Vitamin D protective against BPPV

A group of researchers from Changi General Hospital in Singapore found lower rates of benign paroxysmal positional vertigo (BPPV) recurrence among older adults who supplemented their diet and Canalith Repositioning Procedure (CRP) with vitamin D.

“[In this study] of community-dwelling older adults … vitamin D supplementation improved physical performance in [five-times sit-to-stand (5xSTS)] test,” said the investigators. Moreover, vitamin D replacement was associated with 0.75 (p=0.035) fewer clinical BPPV recurrences per one person year despite the small study sample.

This post hoc analysis of data from a phase IIa study comprised 53 individuals (mean age 66.2 years, 66 percent women) with a history suggestive of idiopathic BPPV. Of these, 39 participants with baseline vitamin D levels <30 ng/mL were randomized 1:1 to vitamin D (group A) or placebo (group B) on top of diet and CRP. [Aging Clin Exp Res 2025;doi:10.1007/s40520-025-02938-4]

In group A, cholecalciferol was given daily at a dose of 2,000 IU for the first 13 weeks then 1,000 IU in the next 13 weeks. Group B participants received placebo at doses and timings mirroring those in group A. The supplements were stopped at week 26, but the dietary interventions went on. The rest who were vitamin D-replete at baseline (≥30 ng/mL; n=14) did not receive any vitamin D for the entire 1-year study period but received dietary interventions.

The numerically better 5xSTS time in group A vs B was seen overall (8.52 vs 10.25 min) and across all subgroups at 12 months, including participants with Clinical Frailty Scale (CFS) scores 2 (8.27 vs 9.48 min) and 3 or 4 (8.94 vs 11.15 min), and those without fear of falling (8.71 vs 10.20 min). According to the researchers, these findings reinforce evidence supporting vitamin D replacement in individuals with muscle function deficiency. [J Clin Endocrinol Metab 2024;109:1907-1947] “This brings up further questions with regard to the group that will benefit the greatest from vitamin D supplementation.”

Fear of falling

Evidence suggests that fear of falling may lead to increased risk of future falls, but this does not appear to be the case in the current study. [Int J Environ Res Public Health 2017;14:469] Of the four participants who had falls during follow-up, only one reported fear of falling at baseline. This fear of falling was evident in 21 of the 49 participants who had no incident falls.

“The idea of fear of falling as being protective has been explored in other studies. [This] helps older adults attract attention to potential risks, which can increase concentration on the task and maintain correct movements required to maintain safety,” the researchers said. This might be the reason why more participants with no incident fall had fear of falling at baseline, they noted.

“The theory of fear of falling is complex and warrants further quantitative and qualitative evaluation to better characterize the consequences and interventions to reduce the risk of future falls,” they said.

Vitamin D deficiency a BPPV risk factor?

BPPV recurrence rates range between 13 and 68 percent despite high treatment success rates with CRP. [J Clin Med 2021;10:4372] Vitamin D deficiency has been suggested as a potential risk factor for BPPV occurrence. [J Neurol 2021;268:4117-4127; Med Hypotheses 2013;80:201-204]

“The significant reduction in clinical BPPV recurrence rate in group A suggests a potential protective effect of vitamin D supplementation against BPPV recurrences in our earlier study,” the investigators noted. “However, interestingly, this does not translate to fewer falls on post hoc analysis, highlighting that there may be further factors contributing to falls in this cohort that is relatively robust with few falls at baseline.”

The study also underpins certain concerns that should be explored in future studies, such as factors affecting vitamin D absorption from diet and the potential positive effect of fear of falling in preventing falls in robust individuals, they added.