Evidence Table 4

Studies examining physiologic interventions in the community (listed chronologically)

SourceSafety Issue Related to Clinical PracticeDesign Type§Study Design, Study Outcome Measure(s)Study Setting & Study PopulationStudy InterventionKey Finding(s)
Latham 2003132Physiologic interventions to prevent falls in patients discharged from acute care to the communityRCTDesign: RCT

Outcomes: Falls over 6 months
Setting: Five hospitals in Auckland, New Zealand, and Sydney, Australia

Population: 243 frail older people (53 percent female)
One dose vitamin D 300,000 IU versus placebo OR 10 weeks of high-intensity home-based exercise versus attention lessonsFalls:
  • Increase in falls for patients receiving vitamin D as compared to placebo, but not statistically significant (relative risk = 1.12, 95% CI = 0.79–1.59).
  • Decrease in falls for patients in exercise group compared to attention group, but not statistically significant (relative risk = 0.96, 95% CI = 0.67–1.36).

Injury: Patients in the exercise group were at increased risk of musculoskeletal injury (risk ratio = 3.6, 95% CI = 1.5–8.0).
Bischoff-Ferrari 2004178Physiologic interventions to prevent falls and fall-related injuries in the communityMeta-analysisDesign: Meta-analysis of five RCTs

Outcomes: Fracture
Setting: Community

Population: 1,237 participant in the five studies
Vitamin D: Large dose = 700–800IU/d Small dose = 400 IU/dFalls: Compared with patients receiving calcium or placebo, vitamin D reduced risk of falling by 22 percent (corrected odds ratio = 0.78, 95% CI = 0.64–0.92).
Fracture:
  • Vitamin D 700–800IU/d reduced the risk of fracture by up to 26 percent.
  • Vitamin D 400 IU/d did not reduce fracture risk.

Numbers needed to treat: 15 patients would need to be treated with vitamin D to prevent 1 person from falling.
Sensitivity analysis of 5 additional studies: Total sample 10,001 – smaller effect size (corrected relative risk = 0.87, 95% CI = 0.80–0.96).
Avenell 2005107Meta-analysisDesign: Metanalysis of RCTs or quasi-randomized trials

Outcomes: Fractures
Setting: Community

Poplulation: 7 trials; 18,668 participants
Vitamin D or an analogue alone, or vitamin D with calcium, or Placebo, no intervention, or calciumVitamin D or analogue alone:
  • No effect on hip fracture (relative risk = 1.17; 95% CI = 0.98–1.41).
  • No effect on vertebral fracture (relative risk = 1.13; 95% CI = 0.50–2.55).
  • Any new fracture (relative risk = 0.99; 95% CI = 0.91–1.09).

Vitamin D or analogue with calcium:
  • Marginal reduction in hip fractures (relative risk = 0.81; 95% CI = 0.68–0.96).
  • Marginal reduction in nonvertebral fractures (relative risk = 0.87; 95% CI = 0.78–0.97).
  • No effect on vertebral fractures.
  • Calcitriol may be associated with an increased incidence of adverse effects.
Grant 2005130Physiologic interventions to prevent falls and fall-related injuries in the communityRCTDesign: Factorial-design trial

Outcomes: New low-energy fractures
Setting: Patients identified in 21 UK hospitals then treated at home after discharge

Population: 5,292 people ≥ 70 years (85 percent female) with new low-trauma fracture, and who were mobile before that fracture
800 IU vitamin D daily or 1,000 mg calcium daily or 800 IU vitamin D plus 1,000mg calcium daily or placeboFalls: No differences between groups (hazard ratio = 0.94; 95% CI = 0.81–1.09).

Fractures:
  • No difference between vitamin D and placebo (hazard ratio = 1.02; 95% CI = 0.88–1.19).
  • No difference between combination treatment and placebo.
Sato 2005137Physiologic interventions to prevent fall-related injuries in acute careRCTDesign: RCT

Outcomes: Vertebral factures, hip fractures
Setting: Community in Japan

Population: 500 women ≥ 70 years with Alzheimer’s disease, vitamin D deficiency, and hyperparathyroidism
Risedronate 2.5 with 1,000 IU vitamin D plus 1,200 mg calcium or placebo with 1,000 IU vitamin D plus 1,200 mg calciumFractures: 72 percent decrease in fractures in the risedronate group (relative risk = 0.28; 95% CI = 0.13–0.59).
Bischoff-Ferrari 2006134Physiologic interventions to prevent falls and fall-related injuries in the communityRCTDesign: RCT

Outcomes: Fall rates
Setting: Community

Population: 199 men and 246 women ≥ 65 years living at home
700 IU of vitamin D plus 500 mg of calcium citrate malate per day or placeboFalls:
  • Vitamin D plus calcium reduced the odds of falling in women by 46 percent (odds ratio = 0.54, 95% CI = 0.30–0.97).
  • Vitamin D plus calcium reduced the odds of falling in women by 65 percent in less active women (odds ratio = 0.35; 95% CI = 0.15– 0.81).
  • Vitamin D plus calcium did not significantly reduced the odds of falling in men (odds ratio = 0.93, 95 percent CI, 0.50–1.72)
McCloskey 2007138Physiologic interventions to prevent falls and fall-related injuries in the communityRCTDesign: RCT (double-blind)

Outcomes: Hip and any clinical fracture
Setting: General community in South Yorkshire and North Derbyshire

Population: 5,579 women ≥ 75 years
800 mg oral clodronate (Bonefos) or placeboHip fracture: Slight increase in risk for hip fracture in placebo group (hazard ratio = 1.02, 95% CI = 0.71–1.47).
Any fracture: 20 percent decrease in risk for any clinical fracture for patients in clodronate group (hazard ratio = 0.80, 95% CI = 0.68–0.94).
Osteoporosis-associated nonhip fractures: 29 percent decrease in clodronate group (hazard ratio = 0.71; 95% CI = 0.57–0.87).
§

Study Design Type: (1) Meta-analysis, (2) Randomized controlled trials, (3) Nonrandomized trials, (4) Cross-sectional studies, (5) Case control studies, (6) Pretest and post-test (before and after) studies, (7) Time series studies, (8) Noncomparative studies, (9) Retrospective cohort studies, (10) Prospective cohort studies, (11) Systematic literature reviews, (12) Literature reviews, nonsystematic/narrative, (13) Quality-improvement projects/research, (14) Changing-practice projects/research, (15) Case series, (16) Consensus reports, (17) Published guidelines, (18) Unpublished research, reviews, etc.

From: Chapter 10, Fall and Injury Prevention

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.

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