Falls and fractures Patient friendly summary

  • Solar ultraviolet-B light may reduce the risk of falls and fractures by producing vitamin D.
  • Vitamin D may lower the risk of falls and fractures by increasing calcium levels, neuromuscular control, and muscle strength.

Falls and fractures are an important cause of disability for the elderly.

Most of them have osteoporosis, a condition of weakened bone tissue. In the United States, osteoporosis causes more than 1.5 million fractures each year.

Hip fractures are a serious injury. Women are more than twice as likely as men to suffer hip fractures. About 35% of the men and 20% of the women die within one year of having a hip fracture.

Risk factors

Risk factors of falls and fractures include:

  • Osteoporosis
  • Diets low in calcium and vitamin C
  • Vitamin D deficiency
  • Poor neuromuscular control

Vitamin C produces collagen. Collagen forms the bone structure where calcium resides. Green, leafy vegetables are a good source of vitamin C and calcium.

Vitamin D deficiency is a risk factor for poor neuromuscular control. This causes people to lose balance. They may not have the muscle strength to avoid falling.

Sunlight exposure and fall and fracture risk

A study in Australia found that fall and fracture rates had a seasonal cycle. Peak rates of hip and wrist fractures occurred in late winter. More falls resulted in fractures at this time as well. There is less sunlight in winter. Wintertime is 1.5 to 3 months after the time of lowest vitamin D levels.

Vitamin D and falls and fractures

Vitamin D levels

Several studies identified low vitamin D levels and their effects on fractures:

  • During a seven-year period, U.S. women with vitamin D levels of 19 ng/mL (48 nmol/L) had a 70% increase in fractures compared to women with vitamin D levels of 28 ng/mL (71 nmol/L).
  • A study in England reported that those with vitamin D levels below 12 ng/mL (30 nmol/L) were most significantly affected by falls.

How vitamin D works

Higher levels of vitamin D provide several benefits against falls and fractures:

  • Increases bone mineral density
  • Improves neuromuscular and psychomotor function, reaction time, and balance
  • Improves muscle strength (in some studies)

Prevention

In general, 800–1000 international units (IU) (20-25 mcg)/day of vitamin D reduces the risk of falls and fractures by about 20% to 25%.

Vitamin D and calcium

According to one study, daily doses of 800 IU vitamin D and 1000 mg calcium lowered the risk of first falls by 27% at 12 months and 39% at 20 months. In this study, muscle strength increased and reaction times decreased.

Oral calcium is touted as necessary to reduce risk of falls. However, studies found that calcium alone provided little benefits or increases in bone mineral density.

Treatment

Elderly patients were studied after suffering a hip fracture. Some patients took 2000 IU (50 mcg) vitamin D3 (cholecalciferol) per day. Other patients took 800 IU vitamin D3 per day. The higher rate of vitamin D3 did not reduce the rate of falls. But the rate of hospital readmissions was lowered by 39%.

People with osteoporosis may benefit from vitamin D supplements. Vitamin D blood levels should be raised to 30–40 ng/mL (75–100 nmol/L).

Find out more…

We will be adding a detailed evidence summary on this topic in the near future.  Please check back soon to find out more.

Page last edited: 17 May 2011