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Shedding light on vitamin D deficiency in women.

Falls are the largest cause of injury mortality among the elderly. More than a third of U.S. people 65 or over will fall each year, with many fracturing a hip, spine, or forearm. These fractures seriously weaken 20-30% of those who experience them, according to the Centers for Disease Control and Prevention (CDC), as well as kick off a cascade of direct costs, including hospitalization, rehabilitation, nursing home stays, and equipment. The CDC estimates that such costs will rise with the growing senior population, reaching more than $43 billion by 2020. Recent research on fall injuries in the elderly suggests that vitamin D supplementation could help prevent some of these falls and fractures.

A number of factors linked to elders' risk of falling--cognitive impairment, poor balance, and injuries to the legs--are difficult to improve. But depletion of vitamin D stores is easily remedied to improve safety and lessen the number of falls.

Vitamin D status depends mainly on eating foods containing the nutrient and ultraviolet light-induced vitamin D synthesis in the skin. "As older people become more frail and disabled," says Leon Flicker, a medical professor at the University of Western Australia, "they do not go out as much, and are more likely to suffer from vitamin D deficiency." If they go into assisted living, levels drop further.

Flicker was lead author of a November 2003 Journal of the American Geriatrics Society study of fall injuries in elderly Australian women in care facilities. He found that 22% of all the women in his study and 45% of the bed-bound women were vitamin D deficient. But adding back dietary vitamin D can reduce their peril. "We would argue that vitamin D supplementation, with calcium, may decrease the risk of falling and make the bone stronger," says Flicker.

"The most exciting thing to realize about vitamin D," says Heike Bischoff-Ferrari, a nutrition researcher at Harvard's Brigham and Women's Hospital, "is that this really is the only thing at hand at this point that both reduces the risk of falling and reduces the risk of fractures in older individuals." Vitamin D-enhanced muscle tone or cognition may play a role in reducing falls themselves. Plus, vitamin D is well tolerated and inexpensive. A team led by Bischoff-Ferrari published a 28 April 2004 meta-analysis of the effects of vitamin D on falling in JAMA.

Given concerns about skin cancer and limited sunlight exposure in certain latitudes, the safest source of vitamin D is dietary supplements. Bischoff-Ferrari and colleagues estimate at least 800 international units of vitamin D may be needed daily to achieve fall prevention in older persons.
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Title Annotation:Aging
Author:McGovern, Victoria
Publication:Environmental Health Perspectives
Date:Jul 1, 2004
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