In 2010, the New Zealand District Health Board (DHB), in partnership with the Accident Compensation Corporation (ACC), began encouraging health professionals to prescribe vitamin D to residents in aged care facilities. Between March 2010 and June 2012 the uptake of vitamin D by aged care residents increased from 15 to 74%.
“MidCentral District Health Board’s (DHB’s) vitamin D project is a good example of how a simple intervention can improve lives and save health dollars” associate Minister of Health Jo Goodhew said in a recent press release.1
“Comparisons from before and after the start of the project show a 32% reduction in aged residential care residents going to the emergency department with fall-related fractures, and a 41% reduction in their hospital admissions due to these fractures,” she stated.
Similar results have been reported in the past. For example, Bischoff et al found that by adding 800IU vitamin D to a 1200mg calcium supplement taken by elderly women could reduce their risk of falling by 49% compared with calcium alone.2
In Australia, the estimated number of hospitalised injury cases due to falls in people aged 65 and over in the financial year 2009-10 was 83,800.3
The benefits of preventing falls in older people cannot be overstated as it enables them to maintain their independence. Of older individuals who suffer a hip fracture, nearly 20% will die within a year; almost half will require long-term care; half will require help at home; and only half of those who walked without help before fracturing a hip will be able to walk without assistance in the year following the fracture.1
Vitamin D deficiency: falls and fractures in the elderly
Vitamin D deficiency is an independent risk factor and predictor of falls in older people. Reduced circulating serum levels have been associated with lower-extremity muscle weakness and impaired balance, as well as accelerated losses in muscle mass, strength and physical function.4
In Australia, older people who are institutionalised or housebound are at a particularly high risk of vitamin D deficiency. For example, up to 80% of women and 70% of men living in hostels or nursing homes in Victoria, NSW and WA were found to be deficient in vitamin D, and 97% had a serum level below the median value of the healthy reference range.5
A major reason for vitamin D deficiency in older people is limited sun exposure. However, reduced production rates of vitamin D in response to UV radiation may also play a role.4,5
Vitamin D supplementation required to treat moderate to severe deficiency
To treat moderate to severe deficiency, it would be reasonable to use 3000-5000IU of vitamin D per day for at least 6-12 weeks, followed by an ongoing maintenance dose of around 1000-2000IU.4
- Hon Jo Goodhew. Press release: Vitamin D project helps prevent falls and saves health costs. Posted 8 Aug 2013, http://www.open.hqsc.govt.nz/falls/news-and-events/news/1040/
- Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003;18(2):343-351.
- AIHW 2013. Hospitalisations due to falls by older people, Australia: 2009-10. Injury research and statistics series no. 70. Cat. no. INJCAT 146. Canberra: AIHW.
- Nowson CA, McGrath JJ, Ebeling PR, et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012;196(11):686-687.
- Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. MJA 2005;182(6):281-285.