April 25, 2018

In 2012, USPSTF recommended vitamin D to prevent senior falls. Now it’s not so sure.

Daily Briefing

    Older adults should exercise rather than take vitamin D supplements to prevent falls, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF) published last week in JAMA—marking a shift from USPSTF's 2012 recommendation for both exercise and vitamin D supplementation to prevent falls in older adults who are at high risk.

    Market Scan: Review the 4 main primary care models for geriatric patients

    About the recommendations

    The latest recommendations are based on a review of randomized clinical trials that tested fall-prevention interventions among community-dwelling adults ages 65 and older. USPSTF excluded trials that involved patients with neurological diagnoses or other disorders that could affect bone strength, such as osteoporosis or vitamin D deficiency.

    Shaky evidence on the effectiveness of vitamin D supplements

    According to USPSTF,the latest research review provided insufficient evidence to determine whether vitamin D supplements reduced the risk of falls. The panel wrote, "Pooled analyses showed neither a significant reduction in falls nor a significant effect on the number of persons experiencing a fall with vitamin D supplementation."

    Janelle Guirguis-Blake, an author of the new recommendations and a researcher at the University of Washington, said the latest research review "suggest[s] that while vitamin D may possibly prevent people with known vitamin D deficiency from falling, ... the evidence to-date does not support a benefit on fall prevention in the general population of older adults, and it appears that mega-high doses of vitamin D can actually cause harm." For instance, they found evidence higher doses of vitamin D supplements are associated with higher rates of fall-related outcomes. 

    As a result, USPSTF downgraded its recommendation on the efficacy of vitamin D supplements for high-risk older adults from a "B" to a "D" (?) recommendation, and the panel advised against adults 65 or older from taking a vitamin D or calcium supplement unless they have osteoporosis or a vitamin D deficiency.

    Alex Krist, vice chair of USPSTF and a professor of family medicine and population health at Virginia Commonwealth University, said, "We recommend that people try to get a healthy dose of vitamin D and calcium through their lifestyle, but we just don't know at this point whether taking them as a supplement is beneficial or harmful overall."

    That said, the researchers did find sufficient evidence to support exercise as a fall-prevention method. Overall, USPSTF found that people who completed exercise regimens had between a 10% and 20% lower risk of falls and fall-related injury. Krist said the exercise programs examined largely focused on strength and resistance training, as well as balance and gait. The exercise programs "included individual and group exercises, as well as referrals to a physical therapist or participation in a class like tai chi," Krist added.

    Reaction

    JoAnn Manson, a researcher at Brigham and Women's Hospital and Harvard Medical School, in an editorial accompanying the recommendations/research review (?) expressed support for the findings, but cautioned that patients who currently are taking vitamin D supplements should not stop without first consulting their physicians.

    Mason wrote, "Adults at high risk (those with osteoporosis or those known to be at high risk of fractures or falls) may still be very good candidates for supplementation. … However, the new reports emphasize the limited and inconsistent research to date and the potential for harm with mega-dose bolus dosing—and that we need to go beyond popping vitamin D and/or calcium pills to prevent fractures and falls" (Rapaport, Reuters, 4/17; Aubrey, "Shots," NPR, 4/17; USPSTF recommendation statement, 4/17; USPSTF evidence report, 4/24).

    Market Scan: Review 4 primary care models for geriatric patients

    For providers with value-based reimbursement, "geriatricizing" primary care is an opportunity to help manage complex care needs and increase access to care for the elderly population.

    This market scan reviews four models for fixed or mobile primary care, including geriatrics clinics, providing primary care in assisted living facilities, forming house call programs, and an overview of strategies to geriatricize existing primary care practices.

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