Background: Vitamin D supplementation reduces the incidence of fractures in older adults. This may be partly mediated by effects of vitamin D on neuromuscular function. Objective: To determine the effects of vitamin D supplementation on aspects of neuromuscular function known to be risk factors for falls and fractures. Design: Randomised, double-blind, placebo-controlled study. Setting: Falls clinic taking referrals from general practitioners and accident and emergency department. Subjects: 139 ambulatory subjects (≥65 years) with a history of falls and 25-hydroxyvitamin D (25OHD) ≤12 μg/l. Intervention: Patients were randomised to receive a single intramuscular injection of 600,000 i.u. ergocalciferol or placebo. Outcome measures: Assessments including biochemistry, postural sway, choice reaction time (CRT), aggregate functional performance time (AFPT), and quadriceps strength were carried out at baseline and 6 months post-intervention. Results: Baseline characteristics were comparable between both groups. 25OHD in the treatment group increased significantly at 6 months. AFPT deteriorated in the control group and improved in the intervention group, representing a significant difference between groups (+6.6 s versus -2.0 s, t=2.80, P<0.05). Similar changes were observed for CRT (-0.06 s versus +0.41 s, t=-2.52, P<0.01) and postural sway (+0.0025 versus -0.0138, t=2.35, P<0.02). There was no significant difference in muscle strength change between groups (-10N versus -2N, t=-1.26, ns). A significant correlation between change in AFPT and change in 25OHD levels was observed (r=0.19, P=0.03). There was no significant difference in the number of falls (0.39 versus 0.24, t=1.08, P=0.28) or fallers (14 versus 11, P=0.52) between two groups. Conclusions: Vitamin D supplementation, in fallers with vitamin D insufficiency, has a significant beneficial effect on functional performance, reaction time and balance, but not muscle strength. This suggests that vitamin D supplementation improves neuromuscular or neuroprotective function, which may in part explain the mechanism whereby vitamin D reduces falls and fractures. © British Geriatrics Society 2004; all rights reserved.
