fall-induced bone fractures, but that it also reduced the occurrence of falls. Vitamin D now has become a routine intervention as a fall-prevention measure. Early analyses found evidence of prevention efficacy (reduced falls), but recent analyses are more equivocal. We retrospectively examined the records of 350 patients in a long-term care facility in which vitamin D administration and the number of falls were recorded as part of a comprehensive database of care. We found a dramatic rise in vitamin D use over the period covered (2006 – 2011) and a corresponding dramatic decrease in the number of falls. However, the number of falls continued to decline after 2008, despite a plateau in number of patients on vitamin D, particularly females. It appears that other factors contribute to the overall decline.

Keywords

Falls; Bone Fracture; Vitamin D; Long-Term Care Facility

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	F. Heidrich and R. S. Thompson, "Osteoporosis prevention: strategies applicable for general population groups," Journal of Family Practice, Vol. 25, 1987, pp. 33-39.
[2]	E. Laird, M. Ward, E. McSorley, J. J. Strain and J. Wallace, "Vitamin D and bone health: potential mechanisms," Nutrients, Vol. 2, 2010, pp. 693-724.
[3]	R. Bouillon, S. Van Cromphaut and G. Carmeliet, "Intestinal calcium absorption: Molecular vitamin D mediated mechanisms," Journal of Cellular Biochemistry, Vol. 88, 2003, pp. 332-339.
[4]	P. Lips and N. M. van Schoor, "The effect of vitamin D on bone and osteoporosis," Best Practice and Research Clinical Endocrinology & Metabolism, Vol. 25, 2011, pp. 585-591.
[5]	O. Engelsen, "The relationship between ultraviolet radiation exposure and vitamin D status," Nutrients, Vol. 2, 2010, pp. 482-495.
[6]	B. A. Gilchrest, "Sun exposure and vitamin D sufficiency," American Journal of Clinical Nutrition, Vol. 88, 2008, pp. 570S-577S.
[7]	M. D'Imporzano, F. M. Liuni and U. Tarantino, "Aceta-bular fragility fractures in elderly patients," Aging Clinical and Experimental Research, Vol. 23, 2011, pp. 71- 73.
[8]	D. W. Stephenson and A. N. Peiris, "The lack of vitamin D toxicity with megadose of daily ergocalciferol (D2) therapy: a case report and literature review," Southern Medical Journal, Vol. 102, 2009, pp. 765-768.
[9]	J. J. Body, P. Bergmann, S. Boonen, Y. Boutsen, O. Bruyere, J. P. Devogelaer, S. Goemaere, N. Hollevoet, J. M. Kaufman, K. Milisen, S. Rozenberg and J. Y. Reginster, "Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club," Osteoporos International, Vol. 22, 2011, pp. 2769-2788.
[10]	T. P. Ip, J. Leung and A. W. Kung, "Management of osteoporosis in patients hospitalized for hip fractures," Osteoporosis International, Vol. 21, 2010, pp. S605-614.
[11]	P. Geusens, "Strategies for treatment to prevent fragility fractures in postmenopausal women," Best Practice and Research in Clinical Rheumatology, Vol. 23, 2009, pp. 727-740.
[12]	M. G. Sweet, J. M. Sweet, M. P. Jeremiah and S. S. Galazka, "Diagnosis and treatment of osteoporosis," American Family Physician, Vol. 79, 2009, pp. 193-200.
[13]	D. L. Schneider, "Management of osteoporosis in geriatric populations," Current Osteoporosis Reports, Vol. 6, 2008, pp. 100-107.
[14]	C. Roux, H. A. Bischoff-Ferrari, S. E. Papapoulos, A. E. de Papp, J. A. West and R. Bouillon, "New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion," Current Medical Research and Opinion, Vol. 24, 2008, pp. 1363-1370.
[15]	J. T. Lin and J. M. Lane, "Nonpharmacologic management of osteoporosis to minimize fracture risk," Nature Clinical Practice Rheumatology, Vol. 4, 2008, pp. 20-25.
