Published January 7, 2021
Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, wants people to know that a study published this month in the Annals of Internal Medicine — which shows no benefit from higher doses of vitamin D in the frail elderly — is not the final chapter on how vitamin D affects this population.
Writing in an editorial that appeared in the same issue of the journal, Troen describes the primary outcome of the National Institutes of Health-funded Study to Understand Fall Reduction and Vitamin D in You (STURDY).
Troen, an expert in geriatrics with a background in molecular biology and biochemistry, studies the biology of aging, frailty, osteoporosis and vitamin D.
The two-year study was designed to determine whether vitamin D3 supplementation reduces falls in community-dwelling adults 70 years of age and older who are at elevated risk for falls and whose blood levels of vitamin D may be insufficient.
Troen explains that the well-executed study found that participants assigned to the groups that took either 2,000 or 4,000 international units (IUs) a day had statistically a significantly greater risk for hospitalization or death than those in the group taking 200 IUs a day.
“These data reveal no benefits from higher-dose vitamin D supplementation and even raise concerns that high doses may have deleterious effects,” Troen writes.
However, he adds, that finding is not conclusive because of several limitations. For one thing, the control group received 200 IUs of vitamin D3, which brought average total daily vitamin D3 intake — including dietary intake — to the recommended daily allowance of approximately 800 IUs.
In addition, vitamin D levels in the blood increased in all participants in the study, which, Troen notes, prevented the study from revealing how frail elderly individuals with frank deficiency of vitamin D might benefit from supplementation.
A lack of information on comorbid conditions, medications that can cause falls and methods of assessing cognitive impairment also limit the power of the study’s findings, Troen says, in addition to the fact that the study lasted for two years. Animal model research Troen and colleagues in the Department of Medicine at the Jacobs School of Medicine and Biomedical Sciences recently completed showed that vitamin D insufficiency over the equivalent of 30 years negatively impacts physical performance.
So, Troen concludes, the question of whether or not adults should take vitamin D3 supplements to prevent falls is far from settled. He discusses a number of other trials that have failed to show that supplementation prevents falls, but he notes they also failed to demonstrate that the supplementation was harmful.
What will prevent falls in the frail elderly? Troen concludes that the answer must be multifaceted, including medication management, assessment of cognition and blood pressure, exercise or physical therapy, disease management, vision care, home safety modifications and potentially vitamin D supplementation. The relationship between exercise and vitamin D status is another important factor that must be further studied, according to Troen.
Troen helped found and is director of UB’s Center for Successful Aging, an interdisciplinary center that seeks to conduct community-responsive research among UB faculty and its community partners to solve challenges facing older adults.
He is a physician-investigator with the VA Western New York Healthcare System and director of geriatrics services at Erie County Medical Center. He is also the director of UB’s Center of Excellence for Alzheimer’s Disease in Western New York, which is funded by New York State. He is chief of the Division of Geriatrics and Palliative Medicine with UBMD Internal Medicine.