Vitamin D deficiency in community older adults with falls of gait imbalance: An under-recognized problem in the inner city

Thiruvinvamalai S. Dharmarajan, M. Akula, S. Kuppachi, Edward P. Norkus

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Introduction. Recent reports suggest that vitamin D deficiency is both under-recognized and undertreated in the geriatric population. In particular, older adults with unexplained pain, falls and gait disorders often may have osteomalacia from vitamin D deficiency. Currently, older adults are not screened for vitamin D status even when clinical skin suggest deficiency. Our pilot study determined the vitamin D status in older, inner city community adults with features suggestive of vitamin D deficiency. Methods. The study was prospective and observational. Communitydwelling adults (> 60 years) from our ambulatory clinic or in-patient geriatric program, with features compatible with vitamin D deficiency (history of falls, gait imbalance, unexplained musculoskeletal pain, and/or fractures), were enrolled. IRB approval and signed informed consents were obtained. Following a history and physical exam, blood samples for vitamin D assay and routine chemistries were obtained. Additional information was collected on age, gender, race, dairy product intake, calcium and/or vitamin D supplement use, weekly sunlight exposure, season of exam (May-October vs. November-April), prior falls and fractures, musculoskeletal pain, and gait disturbances. Results. Data were obtained from 48 patients (32F and 16M), mean age of 79 ± 9 (SD) years (range 60-95). Seventy-seven percent of enrollees had gait disturbances, 77% had a history of falls, 29% had previous fractures and 6% had unexplained pain; 79% consumed milk daily, 25% took calcium supplements and 21% used vitamin D supplements (in a multivitamin or calcium supplement). Self-reported weekly exposure to sunlight ranged from 0 to 42 hours (clothing amount was highly variable). Fifty-four percent of this sample had sub-normal vitamin D status (serum vitamin D < 20 ng/mL). Patient age (P = 0.2287), gender (P = 0.9270), exposure to sunlight (P = 0.3493), season (P = 0.573), and dairy intake (P = 0.735) were not associated with vitamin D status. However, 80% of vitamin D supplement users versus 37% of non-users had normal vitamin D status (P = 0.029) and 75% of calcium supplement users versus 36% of non-users had normal vitamin D status (P = 0.042). A logistic regression model determined that the use of vitamin D or calcium supplements decreased the risk of low vitamin D status by 94% and 93% (P = 0.009 and P = 0.010, respectively). Conclusion. In this pilot study of older adults with gait imbalance and falls, vitamin D deficiency (< 20 ng/mL) was observed in 54% of patients tested and previously unrecognized. Higher serum vitamin D levels appeared related to the use of vitamin D (in multivitamin or calcium supplements) suggesting that deficiency may be preventable and easily treated. As vitamin D deficiency is associated with substantial disability, the need for increased awareness to screen and prevent this disorder is evident.

Original languageEnglish (US)
Pages (from-to)7-19
Number of pages13
JournalJournal of Nutrition for the Elderly
Volume25
Issue number1
DOIs
StatePublished - Aug 2006
Externally publishedYes

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Vitamin D Deficiency
Gait
Vitamin D
Calcium
Sunlight
Musculoskeletal Pain
Geriatrics
Logistic Models
Pain
Osteomalacia
Clothing
Dairy Products
Research Ethics Committees
Informed Consent
Serum

Keywords

  • Falls history
  • Gait imbalance
  • Older adults
  • Vitamin D deficiency

ASJC Scopus subject areas

  • Nutrition and Dietetics

Cite this

Vitamin D deficiency in community older adults with falls of gait imbalance : An under-recognized problem in the inner city. / Dharmarajan, Thiruvinvamalai S.; Akula, M.; Kuppachi, S.; Norkus, Edward P.

In: Journal of Nutrition for the Elderly, Vol. 25, No. 1, 08.2006, p. 7-19.