[16]	S. L. Kates, O. S. Kates and D. A. Mendelson, "Advances in the medical management of osteoporosis," Injury, Vol. 38 Suppl 3, 2007, pp. S17-23.
[17]	J. P. Levine, "Pharmacologic and nonpharmacologic management of osteoporosis," Clinical Cornerstone, Vol. 8, 2006, pp. 40-53.
[18]	S. L. Follin and L. B. Hansen, "Current approaches to the prevention and treatment of postmenopausal osteoporosis," American Journal of Health System Pharmacists, Vol. 60, 2003, pp. 883-901; quiz 903-884.
[19]	H. A. Bischoff-Ferrari, B. Dawson-Hughes, H. B. Staehelin, J. E. Orav, A. E. Stuck, R. Theiler, J. B. Wong, A. Egli, D. P. Kiel and J. Henschkowski, "Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials," British Medical Journal, Vol. 339, 2009, pp. b3692.
[20]	S. Parikh, J. Avorn and D. H. Solomon, "Pharmacological management of osteoporosis in nursing home populations: a systematic review," J Am Geriatr Soc, Vol. 57, 2009, pp. 327-334.
[21]	C. Becker and K. Rapp, "Fall prevention in nursing homes," Clinical Geriatric Medicine, Vol. 26, 2010, pp. 693-704.
[22]	R. R. Kalyani, B. Stein, R. Valiyil, R. Manno, J. W. Maynard and D. C. Crews, "Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis," Journal of the American Geriatrics Society, Vol. 58, 2010, pp. 1299-1310.
[23]	F. Batchelor, K. Hill, S. Mackintosh and C. Said, "What works in falls prevention after stroke?: s systematic review and meta-analysis" Stroke, Vol. 41, 2010, pp. 1715- 1722.
[24]	H. Bischoff-Ferrari, "Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary?," Best Practice and Research Clinical Rheumatology, Vol. 23, 2009, pp. 789-795.
[25]	C. Annweiler, M. Montero-Odasso, A. M. Schott, G. Berrut, B. Fantino and O. Beauchet, "Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects," Journal of NeuroEngineering and Rehabilitation, Vol. 7, 2010, pp. 50.
[26]	E. M. Lewiecki and S. L. Silverman, "Redefining osteoporosis treatment: Who to treat and how long to treat," Arquivos Brasileiros de Endocrinologia & Metabologia Vol. 50, 2006, pp. 694-704.
[27]	C. G. Swift, "The role of medical assessment and intervention in the prevention of falls" Age and Ageing, Vol. 35 Suppl 2, 2006, pp. ii65-ii68.
[28]	K. F. Mauck and B. L. Clarke, "Diagnosis, screening, prevention, and treatment of osteoporosis," Mayo Clinic Proceedings, Vol. 81, 2006, pp. 662-672.
[29]	M. Gass and B. Dawson-Hughes, "Preventing osteoporosis-related fractures: an overview," American Journal of Medicine, Vol. 119, 2006, pp. S3-S11.
[30]	E. S. Siris, "Patients with hip fracture: what can be improved?," Bone, Vol. 38, 2006, pp. S8-12.
[31]	J. M. Hausdorff, D. A. Rios and H. K. Edelberg, "Gait variability and fall risk in community-living older adults a 1-year prospective study," Archives of Physical Medicine and Rehabilitation, Vol. 82, 2001, pp. 1050-1056.
[32]	M. E. Tinetti, M. Speechley and S. F. Ginter, "Risk factors for falls among elderly persons living in the community," New England Journal of Medicine, Vol. 319, 1988, pp. 1701-1707.
[33]	J. T. Chang, S. C. Morton, L. Z. Rubenstein, W. A. Mojica, M. Maglione, M. J. Suttorp, E. A. Roth and P. G. Shekelle, "Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials," British Medical Journal, Vol. 328, 2004, pp. 680.
[34]	A. J. Blake, K. Morgan, M. J. Bendall, H. Dallosso, S. B. Ebrahim, T. H. Arie, P. H. Fentem and E. J. Bassey, "Falls by elderly people at home: prevalence and associated factors," Age and Ageing, Vol. 17, 1988, pp. 365-372.
