Eat Well to Be Well: Vitamin D – a key to preventing falls in the elderly

We all hope that as we age, our ability to live in our own homes independently is a dream that will be a reality. Unfortunately one of the more common reasons why the elderly have to give up that dream is the increased risk of falling, leading to fractures, disability and loss of independence. However, the sun and a vital nutrient in our food can possibly change that. Vitamin D, the sunshine vitamin, appears to play a significant role in helping to prevent falls. Studies have shown this fat-soluble vitamin seems to maintain muscle strength, which is critical in preserving confidence in day-to-day activities and lessening the fear of falling that could result in significant physical injury.

The problem of falls in the elderly is common. For people aged 65 or older, one out of every three will experience falling at some point. In 2013, 2.5 million nonfatal falls occurred in elderly adults that often resulted in head traumas, lacerations and hip fractures, and around 25,500 older adults died from unintentional fall injuries. Hip fractures occur at a rate of more than 258,000 each year with over 95 percent being caused by falls. The majority of falls are preventable, and when the elderly have sufficient vitamin D, it could be a major key to help lower this risk.

Why older adults are at risk for vitamin D deficiency

  • People age 50 and older are at risk for vitamin D deficiency and this risk increases with age for several reasons:
  • Age-related changes in the skin decrease the ability to make vitamin D from sunlight.
  • Those who spend more time indoors or are homebound, not getting sufficient sunlight, will be at a disadvantage in making vitamin D.  It takes about 30 minutes of sun exposure twice a week to have the ability to make vitamin D.  The majority of our vitamin D, about 90 percent, is made through exposure to sunlight.
  • Kidney functioning can decrease with age, making it less likely for the body to process vitamin D properly.
  • Food sources of vitamin D are limited and older adults may not be consuming enough of those sources. Few foods contain vitamin D naturally.  Natural sources come from cod liver oil, tuna, sardines, salmon and mackerel, with smaller amounts found in beef or calf liver, egg yolks and cheese. Fortified food sources where vitamin D has been added is milk, yogurt, margarine, some orange juice, and some breakfast cereals.

“Vitamin D is an essential nutrient when it comes to maintaining bone health, which would also relate to keeping our muscles strong,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City. “Vitamin D aids in calcium absorption. This vitamin is normally made by the body through sunlight exposure and can also be found in foods such as egg yolks, liver and fish.  In general, salmon is known to be a vitamin D powerhouse.  It is rich in vitamin D, calcium, and omega-3 fatty acids which have also been shown to improve bone density.”

  • Certain medications can reduce vitamin D levels:  Phenytoin, Fosphenytoin, Phenobarbital, Carbamazepine and Rifampin.  Other medications can decrease the absorption of vitamin D: Cholestyramine, Colestipol, Orlistat, Mineral oil and Olestra.

How to know if you are vitamin D deficient

The best indicator of vitamin D status is a blood test of your serum concentration of 25(OH)D also called 25-hydroxyvitamin D.  This reflects vitamin D produced cutaneously and obtained from food or supplements, but it does not indicate the amount stored in body tissues.  Older adults who have fallen have been shown to have lower serum 25(OH)D concentrations.

Your doctor can test for vitamin D status. The normal range for vitamin D is 30 ng/ml and higher. The Endocrine Society’s guidelines for vitamin D deficiency is: less than 20 ng/ml is considered vitamin D deficiency, and 21-29 ng/ml is considered vitamin D insufficiency.

Other indications of a vitamin D deficiency include certain symptoms, such as muscle pain and weakness, muscle cramps, joint pain, restless sleep, poor concentration and chronic pain.

What is the daily requirement for vitamin D?

Here is the daily requirement for vitamin D as established by the Institute of Medicine which was updated in 2010:

  • Infants – birth – 12 months – 400 IU
  • Children – 1-3 years – 600 IU
  • Adolescents – 14-18 years- 600 IU
  • Adults – 19-70 years – 600 IU
  • Adults – 71 years and older – 800 IU
  • Pregnancy – 600 IU
  • Breastfeeding – 600 IU

Why is vitamin D important in preventing falls?

There is much evidence through many studies showing that vitamin D deficiency appears to contribute to increased falls in the elderly.  Deficiencies in vitamin D lead can lead to weaker quadriceps muscles in the thighs and muscle weakness in general, slower reaction time, reduced stability, and an overall slower performance in functioning. When this is combined with weak bones or osteoporosis, it is only a matter of time before a person is likely to experience a fall.

How to treat a vitamin D deficiency

A treatment guideline should be established by your physician depending on your serum concentration of 25(OH)D.  There can be several ways that a deficiency of vitamin D can be treated:

  • Adults usually are recommended to take at least 1,500-2,000 IU of vitamin D to get levels more than 30 ng/ml, but this can vary depending on the deficiency.
  • Vitamin D2 or vitamin D3 are both appropriate for correcting a vitamin D deficiency.
  • Getting more sun exposure throughout the week is advised.
  • Consuming more food sources of vitamin D is recommended.
  • Review medications that a person is taking on how it may affect absorption or lowering vitamin D in the body.

“As a physician, I recommend changes in lifestyle first, then medication as a second line of defense, only if necessary,” Dr. Samadi advised. “Supplements like vitamin D3 and calcium are all important for maintaining healthy bones and muscle strength and a good alternative for those whose diet alone is not sufficient.  But starting with what you eat is an important first step.”

Aging is a fact of life and the longer we live, the more important it becomes to be aware of certain nutrients that can make our lives go a little smoother. Vitamin D is one of those nutrients, and if it truly helps with reducing the risk of falls in the elderly, leading to greater independence and a healthier life, we’ll all be better off for it.

Cheryl's-Headshot-2015-80x1Cheryl Mussatto MS, RD, LD, is a registered dietitian and an adjunct professor at Allen Community College, Burlingame, and Butler County Community College, Council Grove; she teaches Basic Nutrition and Therapeutic Nutrition. She is also a certified health and wellness coach, and a consulting dietitian for the Cotton O’Neil Clinic in Osage City. She writes Eat Well to Be Well, a column about health and nutrition, and is a blog contributor for Dr. David Samadi at Contact her at [email protected], visit her website, or like “Eat Well 2 Be Well” on Facebook.

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