Effects of vitamin D and calcium on bone strength, balance and falls in elderly women

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Many osteoporotic fractures occur as a result of bone fragility and falls. Both falls and fractures are huge public health problems in Australia. Falls are the leading cause of injury-related hospitalization and death in person older than 65 years of age. During 1996 almost 36,000 people attended a hospital after a fall and 5% of these resulted in fracturing a bone. The incidence of fall-related hospital admission increases exponentially with age, reaching 4% per annum for men and 7% per annum for women aged 85 years and older. In the community approximately one third of older people fall each year. Compared to men, women are three times more likely to be hospitalized or one and half times more likely to die from a fall-related injury. Importantly women have an increased risk of fracture and over 40% of women over the age of 50 will break a bone. Previous European and American studies suggest that calcium replacement may improve bone strength while vitamin D may reduce falls. However, the separation of these two effects has never been studied. We have previously studied elderly falling women who attended the Emergency Department of large teaching hospitals in Perth and have shown that many are calcium and vitamin D deficient. We are undertaking a short term randomized controlled trial of calcium alone or calcium with vitamin D, to study the effects on bone strength as measured non-invasively, balance and falls in this high risk group of subjects. We have already recruited 100 subjects and six subjects have completed their 6 months assessment. We plan to recruit the remaining 200 subjects during the following 12 months and give all subjects one year of treatment. At the end of this study we should be able to offer clear treatment guidelines for this high risk group of patients.