Vitamin D doesn’t prevent falls and fractures in older people, here’s how it can help

• Vitamin D supplements do not reduce the risk of falls or fractures in healthy older adults, members of the U.S. Preventive Services Task Force say.
• They note that this vitamin may be helpful for older adults with certain conditions, such as osteoporosis.
• There are some foods that provide small amounts of vitamin D, but the most effective way to get the nutrient is through sunlight exposure.

Vitamin D has many health benefits, but it does not reduce the risk of falls or prevent fractures in older adults.

That’s the conclusion of preliminary recommendations released this week by members of the U.S. Preventive Services Task Force (USPSTF).

In their draft recommendation, USPSTF members said taking vitamin D supplements with or without calcium does not prevent falls or fractures in menopausal women or men 60 and older.

Their recommendation applies to people living at home. It does not apply to people in assisted living or nursing homes. It also does not apply to people who take vitamin D or calcium supplements for medical reasons, or who have been diagnosed with osteoporosis.

“Preventing falls and fractures among older adults is important for their health and independence,” John Ruiz, PhD, a professor of clinical psychology at the University of Arizona and a member of the task force, said in a news release.

“Unfortunately, when we reviewed the latest evidence, we found that taking vitamin D with or without calcium does not prevent falls or fractures in older adults, so we recommend that people who do not take these supplements for other medical reasons do not take them.”

The task force will accept public comments on the draft report until Jan. 21. The new recommendations are an update to a 2018 report that recommended daily vitamin D supplementation for women.

Rethinking the impact of vitamin D on fracture risk

Experts not affiliated with the report said there are important takeaways to be gleaned from the task force’s new draft recommendations.

“We know that vitamin D deficiency and a low-calcium diet increase the risk of bone fragility and fractures,” said Edward Hsiao, MD, professor at UCSF and director of the UCSF Metabolic Bone Clinic and the UCSF Endocrinology T32 Program.

“We also know that in cases of weak bones or vitamin D deficiency, supplementation with vitamin D and calcium is important to maintain and improve bone health,” Xiao told Healthline. “This is even more important if the patient is being treated for osteoporosis because these are key matrices for building back bones, so without these supplements, those medications won’t work.”

“These guidelines are consistent with those recently released by the Endocrine Society, of which I am a member,” added Dr. Daniel Bikle, professor of medicine and dermatology at the University of California, San Francisco.

“Basically, they are intended for healthy people. We are not talking about people who have suspected vitamin D deficiency, such as those with malnutrition, osteoporosis, or malabsorption,” he told Healthline.

What are the benefits and side effects of vitamin D?

There are many reasons to get adequate vitamin D, task force members noted.

Vitamin D is a fat-soluble vitamin that facilitates the absorption of calcium, a process that helps keep bones and muscles strong. It may also play a role in supporting the immune system.

In past studies, researchers have suggested that low vitamin D levels may contribute to joint pain. Other studies have suggested that low vitamin D levels may be a cause of chronic inflammation.

Additionally, some studies report that vitamin D may help reduce the risk of heart disease and lower the risk of severe illnesses such as the flu and COVID-19.

However, too much vitamin D can cause stomach upset or kidney problems.

“Vitamin D has multiple effects on the body,” said Dr. Wendolyn Gozansky, a geriatrician and vice president and chief quality officer at Kaiser Permanente.

“I tell my patients to think of vitamin D as a hormone,” she told Healthline. “It has effects on muscle, bone, and immune cells and is metabolized by the liver and kidneys. One of the main functions of vitamin D is to absorb calcium, so it helps keep your heart, muscles, and bones functioning properly. While taking a vitamin D supplement may not prevent falls and fractures, having the right amount of vitamin D in your body can help with overall health.”

Despite these benefits, Gozanski offers a word of caution. “Because vitamin D is a fat-soluble vitamin, if you take too much vitamin D, it can build up in the body over time,” she explains.

“Toxic levels of vitamin D can lead to high blood calcium levels, which can cause nausea, vomiting, constipation, muscle weakness, confusion, kidney stones, and more. Be sure to talk to your doctor about any over-the-counter supplements you’re taking. Just because something is available over the counter doesn’t mean it’s safe for you personally.”

David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in California, notes that many studies on this topic have focused on people with normal vitamin D levels.

“The appropriate conclusion is not that patients do not need any vitamin D, but rather that patients who have adequate vitamin D do not experience a reduced risk of fractures with additional supplementation,” he told Healthline.

Cutler also noted that the task force’s recommendations would mean that insurers likely wouldn’t pay for vitamin D supplementation treatment.

How to Get More Vitamin D

It is recommended that adults get between 600 and 800 international units of vitamin D per day, depending on their age.

It is estimated that more than 40% of American adults are vitamin D deficient.

Not many foods contain excess amounts of vitamin D.

Still, there are some foods that can naturally provide your body with some levels of vitamin D, including:

• Fatty fish (such as salmon, halibut, mackerel)
• Canned tuna
• Cod liver oil
• yolk
• mushroom

Some foods, such as milk and orange juice, are fortified with vitamin D.

However, the main source of vitamin D is sunlight. The vitamin is produced from cholesterol in the skin.

However, overexposure to the sun can increase your risk of skin cancer. The Centers for Disease Control and Prevention (CDC) recommends that you limit your exposure to the sun by wearing a hat, sunglasses, and long-sleeved clothing when in the sun, and applying a broad-spectrum sunscreen to your skin when outdoors.

Cutler notes that all the information about vitamin D can seem confusing.

“Some experts suggest that vitamin D can be safely obtained from sunlight exposure, a recommendation that is considered controversial because it may increase skin cancer risk,” he told Healthline.

“Other experts have suggested that perhaps outdoor sunlight exposure improves health outcomes rather than increasing vitamin D. Needless to say, this delicate balance of benefits and risks is difficult for experts to reconcile, let alone the average person.”

He added: “Discussing vitamin D supplementation with your doctor needs to take into account all the potential benefits and risks for your individual health status.”

“This includes adequate calcium intake through diet, fall prevention through exercise, and genetic factors that may influence kidney stone risk. Therefore, only a thorough assessment of your overall health can make appropriate vitamin D supplementation recommendations,” Cutler explained.

How to avoid falls and fractures

The Centers for Disease Control and Prevention (CDC) reports that more than one in four older adults in the United States falls each year.

The agency notes that a fall doubles the odds of falling. Yet, among older adults who fall, fewer than half report the incident to their doctor.

One in 10 falls results in an injury among older adults, the agency added. Falls among older adults account for 3 million emergency room visits and 1 million hospitalizations in the United States each year. Falls are also a common factor in hip fractures and traumatic brain injuries among older adults.

Fall injuries can limit an older adult’s ability to perform daily activities and live independently.

The Centers for Disease Control and Prevention recommends that older adults engage in regular physical activity to reduce the chance of falls. These activities include:

• Aim for at least 150 minutes of moderate-intensity aerobic activity each week.
• Muscle-strengthening activities, including weight lifting and resistance training, at least 2 days per week.
• Activities that improve balance, such as standing on one foot.

Experts also recommend that older people get screened for osteoporosis, as well as vision and hearing tests.

They also urge older adults to stand up slowly after sitting down to avoid dizziness episodes that could lead to falls.

“As a geriatrician, I tell my patients that the best exercise for preventing falls and fractures is exercise that you enjoy doing regularly,” Gozansky says. “That can mean weight-bearing exercise, like walking or lifting weights, and balance exercises, like yoga or tai chi.”

takeout

Vitamin D supplements do not reduce the risk of falls or fractures in healthy older adults, members of the U.S. Preventive Services Task Force said in a preliminary report.

They note that supplementation may be beneficial for older adults with certain medical conditions, such as osteoporosis.

Experts note that sunlight is the best way to get vitamin D, although excessive exposure to the sun can increase the risk of skin cancer.

They say older people should exercise regularly to strengthen their bones and muscles to help reduce the chance of falls or fractures.