title: Vitamin D deficiency is associated with functional decline and falls in frail elderly women despite supplementation.
abstract: We examined the impact of daily supplementation on vitamin D deficiency, function, and falls in female long-term care residents. Initial vitamin D deficiency was associated with greater functional decline and increased fall risk despite guideline-recommended supplementation, highlighting the importance of preventing vitamin D deficiency in frail elderly.
  
  
  
  Institute of Medicine (IOM) guidelines recommend 800 IU vitamin D daily for older adults and maintaining serum 25-hydroxyvitamin D [25(OH) D] above 20 ng/ml for optimal skeletal health. The adequacy of IOM guidelines for sustaining function and reducing falls in frail elderly is unknown.
  
  
  
  Female long-term care residents aged ≥65 enrolled in an osteoporosis clinical trial were included in this analysis (n = 137). Participants were classified based on baseline 25(OH) D levels as deficient (<20 ng/ml, n = 26), insufficient (20-30 ng/ml, n = 40), or sufficient (>30 ng/ml, n = 71). Deficient women were provided initial vitamin D repletion (50,000 IU D3weekly for 8 weeks). All were supplemented with 800 IU vitamin D3daily for 24 months. Annual functional assessments included Activities of Daily Living (ADLs), Instrumental ADL (IADL), physical performance test (PPT), gait speed, cognition (SPMSQ), and mental health (PHQ-9). We used linear mixed models for analysis of functional measures and logistic regression for falls.
  
  
  
  Daily supplementation maintained 25(OH) D levels above 20 ng/ml in 95% of participants. All groups demonstrated functional decline. Women initially deficient had a greater decline in physical function at 12 (IADL -2.0 ± 0.4, PPT -3.1 ± 0.7, both p < 0.01) and 24 months (IADL -2.5 ± 0.6, ADL -2.5 ± 0.6, both p < 0.01), a larger increase in cognitive deficits at 12 months (1.7 ± 0.4: p = 0.01) and more fallers (88.5%, p = 0.04) compared to those sufficient at baseline, despite supplementation to sufficient levels.
  
  
  
  IOM guidelines may not be adequate for frail elderly. Further study of optimal 25(OH) D levels for maintaining function and preventing falls is needed.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. mpk38@pitt.edu.
authors.forename: M P
authors.initials: MP
authors.lastname: Kotlarczyk
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.|Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Ferchak
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Nace
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
authors.forename: N M
authors.initials: NM
authors.lastname: Resnick
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 1110 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.|Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Greenspan
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use*; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D016330:Frail Elderly; D005684:Gait; D006707:Homes for the Aged; D006801:Humans; D010281:Parathyroid Hormone / Q000097:blood; D017410:Practice Guidelines as Topic; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D
keywords: 25-hydroxyvitamin D; Deficiency; Falls; Frail elderly; Long-term care; Vitamin D