Neuromuscular and Psychomotor Function in Elderly Subjects Who Fall and the Relationship With Vitamin D Status

Dhesi, Jugdeep; Bearne, Lindsay; Moniz, Caje; Hurley, Michael J.; Jackson, Stephen; Swift, Cameron; Allain, Theresa J.

doi:10.1359/jbmr.2002.17.5.891

Cited by 242 publications

(214 citation statements)

References 26 publications

(27 reference statements)

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“…The low D-hormone serum levels observed with a creatinine clearance of <65 ml/min may also be one reason for the increased osteopenia and osteoporosis observed with low creatinine clearance by other authors [15,16]. Our result enhances the theory suggested by other studies [4,5,6,7,17,18,19,20,21,22] that D-hormone is an independent risk factor for falls [1,2,5,23], and that D-hormone is directly involved in the causal pathogenic pathway of decreased muscle strength related falls [9,23,24]. It has been recently confirmed in VDR gene deleted mice that the absence of VDR causes muscle abnormality independently of secondary metabolic changes, e.g.…”

Section: Discussionsupporting

confidence: 87%

“…D-hormone has a scientifically established effect on muscle strength, balance and functional mobility [3,4,5,6,7,8,9], and the effect of D-hormone treatment (alfacalcidol or calcitriol) on risk of falls has been proven in several studies [1,2]. The low D-hormone serum levels observed with a creatinine clearance of <65 ml/min may also be one reason for the increased osteopenia and osteoporosis observed with low creatinine clearance by other authors [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…This positive effect of calcitriol or alfacalcidol on risk of falls or number of fallers is most probably due to an increase in muscle strength [3,4,5] and neuromuscular coordination [6], improved balance [4,5,7] and increased functional mobility [5,8] observed with increasing D-hormone serum levels or under treatment with calcitriol or alfacalcidol [7,9].…”

Section: Introductionmentioning

confidence: 99%

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Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

et al. 2004

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We previously observed that a creatinine clearance (CrCl) of <65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 lg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of <65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08-0.80, P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09-0.88, P=0.028). No such association was observed in participants with a CrCl of ‡65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34-2.52, P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34-2.54, P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of <65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

et al. 2004

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“…(8,9,30,31) For example, vitamin D status has been associated with cognitive function such as attention, which is involved in gait control in older adults. (32)(33)(34)(35)(36) Fast-pace walking is precisely considered as a more attention-demanding task than usual-pace walking, (23,36) which could explain in part the close positive association shown in our study.…”

Section: Discussionsupporting

confidence: 58%

Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: The EPIDOS study

Annweiler

Schott

Montero‐Odasso

et al. 2010

Journal of Bone and Mineral Research

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The purpose of this study was to determine whether there was an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and walking speed measured at usual and fast pace among older women. Usual-and fast-pace walking speeds and 25(OH)D concentrations were assessed in 739 randomized older women (mean age 80.2 AE 3.5 years) from the EPIDOS study. The following 25(OH)D thresholds were used: 10, 20, and 30 ng/mL. Walking speed was dichotomized on being in the worst quintile or not. Age, body mass index, number of chronic diseases, physical activity, quadriceps strength, cognition, use of psychoactive drugs, and serum parathyroid hormone were used as potential confounders. The results show that 90% of subjects had 25(OH)D insufficiency. Only fast-pace walking speed was significantly different between groups ( p ¼ .

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“…Several studies have investigated the risk factors for falls in the elderly [5,6,7]. Among others, vitamin D deficiency and/or low D-hormone (calcitriol/1,25(OH) 2 D 3 ), associated with a decrease of muscle strength [8,9,10,11], decreased balance [8,12,13], and loss of functional mobility [13,14], are more and more recognized to be important risk factors for falls in the elderly. Several recently published studies have shown that supplementation of vitamin D in vitamin D-deficient institutionalized women [15] and treatment with either calcitriol in osteopenic vitamin D-replete women [16] or alfacalcidol, a D-hormone prodrug, in a population of community-dwelling elderly non-vitamin D-deficient men and women [17] can significantly reduce frequency of falls [15,16,17] and number of fallers [17].…”

Section: Introductionmentioning

confidence: 99%

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

et al. 2004

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Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH) 2 D 3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D 3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH) 2 D 3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of <65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ‡65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/ 116; OR=3.68; 95% CI, 1.38-9.82; p=0.009). Conclusions: For the first time we showed that in a communitydwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls.

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Neuromuscular and Psychomotor Function in Elderly Subjects Who Fall and the Relationship With Vitamin D Status

Abstract: ABSTRACT

Cited by 242 publications

References 26 publications

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65�ml/min

Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: The EPIDOS study

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

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