Preventing fractures and falls: Shedding light on the USPSTF's new recommendations
The U.S. Preventive Services Task Force (USPSTF) has released new recommendation statements on preventing fractures and falls in older adults, casting doubt on vitamin D and calcium supplements but advocating for exercise and other interventions. JoAnn Manson, MD, DrPH, chief of the Division of Preventive Medicine at BWH, and Shalender Bhasin, MD, director of the Research Program in Men's Health in the Division of Aging and Metabolism, are coauthors of an editorial published in JAMA accompanying the new guidelines.
In this issue of JAMA, the USPSTF presents recommendation statements based on comprehensive reviews of the evidence. These include:
- Insufficient evidence to assess the benefit/harm of vitamin D and calcium supplementation for preventing primary fractures in men and postmenopausal women;
- Revision of an earlier, favorable assessment of vitamin D for fall prevention in 2012 to a current recommendation against vitamin D supplementation;
- Recommendation, with moderate evidence, of exercise interventions to prevent falls in adults 65 years and older;
- Recommendation, with lower level of evidence, for multi-factorial interventions, including targeting problems with balance, gait, vision, medication use, blood pressure and other factors that can contribute to increased risk of falls.
Manson and her co-authors provide important context for these recommendations, including the additional health benefits likely to be achieved by a renewed focus on physical activity: "The updated recommendations, which emphasize the importance of exercise, have the potential to prevent injurious falls, the cascade of health problems that often result from such falls, and should improve general health and well-being," commented Manson.
The new guidelines also call for more evidence about whether higher doses of vitamin D may help prevent falls and fractures. This is timely because two large-scale clinical trials, including VITAL, will be announcing findings on this very topic over the next year. In addition, large-scale randomized trials, including STRIDE, are evaluating the effectiveness of multi-factorial interventions in fall prevention.
Manson is a leading authority on women's health whose major research interests include the role of vitamin D in a variety of health conditions and the role of lifestyle factors and clinical interventions in chronic disease prevention. She has led several large-scale prospective cohort studies and randomized clinical trials, including VITAL.
Bhasin is an internationally recognized expert in human aging, clinical trials of function promoting therapies for older adults, functional decline in aging and testosterone biology. He also serves as the director of the NIA-funded Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies at BWH. Bhasin is a also a principal investigator of the STRIDE study.