Alfacalcidol reduces the number of fallers in a community-dwelling elderly population with a minimum calcium intake of more than 500 mg daily.
OBJECTIVE
To study the effect of alfacalcidol (1alpha(OH)D3) on fall risk in community-dwelling elderly men and women.


METHODS
Randomized, double-blind, placebo-controlled intervention trial.


METHODS
Basel, Switzerland.


METHODS
Three hundred seventy-eight community-dwelling elderly (191 women/187 men).


METHODS
Participants were randomly assigned to receive 1 microg of alfacalcidol or matched placebo daily for 36 weeks.


METHODS
Serum 25-hydoxyvitamin D3 (25(OH) D,1,25-dihydroxyvitamin D3 (D-hormone), and intact parathormone (iPTH) levels were measured using radioimmunoassay at baseline and every 12 weeks. Numbers of fallers and falls were assessed using a questionnaire during each study site visit. Dietary calcium intake was assessed at baseline using a food frequency questionnaire.


RESULTS
At baseline, participants had, on average, normal vitamin D and D-hormone serum levels. Over 36 weeks, alfacalcidol treatment was associated with fewer fallers (odds ratio (OR)=0.69, 95% confidence interval (CI)=0.41-1.16) than placebo. In a post hoc subgroups analysis by medians of total calcium intake, this reduction reached significance in alfacalcidol-treated subjects with a total calcium intake of more than 512 mg/d (OR=0.45, 95% CI=0.21-0.97, P=.042) but not in those who consumed less than 512 mg/d (OR=1.00, 95% CI= 0.47-2.11, P=.998). Alfacalcidol treatment was also, independent of total calcium intake, associated with a significant 37.9% reduction in iPTH serum levels (P<.0001). No cases of clinically relevant hypercalcemia were observed.


CONCLUSIONS
Provided a minimal calcium intake of more than 512 mg/d, alfacalcidol treatment significantly and safely reduces number of fallers in an elderly community dwelling population.
Dukas
Laurent
L
Geriatric University Clinic, Kantonsspital, Basel, Switzerland. dukasl@uhbs.ch
Bischoff
Heike A
HA
Lindpaintner
Lyn S
LS
Schacht
Erich
E
Birkner-Binder
Dagmar
D
Damm
Thomas N
TN
Thalmann
Beat
B
Stähelin
Hannes B
HB
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000276:Adjuvants, Immunologic / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D011355:Prodrugs / Q000494:pharmacology / Q000627:therapeutic use*; D018709:Statistics, Nonparametric
D000276:Adjuvants, Immunologic; D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D011355:Prodrugs; D002117:Calcitriol; D002118:Calcium; C008088:alfacalcidol