Journal Mobile Options
Table of Contents
Vol. 20, No. 3, 2005
Issue release date: September 2005
Cerebrovasc Dis 2005;20:187–192
(DOI:10.1159/000087203)

Low-Dose Vitamin D Prevents Muscular Atrophy and Reduces Falls and Hip Fractures in Women after Stroke: A Randomized Controlled Trial

Sato Y. · Iwamoto J. · Kanoko T. · Satoh K.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: Vitamin D supplementation is suggested to reduce the risk of falls among ambulatory or institutionalized elderly subjects. The present study was undertaken to address the reduced risk of falls and hip fractures in patients with long-standing stroke by vitamin D supplementation. Methods: Ninety-six elderly women with poststroke hemiplegia were followed for two years. Patients were randomly assigned to one of the two groups, and 48 patients received 1,000 IU ergocalciferol daily, and the remaining 48 received placebo. The number of falls per person and incidence of hip fractures were compared between the two groups. Strength and tissue ATPase of skeletal muscles on the nonparetic side were assessed before and after the study. Results: At baseline, serum 25-hydroxyvitamin D levels were in the deficient range (<10 ng/ml) in all patients; and vitamin D treatment enhanced serum 25-hydroxyvitamin D and1,25-dihydroxyvitamin D levels. Vitamin D treatment accounted for a 59% reduction in falls (95% CI, 28–81%; p = 0.003). There were increases in the relative number and size of type II muscle fibers and improved muscle strength in the vitamin D-treated group. Hip fractures occurred in 4 of 48 placebo group and 0 in 48 vitamin D2 group during the 2-year study period (log-rank, p = 0.049). Conclusion: Vitamin D may increase muscle strength by improving atrophy of type II muscle fibers, which may lead to decreased falls and hip fractures.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Ramnemark A, Nilsson M, Borssén B, Gustafson Y: Stroke, a major and increasing risk factor for femoral neck fracture. Stroke 2000;31:1572–1577.
  2. Sato Y, Kaji M, Oizumi K: Vitamin D deficiency and the risk of hip fractures among disabled elderly stroke patients. Stroke 2001;32:1673–1677.
  3. Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM: Risk factors for falling in home-dwelling older women with stroke: the Women’s Health and Aging Study. Stroke 2003;34:494–501.
  4. Teasell R, McRae M, Foley N, Bhardwaj A: The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil 2002;83:329–333.
  5. Bischoff HA, Dawson-Hughes B, Willett WC, Staehelin HB, Robert Y, Zee RY, Wong JB: Effect of vitamin D on falls. A meta-analysis. JAMA 2004;291:1999–2006.

    External Resources

  6. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE: Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670–676.
  7. Bischoff HA, Stahelin HB, Dick W, Dick W, Akos R, Knecht M: Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003;18:343–351.
  8. Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R, Stahelin HB, Dick W: In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 2001;33:19–24.
  9. Sato Y, Maruoka H, Oizumi K, Kikuyama M: Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients. Stroke 1996;27:2183–2187.
  10. Mahoney FI, Barthel DW: Functional evaluation: The Barthel index. Md St Med J 1965;14:61–65.
  11. Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke – Background and study protocol. Stroke 1985;16:885–890.

    External Resources

  12. Komar L, Nieves J, Cosman F, Rubin A, Shen V, Lindsay R: Calcium homeostasis of an elderly population upon admission to a nursing home. J Am Geriatr Soc 1993;41:1057–1064.
  13. Medical Research Coucil of the United Kingdom. Aids to the Examination of the Peripheral Nervous System. London, Pendragon House, 1978.
  14. Dubowitz V: Definition of pathological changes seen in muscle biopsies; in Dubowitz V (ed): Muscle Biopsy. A Practical Approach. London, Ballière Tindal, 1985, p 90.
  15. Cox DR, Hinckley DV: Theoretical Statistics. London, Champan and Hall, 1974, p 94.
  16. Sato Y, Kaji M, Tsuru T, Oizumi K: Risk factors for hip fracture among elderly patients with Parkinson’s disease. J Neurol Sci 2001;82:89–93.
  17. Gallagher JC, Fowler SE, Detter JR, Sherman SS: Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrinol Metab2001;86:3618–3628.
  18. Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C: Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 2000;15:1113–1118.
  19. Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M, Zajac JD, Flicker L: Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 1999;47:1195–1201.
  20. Bischoff HA, Stähelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P, Tyndall A, Theiler R: Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil 1999;80:54–58.
  21. Sorensen OH, Lund B, Saltin B, Lund B, Andersen RB, Hjorth L, Melsen F, Mosekilde L: Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Lond) 1979;56:157–161.
  22. Russell JA: Osteomalacic myopathy. Muscle Nerve 1994;17:578–580.
  23. Simpson RU, Thomas GA, Arnold AJ: Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle. J Biol Chem 1985;260:8882–8891.
  24. Costa EM, Blau HM, Feldman D: 1,25-dihydroxyvitamin D3 receptors and hormonal responses in cloned human skeletal muscle cells. Endocrinology 1986;119:2214–2220.
  25. Haddad JG, Walgate J, Min C, Hahn TJ: Vitamin D metabolite-binding proteins in human tissue. Biochim Biophys Acta 1976;444:921–925.
  26. Boland R: Role of vitamin D in skeletal muscle function. Endocr Rev 1986;7:434–747.
  27. McKenna MJ: Differences in vitamin D status between countries in young adults and the elderly. Am J Med 1992;93:69–77.
  28. Davies M, Mawer EB, Hann JT, Taylor JL: Seasonal changes in the biochemical indices of vitamin D deficiency in the elderly: a comparison of people in residential homes, long-stay wards and attending a day hospital. Age Ageing 1986;15:77–783.
  29. Bischoff H, Stähelin HB, Vogt P, Friderich P, Vonthein R, Tyndall A, Theiler R: Immobility as a major cause of bone remodeling in residents of a long-stay geriatric ward. Calcif Tissue Int 1999;64:485–489.
  30. Eastwood JB, Stamp TC, De Wardener HE, Bordier PJ, Arnaud CD: The effect of 25-hydroxy vitamin D3 in the osteomalacia of chronic renal failure. Clin Sci Mol Med 1977;52:499–508.
  31. Stern G, Thonchin M, Smith R: Muscular weakness in metabolic bone disease. Neurology 1973;20:480–483.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50