Vitamin D replacement therapy, in conjunction with core strengthening and balance exercises, may be associated with improved balance, reduced fall risk, and improved quality of life (QoL) in postmenopausal women with vitamin D deficiency. These findings were published in the International Journal of Clinical Practice.
The study included postmenopausal women between the ages of 50 to 70 years and a 25(OH) vitamin D level of <25 nmol/L. They were selected because they were either candidates for osteoporosis or already had a diagnosis of osteoporosis. Patients were recruited from a tertiary care hospital and randomly assigned to receive or undergo either vitamin D replacement (n=21; mean vitamin D, 19.10±4.40 nmol/L), core and balance exercises (n=18; mean vitamin D, 20.56±4.70 nmol/L), or vitamin D replacement plus core and balance exercises (n=20; mean vitamin D, 18.53±4.20 nmol/L). A control group of women with 25(OH) vitamin D levels of >75nmol/L (n=40; mean vitamin D, 96.78±23.83 nmol/L) were included and performed the core and balance exercises only.
Vitamin D replacement therapy consisted of oral 50,000 international units vitamin D per week for 8 weeks. Vitamin D levels were classified as desirable (>75 nmol/L), inadequate (50-74 nmol/L), insufficient (25-49 nmol/L, and deficient (<25 nmol/L). Researchers evaluated participants prior to and after 8 weeks of their assigned interventions with the Berg balance test (BBT) and Biodex balance system (postural stability and fall risk tests) as well as the Nottingham Health Profile (NHP) for QoL.
Individuals who had desirable levels of vitamin D had significantly better mean BBT scores vs those with deficient vitamin D levels (53.02±2.49 vs 51.88±2.21, respectively; P =.021). The desirable vitamin D group also had better APSI, MLSI, OSI and fall risk test scores, but the differences were not statistically significant. In contrast, women considered deficient in vitamin D had significantly worse scores for NHP pain (50.16±28.76 vs 31.12±27.78; P <.001), emotional reactions (34.03±27.94 vs 17.97±21.59; P =.002), social isolation (28.31±30.16 vs 13.81±22.78; P =.008), and NHP total score (236.62±133.34 vs 161.10±109.88; P =.008).
Following vitamin D replacement therapy, the mean 25(OH) vitamin D levels were 79.7 nmol/L for the vitamin D replacement groups and 81.6 nmol/L for the combined vitamin D and exercise group. After the 8-week study period, all groups demonstrated significant improvements in balance parameters and fall risk, except the vitamin D replacement only group (mediolateral stability index) and QoL in the exercise-only group. Improvements in emotional reaction, physical activity, and the total NHP score were also observed in women who received only vitamin D replacement therapy, vitamin D plus exercise, as well as the control group, who underwent only core and balance exercises.
The participants who received only vitamin D replacement therapy had significant improvement in the NHP pain subdomain score (45.05±25.75 to 32.73±25.73; P =.042). Additionally, improvements in the social isolation subdomain of the NHP were observed in patients who underwent only vitamin D replacement (39.85±30.62 to 12.78±19.79; P =.001) and vitamin D plus core and balance exercises (24.35±26.27 to 9.45±17.00; P =.013).
Limitations of this study included the small sample size, the short duration of follow-up, and the inclusion of only postmenopausal women between the ages of 50 and 70 years. The researchers added that “any superior effect of vitamin D or exercise on each other was not determined,” according to the researchers.
Ozsoy-Unubol T, Candan Z, Atar E, et al. The effect of vitamin D and exercise on balance and fall risk in postmenopausal women: a randomized controlled study. Int J Clin Pract. Published online September 13, 2021. doi:10.1111/ijcp.14851