|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 5 | Page : 737-738
Recent trial on Vitamin D: Higher dose increases fall?
Adrija Hajra1, Dhrubajyoti Bandyopadhyay2
1 Department of Internal Medicine, IPGMER, Kolkata, West Bengal, India
2 Department of Accident and Emergency, Lady Hardinge Medical College, New Delhi, India
|Date of Web Publication||14-Sep-2016|
38/A/2, SB Ghosh Lane, Serampore, Hooghly - 712 202, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hajra A, Bandyopadhyay D. Recent trial on Vitamin D: Higher dose increases fall?. Indian J Endocr Metab 2016;20:737-8
Several postulations are there to explain the interrelationship of Vitamin D and muscle strength. The Vitamin D receptors are found to be expressed in human muscle tissue.  Studies among older individuals suggested that Vitamin D receptor activation in muscle induces de novo protein synthesis. This effect is particularly seen in type II fast twitch muscle fibers. This finding proposed an association between muscle strengthening the effect of Vitamin D and prevention of fall. 
Several studies have found the beneficiary impact of this vitamin on muscle strength. However, reversed results are also there. A meta-analyses of double-blind, randomized control trial (RCT) support a benefit of Vitamin D supplementation in the prevention of falls and hip fractures among patients of 65 years and older at high risk of Vitamin D deficiency.  However, questionable outcomes are also there in meta-analyses where this age restriction is not maintained. 
Currently, we have come to know about another study (NCT01017354). It is a 1-year, double-blind, randomized clinical trial conducted in Zurich, Switzerland. Analysis of data was done from June 15, 2012, to October 10, 2015. The study was done involving 200 community-dwelling men and women 70 years and older with a prior fall. 
Participants were randomized to one of three study groups with monthly supplementation with Vitamin D3. The first one was the control group and received 24,000 IU of Vitamin D3 monthly. The second group was given 60,000 IU of Vitamin D3. The third group received 24,000 IU of Vitamin D3 plus 300 μg of calcifediol. The first group and the third group had significantly higher percentages of patients with fall compared with the second group at 12 months. 
In this RCT, older age group participants receiving higher dose Vitamin D3 did not experience improved lower extremity function. Rather, they had the highest percentages of fallers compared with the control group (24,000 IU). 
However, this study has some limitations also. History of prior fall in study group has increased a risk of functional decline to some extent. Another point is that this study lacks a placebo group. 
We should be hopeful about two upcoming trials VITAL (the Vitamin D and Omega-3 Trial) and DO-HEALTH (the Vitamin D3-Omega-3-Home Exercise-Healthy Ageing and Longevity Trial) to provide some more information about Vitamin D action. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, et al.
Monthly high-dose Vitamin D treatment for the prevention of functional decline: A randomized clinical trial. JAMA Intern Med 2016;176:175-83.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al.
Fall prevention with supplemental and active forms of Vitamin D: A meta-analysis of randomised controlled trials. BMJ 2009;339:b3692.
Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, et al.
A pooled analysis of Vitamin D dose requirements for fracture prevention. N Engl J Med 2012;367:40-9.