[35]	P. C. Walker, A. Alrawi, J. F. Mitchell, R. E. Regal and U. Khanderia, "Medication use as a risk factor for falls among hospitalized elderly patients," American Journal of Health System Pharmacists, Vol. 62, 2005, pp. 2495-2499.
[36]	B. H. Alexander, F. P. Rivara and M. E. Wolf "The cost and frequency of hospitalization for fall-related injuries in older adults," American Journal of Public Health, Vol. 82, 1992, pp. 1020-1023.
[37]	J. E. Dunn, S. E. Furner and T. P. Miles, "Do falls predict institutionalization in older persons? An analysis of data from the Longitudinal Study of Aging," Journal of Aging Health, Vol. 5, 1993, pp. 194-207.
[38]	C. Casteel, C. Peek-Asa, C. Lacsamana, L. Vazquez and J. F. Kraus, "Evaluation of a falls prevention program for independent elderly," Am J Health Behav, Vol. 28 Suppl 1, 2004, pp. S51-60.
[39]	R. M. Francis, "Calcium, vitamin D and involutional osteoporosis," Curr Opin Clin Nutr Metab Care, Vol. 9, 2006, pp. 13-17.
[40]	M. C. Chapuy, M. E. Arlot, F. Duboeuf, J. Brun, B. Crouzet, S. Arnaud, P. D. Delmas and P. J. Meunier, "Vitamin D3 and calcium to prevent hip fractures in the elderly women," New England Journal of Medicine, Vol. 327, 1992, pp. 1637-1642.
[41]	M. C. Chapuy, M. E. Arlot, P. D. Delmas and P. J. Meunier, "Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women," British Medical Journal Vol. 308, 1994, pp. 1081-1082.
[42]	B. Dawson-Hughes, S. S. Harris, E. A. Krall and G. E. Dallal, "Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older," New England Journal of Medicine, Vol. 337, 1997, pp. 670-676.
[43]	P. Lips, W. C. Graafmans, M. E. Ooms, P. D. Bezemer and L. M. Bouter, "Vitamin D supplementation and fracture incidence in elderly persons. A randomized, place-bo-controlled clinical trial," Ann Intern Med, Vol. 124, 1996, pp. 400-406.
[44]	A. Avenell, W. J. Gillespie, L. D. Gillespie and D. O'Connell, "Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis," Cochrane Database of Systematic Reviews, 2009, pp. CD000227.
[45]	R. J. Heikinheimo, J. A. Inkovaara, E. J. Harju, M. V. Haavisto, R. H. Kaarela, J. M. Kataja, A. M. Kokko, L. A. Kolho and S. A. Rajala, "Annual injection of vitamin D and fractures of aged bones," Calcified Tissue International, Vol. 51, 1992, pp. 105-110.
[46]	A. C. Ross, J. E. Manson, S. A. Abrams, J. F. Aloia, P. M. Brannon, S. K. Clinton, R. A. Durazo-Arvizu, J. C. Gallagher, R. L. Gallo, G. Jones, C. S. Kovacs, S. T. Mayne, C. J. Rosen and S. A. Shapses, "The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know," Journal of Clinical Endocrinology and Metabolism, Vol. 96, 2011, pp. 53-58.
[47]	R. Vieth, "Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety," American Journal of Clinical Nutrition, Vol. 69, 1999, pp. 842-856.
[48]	L. D. Gillespie, M. C. Robertson, W. J. Gillespie, S. E. Lamb, S. Gates, R. G. Cumming and B. H. Rowe, "Interventions for preventing falls in older people living in the community," Cochrane Database of Systematic Reviews, 2009, pp. CD007146.
[49]	I. D. Cameron, G. R. Murray, L. D. Gillespie, M. C. Robertson, K. D. Hill, R. G. Cumming and N. Kerse, "Interventions for preventing falls in older people in nursing care facilities and hospitals," Cochrane Data- base of Systematic Reviews, 2010, pp. CD005465.
[50]	C. A. Nowson, "Prevention of fractures in older people with calcium and vitamin D," Nutrients, Vol. 2, 2010, pp. 975-984.