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The Effect of Pre-Admission Vitamin D Supplementation on the Clinical Status of Frail Older Adults

Background: Vitamin D supplementation (VDS) is associated with reduced falls risk, improved physical performance and stronger bones reducing the risk of osteoporosis. The aim of this study was to determine the effect of pre-admission VDS on the clinical status of frail older adults.

Methods: Older adults acutely admitted to a university hospital who screened positive for frailty (PRISMA7) underwent comprehensive geriatric assessment. Baseline demographics, clinical history, Rockwood clinical frailty score (CFS) and laboratory results including vitamin D, parathyroid hormone (PTH), C-terminal crosslinking telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (PINP) were recorded. Clinical research ethics was approved.

Results: Of the 127 frail older adults recruited, 61 were taking VDS pre-admission and 66 were not. There was no difference in CFS between the groups (5.7 ± 1.2 v 6.0 ± 1.0, p = 0.075). Vitamin D (82.0 ± 35.2 v 44.1 ± 25.0nmol/L, p < 0.001) was higher while CTX (0.430 ± 0.260 v 0.565 ± 0.344ug/L, p = 0.023) and PTH (51.4 ± 32.8 v 69.5 ± 49.4 ng/L, p = 0.018) were lower in those taking VDS compared to those not. There was no significant difference in P1NP (48.3 ± 33.3 v 65.4 ± 65.7ug/L, p = 0.079).

A greater proportion of those on VDS (29.5%) were taking antiresorptive therapy compared to those not (9.1%) (p = 0.006). Self-reported dietary calcium intake was adequate in 80.3% of those taking and 83.3% of those not taking VDS (p = 0.818). There was no difference in the proportion of participants with ≥1 risk factor for fracture between the groups (88.5% v 84.8%, p = 0.36).

Conclusion: Participants on pre-admission VDS had higher vitamin D and lower CTX and PTH suggesting that these participants may have increased bone density and lower long-term fracture risk. The greater proportion of participants on VDS taking antiresorptive therapy could explain the difference in CTX between the groups. There was no difference in CFS between those taking and those not taking pre-admission VDS.