Research output: Contribution to journalArticle

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abstract = "Introduction. Recent reports suggest that vitamin D deficiency is both under-recognized and undertreated in the geriatric population. In particular, older adults with unexplained pain, falls and gait disorders often may have osteomalacia from vitamin D deficiency. Currently, older adults are not screened for vitamin D status even when clinical skin suggest deficiency. Our pilot study determined the vitamin D status in older, inner city community adults with features suggestive of vitamin D deficiency. Methods. The study was prospective and observational. Communitydwelling adults (> 60 years) from our ambulatory clinic or in-patient geriatric program, with features compatible with vitamin D deficiency (history of falls, gait imbalance, unexplained musculoskeletal pain, and/or fractures), were enrolled. IRB approval and signed informed consents were obtained. Following a history and physical exam, blood samples for vitamin D assay and routine chemistries were obtained. Additional information was collected on age, gender, race, dairy product intake, calcium and/or vitamin D supplement use, weekly sunlight exposure, season of exam (May-October vs. November-April), prior falls and fractures, musculoskeletal pain, and gait disturbances. Results. Data were obtained from 48 patients (32F and 16M), mean age of 79 ± 9 (SD) years (range 60-95). Seventy-seven percent of enrollees had gait disturbances, 77{\%} had a history of falls, 29{\%} had previous fractures and 6{\%} had unexplained pain; 79{\%} consumed milk daily, 25{\%} took calcium supplements and 21{\%} used vitamin D supplements (in a multivitamin or calcium supplement). Self-reported weekly exposure to sunlight ranged from 0 to 42 hours (clothing amount was highly variable). Fifty-four percent of this sample had sub-normal vitamin D status (serum vitamin D < 20 ng/mL). Patient age (P = 0.2287), gender (P = 0.9270), exposure to sunlight (P = 0.3493), season (P = 0.573), and dairy intake (P = 0.735) were not associated with vitamin D status. However, 80{\%} of vitamin D supplement users versus 37{\%} of non-users had normal vitamin D status (P = 0.029) and 75{\%} of calcium supplement users versus 36{\%} of non-users had normal vitamin D status (P = 0.042). A logistic regression model determined that the use of vitamin D or calcium supplements decreased the risk of low vitamin D status by 94{\%} and 93{\%} (P = 0.009 and P = 0.010, respectively). Conclusion. In this pilot study of older adults with gait imbalance and falls, vitamin D deficiency (< 20 ng/mL) was observed in 54{\%} of patients tested and previously unrecognized. Higher serum vitamin D levels appeared related to the use of vitamin D (in multivitamin or calcium supplements) suggesting that deficiency may be preventable and easily treated. As vitamin D deficiency is associated with substantial disability, the need for increased awareness to screen and prevent this disorder is evident.",
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T1 - Vitamin D deficiency in community older adults with falls of gait imbalance

T2 - An under-recognized problem in the inner city

AU - Dharmarajan, Thiruvinvamalai S.

AU - Akula, M.

AU - Kuppachi, S.

AU - Norkus, Edward P.

