The Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial

Author:

Michos Erin D123ORCID,Kalyani Rita R34,Blackford Amanda L5,Sternberg Alice L2,Mitchell Christine M23,Juraschek Stephen P6,Schrack Jennifer A27,Wanigatunga Amal A27,Roth David L78,Christenson Robert H9,Miller Edgar R310,Appel Lawrence J310

Affiliation:

1. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA

2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21205, USA

4. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA

5. Division of Biostatistics and Bioinformatics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA

6. Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, MA 02215, USA

7. Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD 21205, USA

8. Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA

9. Department of Pathology, University of Maryland Medical Center, Baltimore, MD 21201, USA

10. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA

Abstract

Abstract Context The Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized trial enrolling older adults with low 25-hydroxyvitamin D [25(OH)D], demonstrated vitamin D supplementation ≥ 1000 IU/day did not prevent falls compared with 200 IU/day, with doses ≥ 2000 IU/day potentially showing safety concerns. Objective To examine associations of achieved and change in 25(OH)D concentrations after 3 months of vitamin D supplementation with fall risk. Design Observational analysis of trial data. Setting General community. Participants A total of 637 adults aged ≥ 70 with baseline 25(OH)D concentrations 10 to 29 ng/mL and elevated fall risk. Three-month on-treatment absolute 25(OH)D; absolute and relative changes from baseline. Main Outcome Measures Incident first fall (primary) and first consequential fall (injury or sought medical care) up to 24 months. Cox models were adjusted for sociodemographics, season, Short Physical Performance Battery, and body mass index. Results At baseline, mean (SD) age was 77.1 (5.4) years and 25(OH)D was 22.1 (5.1) ng/mL; 43.0% were women and 21.5% non-White. A total of 395 participants experienced ≥ 1 fall; 294 experienced ≥ 1 consequential fall. There was no association between absolute achieved 25(OH)D and incident first fall (30-39 vs < 30 ng/mL hazard ratio [HR], 0.93; 95% CI, 0.74-1.16; ≥40 vs < 30 ng/mL HR, 1.09; 95% CI, 0.82-1.46; adjusted overall P = 0.67), nor absolute or relative change in 25(OH)D. For incident consequential first fall, the HR (95% CI) comparing absolute 25(OH)D ≥ 40 vs < 30 ng/mL was 1.38 (0.99-1.90). Conclusion Achieved 25(OH)D concentration after supplementation was not associated with reduction in falls. Risk of consequential falls may be increased with achieved concentrations ≥ 40 ng/mL. Trial Registration ClinicalTrials.gov: NCT02166333

Funder

National Institute on Aging

Mid-Atlantic Nutrition Obesity Research Center

Johns Hopkins Institute for Clinical and Translation Research

Amato Fund for Women’s Cardiovascular Health Research

National Institute of Diabetes and Digestive and Kidney Diseases

National Heart, Lung, and Blood Institute

Johns Hopkins Older Americans Independence Center

Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research

National Institutes of Health

Publisher

The Endocrine Society

Subject

Endocrinology, Diabetes and Metabolism

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