Falls in the elderly are a real and growing problem. Over 30% of people over the age of 65 suffer from falls which can lead to further physical damage. As the European Food Safety Authority (EFSA) reports: “approximately 5% of falls in the elderly result in bone fracture, the most common age-related bone fractures being in the wrist, spine, hip, humerus and pelvis. In community dwelling older people, 25% of age-related fractures are in the hip and 95 % of hip fractures are caused by falls.”
A new and approved claim by EFSA states that vitamin D: “reduces the risk of falling” (please follow the link for more information). In this article we will discuss the mechanisms behind which vitamin D can help to prevent falls in the elderly; maintaining muscle mass, proprioception and preventing the onset of Sarcopenia.
Vitamin D – a Quick Recap
The foremost piece of information to appreciate regarding this nutrient is that it is commonly known as ‘The Sunshine Vitamin.’ This is because sunlight is necessary for the synthesis of vitamin D in the skin and those that are lacking it are in a high risk category of potential deficiency. As mentioned in a previous blog, Vitamin D – A Timely Reminder on its Importance, in this country the amount of sunlight in our winter months is insufficient forcing us to draw upon our bodily reserves thus accentuating the importance of supplementation due to a severe lack of vitamin D in our diets.
Vitamin D is a hormone produced in the skin and around 90% of the body’s storage is from exposure to sunlight. Upon ingestion, vitamin D travels through the bloodstream to the liver where it is turned into the precursor for the vitamin D hormone. Once released back into the bloodstream, the precursor (or prohormone) travels to the kidneys where it is ‘activated’ into Calcitriol (active form of vitamin D).
The active form of vitamin D works by attaching itself to the vitamin D receptor (VDR) which, in turn, is responsible for essential processes throughout several tissues in the body, including bone, muscle, and the brain. As a result of levels of vitamin D decreasing significantly with aging, VDR activation and muscle cell function all over the body becomes far less efficient.
New Permitted Claim
We are all aware that falls are common amongst the elderly: “Each year one in three people aged 65 years or older experiences at least one fall, with 9% of falls leading to an emergency room visit and 5-6% resulting in a fracture“, reported a study from 2009 on fall prevention. Even more worrying is the fact that: “falls now represent the commonest accident of daily living and are the leading cause of accidental death in the elderly” as reported in the The Journal of Engineering and Rehabilitation. It is a significant problem without structured programmes in place for prevention.
However, as the Vitamin D Council reported in 2013, a study was conducted by Gilbert. T Chua and Roger Wong that concluded that vitamin D aids the prevention of falls in the elderly. Four randomized and controlled trials were conducted on participants with an average age of 75; three administered oral vitamin D ranging from 800-1,000 IU/day, while the fourth study prescribed 100,000 IU oral vitamin D every 3 months.
“The authors report a 28% reduction in the number of falls per person, per year. When looking at only the daily dosage studies, there is a significant (44%) reduction in the number of falls. This indicated that daily high dose vitamin D is more effective than quarterly supratherapeutic [above the therapeutic level] doses in reducing fall rate,” the authors explain.
This emphasizes the importance of this latest EFSA claim for vitamin D. However, despite the enormity of this claim in terms of its implications for treatments and further research, you could be forgiven for finding it rather puzzling. Let us examine further the science behind this permitted claim and what the exact mechanisms are behind it.
Vitamin D – The Mechanisms of Prevention
A recent article on the Nutrition Society website provided the following statistics; “Our muscle strength peaks when we reach 30 years old. Over the age of 50, our muscles get weaker at a rate of around 15 per cent every ten years; increasing to 30 per cent per decade after the age of 70.”
It has been acknowledged through comprehensive research that vitamin D may help to strengthen our muscles during the periods of life that we need it most – from 50 onwards.
It is clear from statistics such as the above that the decrease in muscle mass as we age is fast and detrimental to heath as well as increasing the risk of falls. It has been recorded that we lose up to 50% of our skeletal muscle mass between the ages of 20 and 90.
The European Working Group on Sarcopenia in Older People (EWGSOP) defines Sarcopenia as: “a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death.” The onset of Sarcopenia is greatly associated with an increase in the risk of falls in the elderly.
Stages of Sarcopenia
Through extensive research EWGSOP has determined certain ‘stages’ of Sarcopenia that reflect its severity:
- ‘Presarcopenia’ – low muscle mass, however no impact on muscle strength or physical performance
- ‘Sarcopenia’ – low muscle mass, low muscle strength OR low physical performance
- ‘Severe Sarcopenia’ – low muscle mass, low muscle strength AND low physical performance.
Recognising these stages may help with the selection of suitable treatments and setting recovery goals.
In a study conducted in 2012 by Stephan Von Haehling on muscle wasting, he states that: “On average, it is estimated that 5–13 % of elderly people aged 60–70 years are affected by Sarcopenia. The numbers increase to 11–50 % for those aged 80 or above.” It is a growing problem, with EWGSOP reporting that it is expected to affect around 200 million people in the next 40 years.
Although reliant on several factors such as diet, nutrition and exercise, over the past few years there has been extensive research suggesting that vitamin D has an essential impact on muscle function and strength and is therefore a key nutrient in the prevention of Sarcopenia.
