Physical Performance, Muscle Strength, Falls, and Vitamin D
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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.
KeywordsPhysical performance Muscle strength Falls Vitamin D Vitamin D receptor Genomic and non-genomic pathways Meta-analyses Prevention of falls
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