| OBJECTIVE: The purpose of this study was as follows: through cross-sectional survey, to observe fall rate and evaluate vitamin D status among the community-dwelling elderly women in Beijing, and to determine the association between fall and fall risk assessment indices including muscle strength and balance, and to determine the association between fall and vitamin D status. then after the treatment, to test the efficacy of vitamin D supplementation in improving fall risk assessment indices and preventing falls and fractures after falls in the case of the same calcium supplementation account, and to provide the experience to the prevention of falls and fractures after falls, then to improve the quality of older women life, releasing the burden of state, society and their family.METHODS: A total of 399 community-dwelling elderly women over 60 years (60 to 86 years old)were selected randomly from 17 communities of 6 blocks in 3 districts from late spring to beginning summer in Beijing. fasting blood samples were collected in the morning and subsequently centrifuged. Serum 25- hydroxyvitamin D (Serum 25(OH)D) and calcium metabolism indictors were measured. The elderly women's socioeconomic status ,fall information , physical activity and dietary intake were collected by questionnaires, and falls risk assessment indicators including grip strength, lower limb strength, timed up and go test , leg standing with eyes closed time, reaction time, and knee effective extensor were measured. bone mineral density(BMD) at lumber spine, hips(femoral neck, torch, femoral Wards' triangle), and total body were measured by DEXA (Norland XR-46, America).In intervention study, 308 people from the cross-section survey was willing to continue to participate in a one-year double-blind intervention study ,which were divided randomly into two groups randomly, Calcium group(146 people) and Calcium plus Vitamin D group(162 people), who took supplementation of calcium 900 mg or calcium 900 mg plus vitamin D 798 IU per-day for one year respectively, and then information was collected as cross-section survey.RESULTS: 1.Cross-section survey results.(1) Fall rate was 18.04%, the total body BMD was 0.829±0.090kg/cm2,the rate of osteoporosis in lumbar spine (L2-4) and femoral neck was 14.2%and 12.3%respectively among the community-dwelling elderly women in Beijing.the average serum 25(OH)D level was 14.45±5.71 ng/ml (mean±standard deviation)at late spring and early summer and the percentage of vitamin D deficiency (serum25 (OH) D <10ng / ml) was about 21.80% and the prevalence of serum 25(OH)D (10ng / ml≤serum25 (OH) D <20ng / ml) insufficiency was 62.41% among the community-dwelling elderly women in Beijing..(2)Fall was negatively correlated with grip strength, lower limb strength(r=-0.152～-0.453,P<0.05), right grip strength and lower limb strength were lower among fallers than non-fallers(P <0.05);fall was also positively correlated with timed up and go time and reaction time(r=0.458～0.564, P<0.05),and negatively correlated with leg standing with eyes closed time, knee effective extensor(r=-0.154～-0.621, P<0.05),and timed up and go test and reaction time were higher among fallers than non-fallers (P <0.05), leg standing with eyes closed time, knee effective extensor were lower among fallers than non-fallers (P <0.05). fall was not correlated with BMD(P>0.05) .(3) Fall was negatively correlated with vitamin D status(r=-0.213,P=0.012),and fallers'vitamin D status was significantly lower than non-fallers(P<0.05).Serum 25(OH)D level was positively correlated with right grip strength, lower limb strength(r=0.152～0.192,P<0.05), right grip strength and lower limb strength were higher in the vitamin D appropriate group(serum25 (OH) D≥20ng / ml) than in the poor vitamin D group(serum25 (OH) D <10ng / ml) (P <0.05).Serum 25(OH)D level was also positively correlated with leg standing with eyes closed time, left knee effective extensor, knee effective extensor(r=0.097～0.136,P <0.05)and negatively correlated with timed up and go test (r =-0.150, P <0.05); leg standing with eyes closed time, left knee effective extensor, knee effective extensor was also higher in the vitamin D appropriate group than in the poor vitamin D group (P <0.05).and timed up and go test was significantly lower correspondingly (P <0.05).2. Intervention trial results(1) After the treatment, fall rate was 7.60% in Calcium plus Vitamin D group, and 11.20% in Calcium group, and was significantly different between the two group(P <0.05);Compared to pre-intervention, there was 13.39% fall reduction (RR=0.825,95%CI[0.755～0.090])in Calcium Plus Vitamin D group, and 3.97% fall reduction in Calcium group(RR=0.956,95%CI[0.866～1.054]). (2) After the intervention, right hand grip, left-leg lower limb strength and left-knee effective extensor increased in Calcium plus Vitamin D group, and was significantly higher by 3.24%,5.01%,2.62% respectively than before the treatment,(P <0.05),but the above indices were lower by 2.78%,1.50%,2.74% respectively in Calcium group. timed up and go test , reaction time was significantly lower than before the treatment in both group, by 19.09%,22.38% respectively in Calcium plus Vitamin D group and by 12.71%,6.68% respectively in Calcium group.(3) After the intervention, BMD was significantly higher than before the treatment at the femoral Wards' triangle, femoral torch, the left upper limb ,right upper limb and total in both group(P<0.05),and increased by 9.17%, 2.07%, 4.01%, 2.97%, 1.30% respectively in Calcium plus Vitamin D group, and by 8.70%, 1.57%, 3.65%, 2.61%, 0.24% in Calcium group, but only the change at the total BMD between the two groups was observed significantly(P <0.05). (4) after the intervention, The mean serum 25 (OH) D concentration was 23.98 ng/ml in Calcium plus Vitamin D group and 14.66 ng / ml in Calcium group, and was significantly different between the two group(P<0.05), and compared to pre-intervention, the mean serum 25 (OH) D concentration was significantly increased by 54.01% in Calcium plus Vitamin D group (P = 0.0001), but decreased by 8.20% in Calcium group, and no significant difference (P> 0.05); The percentage of vitamin D deficiency and serum 25(OH)D insufficiency was only 36.23% in Calcium plus Vitamin D group, but as high as 81.41% in Calcium group.CONCLUTIONS: (1) The rate of fall , fracture after fall is relative high, and the prevalence of vitamin D inadequacy of them are common among the community-dwelling elderly women in Beijing. (2) fall is closely correlated with muscle strength and body balance, and fallers have lower muscle strength and body balance than non-fallers.(3) Vitamin D is closely correlated with muscle strength and body balance, and the elderly women who have lower vitamin D status have lower muscle strength and body balance.(4) In the case of the same calcium supplementation account, Vitamin D nutritional status is significantly improved by the supplementation of vitamin D plus calcium among the community-dwelling elderly women in Beijing , falls risk assessment indicators including muscle and body balance are also significantly improved, and fall rate is reduced notably by the supplementation of vitamin D plus calcium among the community-dwelling elderly women in Beijing. so the supplementation of vitamin D and calcium is important in fall prevention among the community-dwelling elderly women. (5) The supplementation of calcium can release the bone loss of older women effectively, increase their bone mineral density, the effect is better if supplying with vitamin D. so it plays great significance in reducing the incidence of fractures after falls among the community-dwelling elderly women.
|
PDF Full Text Request