Vitamin D Supplementation for the Prevention of Falls and Fractures in Residents of Long-Term Care Facilities: A 2021 Update [Internet]

Excerpt

Among seniors (i.e., the elderly population older than 65 years of age), falls and the associated complications are a serious problem. It impacts the individual, their family, and society. Falls may result in pain, fracture, functional impairment, disability, and death. During 2015–2016, it was estimated that 11.9% of adults older than 40 years of age were living with diagnosed osteoporosis. Characteristics of osteoporosis include reduction in bone mass and fragmentation of the bone structure. The prevalence of osteoporosis increases with age. Seniors generally have osteoporosis, which makes them prone to the risk of fractures resulting from falls.^, Among the seniors in Canada, it has been estimated that the annual rate of falls will be 30% for those living in the community and 50% for those living in long-term care (LTC) facilities. Hence, preventive measures to maintain bone health and reduce falls are important.

Vitamin D plays an important role for maintenance of musculoskeletal health. Low vitamin D has been associated with bone loss and muscle weakness. Sunlight helps in vitamin D production. It has been reported that endogenous vitamin D production in persons aged older than 65 years is 25% of that in persons in the age range of 20 to 30 years, when exposed to the same amount of sunlight. In seniors, supplementation may be necessary to increase levels of vitamin D. There appears to be uncertainty with respect to the effectiveness of vitamin D supplementation in reducing falls and fractures in seniors living in LTC facilities.^,

A previous 2019 CADTH report assessed the use of vitamin D supplementation for the prevention of falls and fractures in residents of LTC facilities. According to this report, moderate-quality evidence suggested that, for older adults, vitamin D supplementation may reduce the rate of falls but not the number of individuals who fall. Additionally, according to the report, vitamin D supplementation appeared to be less costly and more effective than no treatment; and the identified guidelines recommended standard dose (at least 1,000 IU daily) vitamin D supplementation and cautioned that high dose (more than 4,000 IU daily) resulted in higher fall rates than standard dose. This current report is an update and will review the evidence available since the publication of the 2019 CADTH report. It will summarize the evidence regarding the clinical effectiveness and cost-effectiveness of vitamin D supplementation for the prevention of falls and fractures in elderly patients residing in LTCs; and also summarize the evidence-based guidelines regarding vitamin D supplementation for the prevention of falls and fractures in elderly patients residing in LTC facilities.