PY - 2006/8

Y1 - 2006/8

N2 - Introduction. Recent reports suggest that vitamin D deficiency is both under-recognized and undertreated in the geriatric population. In particular, older adults with unexplained pain, falls and gait disorders often may have osteomalacia from vitamin D deficiency. Currently, older adults are not screened for vitamin D status even when clinical skin suggest deficiency. Our pilot study determined the vitamin D status in older, inner city community adults with features suggestive of vitamin D deficiency. Methods. The study was prospective and observational. Communitydwelling adults (> 60 years) from our ambulatory clinic or in-patient geriatric program, with features compatible with vitamin D deficiency (history of falls, gait imbalance, unexplained musculoskeletal pain, and/or fractures), were enrolled. IRB approval and signed informed consents were obtained. Following a history and physical exam, blood samples for vitamin D assay and routine chemistries were obtained. Additional information was collected on age, gender, race, dairy product intake, calcium and/or vitamin D supplement use, weekly sunlight exposure, season of exam (May-October vs. November-April), prior falls and fractures, musculoskeletal pain, and gait disturbances. Results. Data were obtained from 48 patients (32F and 16M), mean age of 79 ± 9 (SD) years (range 60-95). Seventy-seven percent of enrollees had gait disturbances, 77% had a history of falls, 29% had previous fractures and 6% had unexplained pain; 79% consumed milk daily, 25% took calcium supplements and 21% used vitamin D supplements (in a multivitamin or calcium supplement). Self-reported weekly exposure to sunlight ranged from 0 to 42 hours (clothing amount was highly variable). Fifty-four percent of this sample had sub-normal vitamin D status (serum vitamin D < 20 ng/mL). Patient age (P = 0.2287), gender (P = 0.9270), exposure to sunlight (P = 0.3493), season (P = 0.573), and dairy intake (P = 0.735) were not associated with vitamin D status. However, 80% of vitamin D supplement users versus 37% of non-users had normal vitamin D status (P = 0.029) and 75% of calcium supplement users versus 36% of non-users had normal vitamin D status (P = 0.042). A logistic regression model determined that the use of vitamin D or calcium supplements decreased the risk of low vitamin D status by 94% and 93% (P = 0.009 and P = 0.010, respectively). Conclusion. In this pilot study of older adults with gait imbalance and falls, vitamin D deficiency (< 20 ng/mL) was observed in 54% of patients tested and previously unrecognized. Higher serum vitamin D levels appeared related to the use of vitamin D (in multivitamin or calcium supplements) suggesting that deficiency may be preventable and easily treated. As vitamin D deficiency is associated with substantial disability, the need for increased awareness to screen and prevent this disorder is evident.

AB - Introduction. Recent reports suggest that vitamin D deficiency is both under-recognized and undertreated in the geriatric population. In particular, older adults with unexplained pain, falls and gait disorders often may have osteomalacia from vitamin D deficiency. Currently, older adults are not screened for vitamin D status even when clinical skin suggest deficiency. Our pilot study determined the vitamin D status in older, inner city community adults with features suggestive of vitamin D deficiency. Methods. The study was prospective and observational. Communitydwelling adults (> 60 years) from our ambulatory clinic or in-patient geriatric program, with features compatible with vitamin D deficiency (history of falls, gait imbalance, unexplained musculoskeletal pain, and/or fractures), were enrolled. IRB approval and signed informed consents were obtained. Following a history and physical exam, blood samples for vitamin D assay and routine chemistries were obtained. Additional information was collected on age, gender, race, dairy product intake, calcium and/or vitamin D supplement use, weekly sunlight exposure, season of exam (May-October vs. November-April), prior falls and fractures, musculoskeletal pain, and gait disturbances. Results. Data were obtained from 48 patients (32F and 16M), mean age of 79 ± 9 (SD) years (range 60-95). Seventy-seven percent of enrollees had gait disturbances, 77% had a history of falls, 29% had previous fractures and 6% had unexplained pain; 79% consumed milk daily, 25% took calcium supplements and 21% used vitamin D supplements (in a multivitamin or calcium supplement). Self-reported weekly exposure to sunlight ranged from 0 to 42 hours (clothing amount was highly variable). Fifty-four percent of this sample had sub-normal vitamin D status (serum vitamin D < 20 ng/mL). Patient age (P = 0.2287), gender (P = 0.9270), exposure to sunlight (P = 0.3493), season (P = 0.573), and dairy intake (P = 0.735) were not associated with vitamin D status. However, 80% of vitamin D supplement users versus 37% of non-users had normal vitamin D status (P = 0.029) and 75% of calcium supplement users versus 36% of non-users had normal vitamin D status (P = 0.042). A logistic regression model determined that the use of vitamin D or calcium supplements decreased the risk of low vitamin D status by 94% and 93% (P = 0.009 and P = 0.010, respectively). Conclusion. In this pilot study of older adults with gait imbalance and falls, vitamin D deficiency (< 20 ng/mL) was observed in 54% of patients tested and previously unrecognized. Higher serum vitamin D levels appeared related to the use of vitamin D (in multivitamin or calcium supplements) suggesting that deficiency may be preventable and easily treated. As vitamin D deficiency is associated with substantial disability, the need for increased awareness to screen and prevent this disorder is evident.

KW - Falls history

KW - Gait imbalance

KW - Older adults

KW - Vitamin D deficiency

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