Recently we reported that in a randomized controlled trial, vitamin D helped prevent the deterioration of Parkinson’s disease compared to placebo. The trial took place in Japan, lasted for one year and administered 1200 IU of vitamin D per day.
In yet another study out of Japan, Professor Yoshihiro Sato and colleagues report that vitamin D reduces falls and hip fractures in vascular Parkinsonism but not in Parkinson’s disease.
The study was an open label trial, where they administered 1200 IU of vitamin D2 to 92 elderly patients with Parkinson’s disease and 94 elderly patients with vascular Parkinsonism. An open label trial is a study where there is an intervention but no placebo group to compare to.
Parkinsonism describes a class of diseases that include a number of core symptoms including tremor, rigidity and slowness of movement. Parkinson’s disease accounts for about 85% of all who suffer from Parkinsonism. A more atypical form of the disease is vascular Parkinsonism, which accounts for about 3% of those who suffer from Parkinsonism.
What is vascular Parkinsonism? In this study, people were diagnosed with vascular Parkinsonism if they met the following criteria:
- Have Parkinsonism
- Have cerebrovascular disease, a disease often caused by hypertension which damages the blood vessels supplying the brain
- Have a relationship between the two, like onset of Parkinsonism after a stroke event
At baseline, all 186 patients were assessed for hip muscle strength using the British Medical Research Council scale; a scale from 0 to 5 where 0 is no muscle strength and 5 represents normal strength. They were also classified at baseline as either “fallers” or “non-fallers,” based on whether they had fallen within the past three months before the trial.
During the trial, the participants recorded when they suffered from a fall, marking an “X” on a calendar on days they fell.
After the two year trial, here is what they found:
- Vitamin D levels rose from about 9 ng/ml to 23 ng/ml.
- The percentage of classified fallers started at 36% in the Parkinson’s disease group and did not significantly change over the course of the trial.
- The percentage of classified fallers started at 34% in the vascular Parkinsonism group and significantly fell to 16% over the course of the trial.
- In both people with Parkinson’s disease and vascular Parkinsonism, the strength of the hip muscle improved over the two years. In Parkinson’s disease, the rating rose from 3.8 to 4.5. In vascular Parkinsonism, the rating rose from 3.9 to 4.4.
- Hip fractures caused by falls occurred in seven cases in the Parkinson’s disease group, and in one case in the vascular Parkinsonism group.
The authors conclude,
“Vitamin D supplementation in vascular Parkinsonism patients with low serum vitamin D causes decreased risk for falls, while such a phenomenon is not observed in Parkinson’s disease patients.”
Limitations of this study include lack of placebo to compare results to, low vitamin D dosage and subsequent low vitamin D levels, and the use of vitamin D2 rather than D3.
Prevention of fractures is an important issue in the management of Parkinsonism. Here, the researchers found that vitamin D was beneficial to vascular Parkinsonism but not Parkinson’s disease in regards to fall and fracture rate. Whether vitamin D truly doesn’t prevent falls and fractures in Parkinson’s disease or if the use of vitamin D was too small and incorrect of a dose (1200 IU of vitamin D2) is unclear at this time. The fact that hip muscle strength improved equally in both groups of patients, yet only vascular Parkinsonism patients saw fall reduction led the researchers to speculate that there may be Parkinson’s disease-specific abnormalities that cause falls and weakness, independent of strength of muscle fibers.
This calls for further research in the form of a randomized controlled trial, using vitamin D3 and using vitamin D at a much higher dose than used in this study. In the meantime, it appears that vitamin D can help manage falls and fractures in vascular Parkinsonism.
Sato Y et al. Vitamin D reduces falls and hip fractures in vascular Parkinsonism but not in Parkinson’s disease. Therapeutics and Clinical Risk Management, 2013