Comprehensive Interventions Including Vitamin D Effectively Reduce the Risk of Falls in Elderly Osteoporotic Patients

摘要

Objective To evaluate the effects of different intervention measures to prevent falls in elderly osteoporotic patients. Methods A randomized controlled trial was conducted in our outpatient ward from August 2014 to September 2015. A total of 420 patients over 60?years of age were assigned to four groups. NA VitD group took 800?mg calcium and 800 IU non-active vitamin D. P-NA VitD group took 800?mg calcium, 800 IU non-active vitamin D, and received physical exercise. A VitD group took 800?mg calcium and 0.5?μg active vitamin D. P-A VitD took 800?mg calcium, 0.5?μg active vitamin D, and received physical exercise. Physical exercise includes guidance in improving muscle strength and balance ability. Short physical performance battery (SPPB), grip strength, modified falls efficacy scale (MFES), blood calcium, and 25-hydroxyl vitamin D were measured before interventions and at 3, 6, and 12?months after interventions. Bone mineral density (BMD) was detected before interventions and at 12?months after interventions. The incidence of falls and fractures, adverse events, and drug reactions were recorded for 12?months. Results A total of 420 patients were allocated in the four groups: 98 cases into the NA VitD group (11 males, 87 females), 97 cases into the P-NA VitD group (13 males, 84 females), 99 cases in the A VitD group (15 males, 84 females), and 98 cases into the P-A VitD group (11 males, 87 females). At 6 months after interventions, the SPPB of A VitD group significantly increased from 6.9?±?1.9 to 8.0?±?2.4 ( P ?0.05), and the SPPB of A VitD group significantly increased from 7.2?±?2.1 to 8.6?±?1.7 ( P ?0.05). At 6 months after interventions, MFES of P-NA VitD group 7.0?±?1.6 to 7.6?±?1.6 ( P ?0.05), and MFES of P-A VitD group significantly increased from 6.7?±?1.6 to 7.5?±?1.6 ( P ?0.05). At 12?months after interventions, SPPB of all groups, grip strength, and MFES of P-NA VitD group, A VitD group, P-A VitD group were significantly improved ( P ?0.05). The BMD of lumbar vertebrae of A VitD group significantly increased from 0.742?±?0.042 to 0.776?±?0.039, and P-A VitD group significantly increased from 0.743?±?0.048 to 0.783?±?0.042 ( P ?0.05). No serious adverse events occurred during the 12?months of follow-up. Conclusion Active vitamin D is better than non-active vitamin D to improve physical ability and the BMD of lumbar vertebrae and reduce the risk of falls.