PCP NOTES:
Short articles on falls and dizziness in a primary care setting
VITAMIN D DEFICIENCY AND FALLS RISK by Neal Alpiner, M.D., PM&R
VITAMIN D is well known for it’s role in calcium and phosphorus homeostasis. Vitamin D has two major forms, D2 (ergocalciferol), and D3 (cholecalciferol). D3, known for it’s conversion in the skin from exposure to the sun’s ultraviolet b, is critical to human health and well-being.
Over the past several decades the number of cases of young adult and adult Vitamin D Deficiency has been steadily growing (refer to article in Archives Internal Medicine March 2009). These findings are particularly dramatic in northern regions where winter, and summer, sunlight exposure is limited.
Vitamin D Deficiency is associated with a wide range of clinical symptoms affecting the neuromuscular and musculoskeletal systems. Common complaints described, but not limited to: sleep disturbances, muscle cramping, muscle soreness and pain, muscle weakness, fatigue/low energy, depression, articular pain syndromes and poor exercise tolerance.
The impact Vitamin D Deficiency has on fall risk and balance disorders cannot be overlooked. The primary care physician needs to be aware of this association and workup should be targeted to vitamin D3 levels.
The following scenarios depict how Vitamin D deficiency can increase falls risk:
Scenario #1 65 year old female has frequent night-time awakenings. She gets out of bed many times as she is restless and unsettled. During one of her awakenings she falls and fractures her right hip. Her restlessness and poor sleep was later found to be associated with low vitamin D levels.
Scenario #2 73 year old male has increased fatigue and when he attempts exercise he has limited endurance or follow through. He goes to his PCP and work up is non-focal. Patient is placed on anti-fatigue medication. While walking at his local mall, patient falls with resultant lumbar strain. Patient stated in the ER he fall because he just did not have the energy. Work up revealed low vitamin D levels.
Scenario #3 50 year old female complains of joint pains without swelling, warmth or erythema. Work up x-rays normal, blood work esr/crp/rheumatoid factor/ana are unremarkable. Patient continues with these symptoms for 6 months. Patient sees several specialists and is treated with multiple medications including narcotics. Patient develops depressive symptoms and is placed on serotonin agonist with minimal relief. After another 2 months endocrinologist orders vitamin D levels. She is started on replacement therapy and within 2 months her symptoms resolve and she is weaned off all medication.
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