2005; Broe et al., 2007) found a significant effect of vitamin D on fall incidence. The only two significant studies for fallers are Pfeifer et al. (2000, 2009), although Pfeifer et al. (2000) was a 2-month study and administered calcium with the vitamin D placebo.

Observational studies have long suggested an association between a higher serum 25OHD level and a lower risk of falls in elderly persons; however, when analyzed as a whole in the AHRQ reviews, there was no consistency between study findings. Snijder et al. (2006), a study of elderly subjects participating in the Longitudinal Aging Study Amsterdam, a prospective cohort study, was not included in the AHRQ reviews. This study found that a low serum 25OHD level (< 25 nmol/L) was independently associated with an increased risk of falling for subjects who experienced two or more falls compared with those who did not fall or fell once; however the study outcome does not affect the discordant findings among observational studies identified in the AHRQ reviews.

Most observational studies of associations between serum 25OHD levels and physical performance have been cross–sectional, which limits causal inference. A cross–sectional study of 4,100 older adults from NHANES III found higher serum 25OHD concentrations associated with better lower-extremity function (Bischoff-Ferrari et al., 2004b). Much of the improvement occurred at concentrations ranging from 22.5 nmol/L to approximately 40 nmol/L, but some improvement was also seen from 40 to 94 nmol/L (the top of the reference range). Results were similar in men and women, three racial/ethnic groups (whites, African Americans, and Mexican Americans), active and inactive persons, and those with high and low calcium intakes. A study of Dutch adults 65 years of age and older found that serum 25OHD concentrations below 20 nmol/L were significantly associated with poorer physical performance at baseline and a greater decline in physical performance over a 3-year period (Wicherts et al., 2007). Another cross–sectional study of healthy post-menopausal women found that serum 25OHD level was significantly associated with physical fitness indexes, including balance, handgrip strength, androidal fat mass, and lean mass (Stewart et al., 2009). Finally, a cross–sectional study of 60 men and women with heart failure (mean age of 77 years) found a significant association between serum 25OHD level and 6-minute walk distance and frailty status (Boxer et al., 2008). Taken together, however, this evidence is weakened by the cross–sectional study design, does not provide strong support for an association between serum 25OHD level and physical performance, and does not contradict the findings of the AHRQ reviews.