Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min

We previously observed that a creatinine clearance (CrCl) of < 65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women ( n= 191) and men ( n= 187), aged 70 years and older, 191 received randomly 1 mu g capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of < 65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08 - 0.80, P= 0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09 - 0.88, P= 0.028). No such association was observed in participants with a CrCl of greater than or equal to 65 ml/min ( for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34 - 2.52, P= 0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34 - 2.54, P= 0.885). In the placebo group frequency of falls was dependent on CrCl ( P= 0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl ( P= 0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of < 65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.