Tuesday, May 01, 2018 Vitamin D Takes a Tumble in New Falls Prevention Recommendations The US Preventive Services Task Force (USPSTF) has updated its recommendations for falls prevention in older adults, and this time around, vitamin D supplements are out of the picture, at least for adults aged 65 or older without osteoporosis or vitamin D deficiency. As in previous versions of the recommendations, exercise-based interventions still receive the highest support, with a B grade based on studies reviewed by USPSTF researchers. However, the use of vitamin D supplements didn't fare as well, falling from a B grade in the last version of the recommendations to D grade in the latest edition, meaning that the USPSTF recommends against its use. The drop is at least partially due to a decision by the task force to exclude studies that involved participants with vitamin D deficiency or insufficiency from its evaluation this time around. "With this revised scope of review, as well as newer evidence from trials reporting no benefit, the USPSTF found that vitamin D supplementation has no benefit in falls prevention in community-dwelling older adults not known to have vitamin D deficiency or insufficiency," the report states. The task force clarified that its recommendations around vitamin D also are not intended to apply to older adults with osteoporosis or a history of fractures. Conversely, exercise interventions continued to receive strong support due to the solid favorable evidence that continues to mount—even if the approach can't be narrowed to a single or few recommended interventions. "Effective exercise interventions include supervised individual and group classes and physical therapy, although most studies reviewed by the USPSTF included group exercise," the report states. "Given the heterogeneity of interventions reviewed by the USPSTF, it is difficult to identify specific components of exercise that are particularly efficacious." While the report does mention exploratory research that seems to indicate that greater falls reduction is achieved through group (vs individual) exercise, exercise with multiple components, and exercise that includes strength training, USPSTF authors write that these results should be "interpreted with caution." A third intervention, titled "multifactorial," received the same C grade it earned in the previous report. According to USPSTF, "multifactorial" interventions are customized approaches based on individual falls risk assessments and could include exercise, psychological interventions, nutrition therapy, medication management, social or community services, and referral to specialists such as a neurologist. Editor's note: Want more on falls prevention? Check out the falls-related resources at PTNow, including a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. APTA also offers resources on its Balance and Falls webpage.