Effects of active vitamin D analogues on muscle strength and falls in elderly people: an updated meta-analysis

Updated meta-analysis of randomized trials in elderly adults, predominantly women, across various settings. The review assessed falls and muscle strength outcomes with active vitamin D analogues and examined whether calcium co-supplementation altered effects.

Active vitamin D analogues were evaluated as once-daily regimens in the included randomized trials. Reported doses were 0.25 to 0.5 mg/day for calcitriol, 0.5 to 1 mg/day for alfacalcidol, and 0.75 mg/day for eldecalcitol; study durations ranged from 3 months to 24 months when reported. Some trials also examined calcium co-supplementation.

Active vitamin D analogues may reduce falls in elderly adults and appear to improve quadriceps strength, with the clearest signal for alfacalcidol and eldecalcitol. They did not produce consistent benefit for global muscle strength, hand grip strength, or back extensor strength, and calcium supplementation did not appear to enhance effects. No clear differences were seen among calcitriol, alfacalcidol, and eldecalcitol. Overall, the evidence suggests a possible benefit, but confirmation is needed in larger, better-designed trials and safety remains uncertain.

The evidence base was limited and depended on randomized trials with relatively small active arms, ranging from N=8 to N=193, and several outcomes were inconsistently reported. Trial durations were often short or variably reported, and safety data were not clearly established. Heterogeneity across compounds, doses, and study settings limits certainty and generalizability.