MedicalResearch.com Interview with:
Dr. Alex Krist, M.D., M.P.H.
Dr. Krist is is a professor of family medicine and population health at Virginia Commonwealth University and active clinician and teacher at the Fairfax Family Practice residency.
What is the background for these recommendation statements? What are the main findings?
Response: Falls are the leading cause of injuries in adults age 65 and older and can lead to serious disability and even death. Bone fractures—which may result from a fall—can also cause serious disability and death in older adults.
The U.S. Preventive Services Task Force looked into the most recent evidence on the best ways to prevent falls and fractures in older adults. We found that clinicians should recommend exercise or physical therapy to help prevent falls by older adults who live at home and are at higher risk for falling.
Additionally, we concluded that taking a low dose of vitamin D and calcium does not help prevent fractures due to osteoporosis, but we don’t know if taking a higher dose is effective or not, so we are calling for more research.
What should readers take away from your recommendations?
Response: We know that exercise and physical therapy are helpful for preventing falls in older adults. We also know that taking vitamin D does not help prevent falls in older adults and taking lower doses of vitamin D and calcium do not prevent fractures in postmenopausal women.
However, there are a couple areas where the research isn’t as clear. We are calling for more research on the benefits and harms of vitamin D, alone or combined with calcium, at any dose to see if it prevents fractures in men and in women who have not gone through menopause. We are also calling for more studies that look at whether higher doses of vitamin D and calcium (alone or combined) can prevent fractures in women who have gone through menopause. Until we have clearer evidence, we cannot make a definitive recommendation on whether or not vitamin D and calcium should be used for these purposes.
What recommendations do you have for future research based on your review of the evidence?
Response: In terms of the prevention of fractures, better studies are needed to understand if larger doses of vitamin D (more than 400 IU daily) and calcium (more than 1,000 mg daily) help to prevent fractures in women who have been through menopause, or if any dose of these supplements can help prevent fractures in men and in premenopausal women. Finally, we also want to know if vitamin D and calcium supplements have similar results in diverse populations, since most studies just looked at white women.
For falls prevention, more research is needed to figure out what risk assessment tools can be used to identify older adults who are at increased risk for falls. We also want to know which approaches are effective for adults in different age groups and which exercise approaches are most effective. Additionally, we need to know more about how helpful medication management, home safety, and psychological counseling are when offered alone, and not as part of a personalized program.
Is there anything else you would like to add? Any disclosures?
Response: Exercise can help older adults who are at risk for a fall. In addition, having a clinician check someone’s individual risks for falls and then help address those specific risks—called multifactorial interventions—may be beneficial for some older adults. It’s important to note that these recommendations only apply to older adults who live at home and not in a nursing home, assisted living community, or any other institutionalized care setting. They also do not apply to people who have osteoporosis or vitamin D deficiency. Anyone who is concerned about their risk of hurting themselves by falling or fracturing a bone, or who is wondering if they should take a vitamin, should discuss this with their doctor.
Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement.
US Preventive Services Task Force, JAMA. 2018.
US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB Davidson KW7, Doubeni CA, Epling JW Jr9, Kemper AR10, Krist AH, Kubik M,, Landefeld S,, Mangione CM,, Silverstein M,, Simon MA,, Tseng CW,
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