Physical Performance, Muscle Strength, Falls, and Vitamin D

  • Paul LipsEmail author
  • Natasja M. van Schoor


Vitamin D status is associated with muscle strength, physical performance, and falls as has been observed in many epidemiological studies. When serum 25-hydroxyvitamin D increases from very low levels to 50 nmol/l, physical performance increases and plateaus with higher levels of serum 25(OH)D. Randomized controlled clinical trials were performed with vitamin D alone or with vitamin D and calcium with the endpoint falls. Eight of thirteen studies showed a significant decrease of fall incidence, and in six of seven significant double-blind studies, vitamin D was combined with calcium and compared with double placebo. The decrease of fall incidence ranged from −19 to −70 %. One study with vitamin D3 dose of 500,000 IU once per year showed an increased fall incidence in the vitamin D group compared with the placebo group. The increased fall incidence was observed in the first 3 months after the high vitamin D dose. Eight meta-analyses have been performed on the effects of vitamin D on fall incidence. One may conclude from these that vitamin D3 is effective in doses of 800 IU/day or more and preferably combined with calcium. Vitamin D may influence muscle strength through genomic and non-genomic pathways. The active metabolite 1,25-dihydroxyvitamin D binds to the nuclear vitamin D receptor and can activate more than 300 genes, and it may also bind to a membrane receptor thus activating second messengers leading to fast calcium influx. Vitamin D may influence muscle fiber proliferation and differentiation, and calcium influx and calcium transport to the sarcoplasmic reticulum. There is still some debate on the presence of the vitamin D receptor in human muscle tissue because it was demonstrated by some but not by other investigators.

In conclusion, vitamin D can influence muscle strength, balance, and prevent falls.


Physical performance Muscle strength Falls Vitamin D Vitamin D receptor Genomic and non-genomic pathways Meta-analyses Prevention of falls 


  1. 1.
    Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in the elderly women. New Engl J Med. 1992;327:1637–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged  >  or  =  60 y. Am J Clin Nutr. 2004;80:752–8.PubMedGoogle Scholar
  3. 3.
    Wicherts IS, van Schoor NM, Boeke AJ, Visser M, Deeg DJ, Smit J, Knol DL, Lips P. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;92:2058–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Visser M, Deeg DJH, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003;12:5766–72.CrossRefGoogle Scholar
  5. 5.
    Snijder MB, van Schoor NM, Pluijm SMF, van Dam RM, Visser M, Lips P. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab. 2006;91:2980–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Flicker L, Mead K, MacInnes RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc. 2003;51:1533–8.PubMedCrossRefGoogle Scholar
  7. 7.
    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;15:1113–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2009;20:315–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Flicker L, MacInnes RJ, Stein MS, Scherer SC, Mead KE, Nowson CA, Thomas J, Lowndes C, Hopper JL, Wark JD. Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc. 2005;53:1881–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Graafmans WC, Lips P, Ooms ME, van Leeuwen JPTM, Pols HAP, Uitterlinden AG. The effect of vitamin D supplementation on the bone mineral density of the femoral neck is associated with vitamin D receptor genotype. J Bone Miner Res. 1997;12:1241–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Latham NK, Andersson CS, Lee A, Bennett DA, Moseley A, Cameron ID, Fitness Collaborative Group. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc. 2003;51:291–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ, Nottingham Neck of Femur (NONOF) Study. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: the Nottingham Neck of Femur (NONOF) Study. Age Ageing. 2004;33:45–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med. 2006;166:424–30.PubMedGoogle Scholar
  14. 14.
    Law M, Withers H, Morris J, Andersson F. Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing. 2006;35:482–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc. 2007;55:234–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Prince RL, Austin N, Devine A, Dick IM, Bruce D, Zhu K. Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Arch Intern Med. 2008;168:103–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kärkkäinen MK, Tuppurainen M, Salovaara K, Sandini L, Rikkonen T, Sirola J, Honkanen R, Arokosi J, Alhava E, Kroger H. Does daily vitamin D 800 IU and calcium 1000 mg supplementation decrease the risk of falling in ambulatory women aged 65–71 years? A 3-year randomized population-based trial (OSTPRE-FPS). Maturitas. 2010;65:359–65.PubMedCrossRefGoogle Scholar
  18. 18.
    Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303:1815–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Lips P, Binkley N, Pfeifer M, Recker R, Samanta S, Cohn DA, Chandler J, Rosenberg E, Papanicolaou DA. Once-weekly dose of 8400 IU vitamin D3 compared with placebo: effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. Am J Clin Nutr. 2010;91:985–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Neelemaat F, Lips P, Bosmans JE, Thijs A, Seidell JC, van Bokhorst-de van der Schueren MA. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults. J Am Geriatr Soc. 2012;60:691–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011;59:2291–300.PubMedCrossRefGoogle Scholar
  23. 23.
    Latham NK, Andersson CS, Reid IR. Effects of ­vitamin D supplementation on strength, physical performance, and falls in older persons: a systematic review. J Am Geriatr Soc. 2003;51:1219–26.PubMedCrossRefGoogle Scholar
  24. 24.
    Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004;291:1999–2006.PubMedCrossRefGoogle Scholar
  25. 25.
    Jackson C, Gaugris S, Sen SS, Hosking D. The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta-analysis. QJM. 2007;100:185–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Richy F, Dukas L, Schacht E. Differential effects of D-hormone analogs and native vitamin D on the risk of falls: a comparative meta-analysis. Calcif Tissue Int. 2008;82:102–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the ­community. Cochrane Database Syst Rev. 2009;15:CD007146.Google Scholar
  28. 28.
    Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692.PubMedCrossRefGoogle Scholar
  29. 29.
    Kalyani RR, Stein B, Valiyil R, Manno R, Maynard JW, Crews DC. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc. 2010;58:1299–310.PubMedCrossRefGoogle Scholar
  30. 30.
    Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil. 2010;7:50.PubMedCrossRefGoogle Scholar
  31. 31.
    Endo I, Inoue D, Mitsui T, Umaki Y, Akaike M, Yoshizawa T, Kato S, Matsumoto T. Deletion of vitamin D receptor gene in mice results in abnormal skeletal muscle development with deregulated expression of myoregulatory transcription. Endocrinology. 2003;144:5138–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Bischoff-Ferrari HA, Borchers M, Gudat F, Durmuller U, Stähelin HB, Dick W. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res. 2004;19:265–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Wang Y, DeLuca HF. Is the vitamin D receptor found in muscle? Endocrinology. 2011;152:354–63.PubMedCrossRefGoogle Scholar
  34. 34.
    Ceglia L, da Silva Morais M, Park LK, Morris E, Harris SS, Bischoff-Ferrari HA, Fielding RA, Dawson-Hughes B. Multi-step immunofluorescent analysis of vitamin D receptor loci and myosin heavy chain isoforms in human skeletal muscle. J Mol Histol. 2010;41:137–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Internal Medicine, Section EndocrinologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations