BMJ 2015;350:h1592 doi: 10.1136/bmj.h1592 (Published 24 March 2015)

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RESEARCH NEWS Falls in older women are not reduced by exercise or vitamin D, study finds Jacqui Wise London

The overall rate of falls among older women is not reduced by exercise training or vitamin D supplements, a randomised trial has found. But the study, published in JAMA Internal Medicine, found that strength and balance training cut the number of injurious falls by more than half.1

The two year Finnish study included 409 women aged 70 to 80 who lived at home. They had all fallen at least once during the previous year and were not taking vitamin D supplements before the study. The women were randomised into four groups: vitamin D (800 IU/day) without exercise, placebo without exercise, placebo with exercise, or vitamin D with exercise. The exercise consisted of supervised group training classes twice a week for the first 12 months and once a week for the following year, focusing on balance, weights, agility, and muscle strengthening. Results showed that neither vitamin D nor exercise reduced falls. Fall rates per 100 person years were 132.1 in the vitamin D without exercise group; 118.2 in the placebo without exercise group; 120.7 in the placebo and exercise group; and 113.1 in the vitamin D and exercise group.

“Given the fact that fall risk is multifactorial, exercise may be the most effective and feasible strategy for preventing injurious falls in community dwelling older adults replete with vitamin D,” the authors concluded. One limitation of the study is that milk in Finland is fortified, so the women’s vitamin D levels may have been too high to show any beneficial effects of taking supplements. Vitamin D supplementation may have greater effects on the risk of falls in women who are deficient in the vitamin. In an accompanying commentary Erin LeBlanc, of Kaiser Permanente Northwest in Oregon, USA, and Roger Chou, of Oregon Health and Science University, said, “Given its low cost and low risk, vitamin D should remain in the physician’s armamentarium for fall prevention, at least until more data are available. Taking a person’s vitamin D status into account may be a useful clinical consideration.” But they added, “The strongest and most consistent evidence for prevention of serious falls is exercise, which has multiple other health benefits.”

However, the rate of injurious falls was reduced by more than half among women who exercised, with or without vitamin D. Injurious falls were defined as those where medical care was sought from a nurse, doctor, or hospital and included injuries such as bruises, sprains, and fractures. The hazard ratio among injured fallers was 0.38 (95% confidence interval 0.17 to 0.83) among exercisers with vitamin D and was 0.47 in exercisers without vitamin D (0.23 to 0.99).

Taking vitamin D maintained femoral neck bone mineral density and increased tibial trabecular density slightly; however, only exercise improved muscle strength and balance. Vitamin D did not enhance the effects of exercise on physical functioning.

1

Uusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med March 2015; doi:10.1001/ jamainternmed.2015.0225.

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Falls in older women are not reduced by exercise or vitamin D, study finds.

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