Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation.
OBJECTIVE
To determine whether vitamin D supplementation reduces the risk of fracture or falls in elderly people in care home accommodation.


METHODS
A randomised controlled trial of cluster design.


METHODS
223 Residential units (mainly identical 30-bedded units), within 118 homes for elderly people throughout Britain, with 3,717 participating residents (76% women, average age 85 years). The units provided mainly or entirely residential care (35% of residents), nursing care (42%) or care for elderly mentally infirm (EMI) residents (23%).


METHODS
Participants were randomly allocated by residential unit (cluster design) to a treated group offered ergocalciferol 2.5 mg every 3 months (equivalent to a daily dose of 1,100 IU), or to a control group. Fractures were reported by staff and confirmed in hospital, and routinely collected data on reported falls were obtained.


RESULTS
After median follow-up of 10 months (interquartile range 7-14 months), 64 (3.6%) of 1,762 vitamin D-treated residents and 51 (2.6%) of 1,955 controls had one or more non-vertebral fractures, and 24 (1.3%) and 20 (1.0%), respectively, had a hip fracture. The proportion reporting at least one fall was 44% in vitamin D-treated and 43% in control residents. The differences between the vitamin D and control groups were not statistically significant. The incidence of all non-vertebral fractures in the care homes (3.2% per year) and of hip fractures (1.1% per year) was low, similar to rates in elderly people in sheltered accommodation, and the pre-treatment serum 25-hydroxy vitamin D concentration was high [median 47 nmol/l, measured in a 1% (n = 18) sample].


CONCLUSIONS
We found no evidence that vitamin D prevents fractures or falls in elderly people in care home accommodation.
Law
Malcolm
M
Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK. m.r.law@qmul.ac.uk
Withers
Heather
H
Morris
Joan
J
Anderson
Frazer
F
D000058:Accidental Falls / Q000517:prevention & control*; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D004872:Ergocalciferols / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014815:Vitamins / Q000493:pharmacokinetics / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D010281:Parathyroid Hormone; D010710:Phosphates; D014815:Vitamins; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium