© Borgis - Postępy Nauk Medycznych 10/2016, s. 773-776
*Małgorzata Berwecka1, Jarosław Amarowicz1, Edward Czerwiński1, 2
Vitamin D3 and falls
Witamina D3 a upadki
1Department of Bone and Joint Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków
Head of Department: Professor Edward Czerwiński, MD, PhD
Assistant: Małgorzata Berwecka, MSc; Jarosław Amarowicz, MSc
2Cracow Medical Center
Head of Center: Professor Edward Czerwiński, MD, PhD
Upadki są jednym z największych problemów medycznych i społecznych dotykających osoby starsze. Należą one do głównych przyczyn niepełnosprawności i śmierci w grupie osób po 75. roku życia. Upadki są następstwem równoczesnego występowania czynników zewnętrznych i wewnętrzny w postaci niewydolności wielu układów i narządów.
Witamina D pełni istotną rolę w prawidłowym funkcjonowaniu aparatu mięśniowego u osób starszych. Jej znaczny niedobór jest jednym z istotnych czynników ryzyka upadku.
Nie podlega również wątpliwości, że niezależnie od przyczyn upadku ćwiczenia fizyczne są najbardziej skuteczne, bowiem wpływają nie tylko na sprawność mięśni, ale na ogólny stan zdrowia organizmu człowieka. Dlatego współcześnie nie można mówić o profilaktyce upadków z pominięciem wpływu różnego typu interwencji ruchowych, obejmujących ćwiczenia domowe, w grupach, indywidualne, siłowe, równoważne, wydolnościowe, Tai Chi, nordic walking i inne. Jednak biorąc pod uwagę rozpowszechnienie deficytów/niedoborów 25(OH)D w populacji osób starszych, szerokie spektrum jej korzystnego oddziaływania na organizm (układ immunologiczny, układ sercowo-naczyniowy, onkogenezę i funkcje poznawcze) oraz niski koszt, jej profilaktyczna suplementacja jest uzasadniona, zwłaszcza jako uzupełnienie różnych form aktywności ruchowej.
Falls are one of the major health and social issues among the elderly. They constitute one of the main causes of disability or death among people over the age of 75. Causes of falls are complex. Falls are almost always caused by the coexistence of a few factors – eliminating even one may be enough to prevent a fall. Vitamin D plays an important role in maintaining proper muscle function in the elderly, including prophylaxis of sarcopenia. Numerous studies present a correlation between the deficiency of 25(OH)D and increased risk of falls. Regardless of the reasons of falls, physical exercises are the most effective preventive measure, because they affect not only muscular system, but health in general. That is why today it is impossible to overestimate the impact of various types of exercise interventions, including: home, group, individual, power, balance exercises, Tai Chi, Nordic walking etc. in fall prophylaxis. Although exercises remain the most efficient way to prevent falls, a wide spectrum of vitamin D3 benefits combined with its low cost gives enough evidence that prophylactic supplementation of vitamin D3 is justified.
Falls as a medical and social issue
“Population aging is a triumph of humanity, but is also a major challenge for the society” – falls among the elderly, both in medical and social context, are among these challenges (1). The problem with falls among the elderly will systematically increase with the following years as the population is aging. Falls are one of the major causes of disability or death among people over 75. The frequency of injuries caused by falls has increased by 131% over the last three decades. The lack of undertaking proper prophylactic measures may result in further increase of fall-related injuries – as high as 100% until 2030. It is estimated that each year 1 out of 3 people over 65 experiences a fall. After the age of 85 the number increases to 50% of the population. The highest risk can be observed among the inhabitants of Social Welfare Homes – 80% over 65 sustain a fall. Falls are also responsible for 50% of hospitalizations among people over 65. They are the cause of 40% of trauma-related deaths (2). Frequency of hospitalizations (due to a fall-related trauma) increases with age – the risk is two times greater for women. Fractures are the main reason for hospitalizations, usually fracture of the hip (3). Falls are not only a significant fracture risk factor in the elderly, but they also have an impact on the quality and length of life. Psychological and social results, such as the fear of a subsequent fall, are also crucial as they are a significant risk factor for subsequent falls. A fall, even without an injury, often results in self-restraint of physical activity, resulting in limited physical function and social interaction, even in isolation. It is a risk factor for dementia and also an independent predictive risk factor for institutional care (4). In 2007 WHO recognized falls as one of the major health and social issues (5).
Causes of falls are complex. Currently there are 400 known clinical risk factors for falls. Despite the fact that some of them cannot be eliminated, there is a great number of those which can be completely eradicated. They have been divided into external (associated with the environment) and internal (associated with health or increase of the disease symptoms). According to EBM among the most crucial factors are: muscle weakness, prevalent falls, balance disorder, gait disturbance, visual or cognitive function impairment, memory loss, depression and others (6). Many studies show that the fall risk is associated with ADL (Activities of Daily Living). Problems with performing even one ADL or IADL (Instrumental Activity of Daily Living) activity doubles the risk of falling (7). Correlation between prevalent falls and the use of orthopedic aids has also been reported (8). What is most important – falls are almost every time caused by the coexistence of a few factors – eliminating even one may be enough to prevent a fall from happening.
Vitamin D and functional performance
Study results present a strong correlation between the efficiency of the musculoskeletal system and the risk of falling. Active form of vitamin D – 1,25(OH)D is a calcitropic hormone that plays an important role in the extracellular homeostasis of calcium and phosphorus between thin borderlines set as a standard required for proper functioning of nerves and muscles. Many studies proved that a higher concentration of vitamin D is associated with better balance, mobility and better self-reliance. Inversely, its deficiency results in lower muscle mass, decreased mobility, weakness of antigravity muscles, slower defense and balance reactions, muscle pains, paresthesia and joint pain (9, 10). It has been observed that people who have sustained a fall have a significantly lower level of 25(OH)D as compared to those who do not have a history of falls (11). Cross-sectional studies (12-15) along with prospective observational surveys (16, 17) present an overview of effect of wit. D on muscle strength (upper and lower limb). It shows that it plays an important role in maintaining proper muscle function in the elderly, including the prophylaxis of sarcopenia.
Vitamin D influences muscles directly and indirectly. It affects the muscles indirectly by inducing changes in calcium absorption. Recent studies show that muscle weakness, detected in vitamin D deficits, may be partially explained by accompanying hypophosphatemia. It shows the effect of vitamin D on the functioning of muscle tissue by improving mitochondria’s oxidative function (18). Another indirect mechanism by which vitamin D affects the skeletal muscles is the reduction of fat tissue (located in and between muscles). Studies indicate that the process of storing fat in muscles increases with age and it is a significant, independent prognostic factor for muscle function and physical performance among elderly. There is also a proof that higher physiological levels of 1,25(OH)D inhibits the growth of fat in muscles by decreasing transdifferentiation of myogenic stem cells into adipocytes (19).
Vitamin D affects the muscles by membrane receptors and nuclei receptor VDR (Vitamin D Receptor). Active vitamin D metabolite – 1,25(OH)2D affects calcium transportation to the tissue by binding with the nuclei receptor VDR in the skeletal muscle tissue. Therefore, it directly influences the strength and time of a muscle contraction, stimulates protein biosynthesis – in consequence increasing amount of type II muscle cells which promotes the growth of muscle speed and strength.
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Płatny dostęp do wszystkich zasobów Czytelni Medycznej
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