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Serum Parathyroid Hormone Predicts Time to Fall Independent of Vitamin D Status in a Frail Elderly Population

Institute of Bone and Joint Research, Department of Public Health, ANZAC Research Institute, University of Sydney, Prince of Wales Medical Research Institute, Sydney, New South Wales 2065, Australia

Address all correspondence and requests for reprints to: Prof. Philip Sambrook, Institute of Bone and Joint Research, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia. E-mail: sambrook{at}med.usyd.edu.au.

Very frail older people constitute an increasing proportion of ageing populations and often have vitamin D deficiency. Falls are frequent in this population and have usually been associated with vitamin D deficiency. In this prospective study we measured serum 25-hydroxyvitamin D (25OHD), serum PTH, and falls in 637 ambulatory subjects living in institutional aged care facilities (intermediate-care hostels or nursing homes). The study sample comprised 121 men (mean age, 82.1 yr) and 516 women (mean age, 86.7 yr). Two hundred and seventy-four subjects fell one or more times over a mean duration of follow-up of 10.2 months. Vitamin D deficiency, defined as a serum 25OHD level below 39 nmol/liter was present in 73.6%. Baseline serum 25OHD and PTH were significantly associated with falls in univariate analyses. In multivariate analyses that also corrected for balance and health status, PTH remained a significant predictor of falls independent of 25OHD. Serum PTH is a predictor of time to first fall in the frail elderly independent of vitamin D status and measures of general health.

Abbreviations: CI, Confidence interval; HR, hazard ratio; 25OHD, 25-hydroxyvitamin D; OR, odds ratio; RCS, Resident Classification Scale; SMMSE, Standardized Mini Mental Status Examination.

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