The increasing percentage of elderly people who are vitamin D deficient and the rise in the number of cases of Sarcopenia is no coincidence. Let us go into more detail on the exact mechanisms involved in the process of preventing Sarcopenia, muscle loss and consequentially the prevention of ‘falling’ – and how vitamin D is pivotal to this.
Muscle Mass and Strength
The strength, mass and repair function of the muscle fibres in your body are absolutely essential to maintaining balance (proprioception) and the general avoidance of ‘falling’.
Type II muscle fibres are ‘fast-twitch’ and are the first on the scene to help prevention during the process of falling. They are the key to maintaining muscle mass and strength throughout life. The efficient fucntioning of the repair process is very much reliant on vitamin D and is a key catalyst for preventing Sarcopenia.
In a study by Lisa Ceglia titled Vitamin D and its Role in Skeletal Muscle, the following results were recorded: ” Sorenson et al. reported an increase in relative fibre composition and in fibre area of type IIa muscle fibres in muscle biopsies from elderly women after treatment with vitamin D and calcium for 3-6 months. A randomized, controlled study found that treatment of 48 elderly stroke survivors with 1000 IU of vitamin D2 daily significantly increased mean type II muscle fibre diameter and percentage of type II fibres over a 2 year period.”
Notch Pathway Activity
Central to all muscle repair and regeneration is the function and overall efficiency of the ‘Notch pathway’ – a highly conserved transmembrane receptor. Research from 2014 on the ‘Notch Pathway’ has affirmed that the regulatory activity of the ‘Notch pathway’ “decreases with age and may contribute to muscle atrophy.”
Maintaining muscle mass and strength is essential to the prevention of falls in the elderly. If the ‘Notch pathway’ is not functioning properly then as a result it is unable to repair and regenerate type II muscle fibres which as we mentioned is a mandatory process for the maintenance of skeletal muscle mass.
Vitamin D can help with the repairing process of skeletal muscle fibres thus helping to maintain the strength and mass needed to prevent Sarcopenia which can result in falls and further injury.
In 1906 the term ‘Proprioception’ was coined by Sir Charles Sherrington, a neurophysiologist. As revealed in an article titled ‘Factors Influencing Proprioception’ it was derived “from the Latin “proprius,” meaning “one’s own,” for sensory information derived from neural receptors embedded in joints, muscles, and tendons. Hence, proprioception was originally defined as “the perception of joint and body movement as well as position of the body, or body segments, in space.”
Despite a lack of extensive research, it is understood that one’s ‘proprioception’, which is known to decrease as we age, could be a key factor in preventing falls in the elderly. An absence of sensory ‘whereabouts’ and therefore balance slows down reaction times and therefore predisposes one to the possibility of falling.
“The deterioration of proprioception throughout the human lifespan has deleterious repercussions on motor coordination and balance”, the above research reported. It is even more interesting that all aged groups rely more on proprioception than on vision for the maintenance of balance.” This simply further accentuates the point that proprioception is an essential factor in preventing falls in the elderly.
There has been further research into the effects of Vitamin D on postural stability with regards to it’s cognitive influence. Recent studies have suggested that vitamin D may: “stabilize postural equilibrium in the elderly via an improvement of attention capacities independently of any muscular action”, as reported by The Journal of Engineering and Rehabilitation. The supplementation of vitamin D in elderly fallers was seen to decrease reaction times to stimuli and improve postural balance. On the opposite side of the spectrum, a low serum level of vitamin D was “independently associated with high amplitude of postural sway and vice versa.”
The above report suggests that the effect of vitamin D on postural balance is more of a cognitive influence as opposed to one relating to muscle mass or strength. The research states that “weekly vitamin D dietary intakes were associated with cognitive impairment among 5,596 community-dwelling healthy older women aged 80.4 years on average.”
It was also noted in the research that vitamin D supplementation has been seen to improve walking performance by mechanisms involving the nervous system as well as muscles.
Although falls in the elderly are currently a common occurrence, they are something that can be largely prevented, reducing the subsequent impact on both families and the NHS. It is clear from the research highlighted in this article that there is an obvious link between vitamin D deficiency and Sarcopenia.
If postural stability and muscle function are lacking then the likelihood of falling increases substantially. Through supplementing vitamin D from a young age, maintaining a nutritious diet, and regularly exercising one can prevent the onset of Sarcopenia and seriously reduce the chance of ‘falling’ through preserving muscle mass, strength and stability.
Full references are available upon request.
If you have any questions regarding this article, any of the health topics raised, or any other health matters please do contact me (Amanda) by phone or email at any time.
Amanda Williams, Cytoplan Ltd
[email protected], 01684 310099
At Cytoplan we have a comprehensive range of vitamin D3 supplements to cater for the whole family – especially those at risk of deficiency. This includes a Wholefood Vegan vitamin D3 supplement from lichen in a higher potency tablet, ideal for vegetarians and vegans. A Wholefood, plant-sourced vitamin D3 spray, ideal for children, vegetarians and vegans. And a higher potency Food State vitamin D3 in tablets, beneficially combined in a base of lactobacillus bulgaricus. Please click the relevant image for more information or follow this link; vitamin D supplements.