Blog | Friday, December 20, 2013

QD: News Every Day--Consensus statement advises vitamin D levels to prevent elderly fall-related injuries

A consensus statement offers advice to help primary care practitioners ensure that their older patients get enough vitamin D to protect against fall-related injuries.

The goal of the consensus statement, issued by the American Geriatrics Society, is to help primary care providers help older patients get adequate vitamin D from diet, sunlight and supplements to achieve vitamin D levels that are associated with protection of fall-related injuries.

All older adults should have a minimum daily vitamin D supplement of 1,000 IU daily, with calcium supplementation, to reduce falls and fractures, the statement begins. The workgroup endorsed 1,000 IU as a minimum daily supplement after a long discussion of the potential benefit of recommending a dose higher than was used in most of the intervention trials that showed protection from falls or fractures.

While there was not enough data to support a recommendation for increased vitamin D supplementation without calcium for older people, in most studies, calcium doses ranged between 500 and 1,200 mg daily.

The goal of the supplementary 1,000 IU is to achieve serum vitamin D levels of 30 ng/mL (75 nmol/L), a minimum goal for older adults, particularly frail adults who are at higher risk of falls, injuries and fractures. The goal of reducing fall-related injuries could be achieved safely and would not require practitioners to measure serum concentrations in older adults unless an underlying condition might increase the risk of hypercalcemia, such as advanced renal disease, certain malignancies or sarcoidosis.

Clinicians should review older patients’ vitamin D intake from diet, sunlight and supplements, and discuss strategies to achieve a total vitamin D input of 4,000 IU daily to reduce the risks for falls or fall-related injuries.

Clinicians should talk with older adults and their caregivers about how to get adequate vitamin D and calcium supplementation. Clinicians can discuss different vitamin D and calcium supplementation schedules with patients and caregivers and help them choose the one they are most likely to follow. For example, vitamin D supplements can be formulated taken daily, weekly or monthly, and there are different combinations of calcium and vitamin D supplements available.

“When developing these recommendations we took into consideration that the depth of the evidence in this area will expand over the next 5 to 10 years. In the meantime, it’s important that in the next 3 to 5 years, the oldest adults who are at the highest risk for falls and related injuries gain the benefits of sufficient vitamin D supplementation,” said Douglas Kiel, MD, FACP, a member of the working group, in a press release.

The statement appeared online Dec. 18 in the Journal of the American Geriatrics Society and will appear in the January 2014 print issue.