Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial.

Seong-Hae Jeong, Ji-Soo Kim, Hyo-Jung Kim, Jeong-Yoon Choi, Ja-Won Koo, Kwang-Dong Choi, Ji-Yun Park, Seung-Han Lee, Seo-Young Choi, Sun-Young Oh, Tae-Ho Yang, Jae Han Park, Ileok Jung, Soyeon Ahn, Sooyeon Kim

Journal: Neurology 2020;95(9):e1117-e1125

PMID: 32759193

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Abstract

OBJECTIVE

To assess the effect of vitamin D and calcium supplementation in preventing recurrences of benign paroxysmal positional vertigo (BPPV).

METHODS

We performed an investigator-initiated, blinded-outcome assessor, parallel, multicenter, randomized controlled trial in 8 hospitals between December 2013 and May 2017. Patients with confirmed BPPV were randomly assigned to the intervention (n = 518) or the observation (n = 532) group after successful treatment with canalith repositioning maneuvers. The primary outcome was the annual recurrence rate (ARR). Patients in the intervention group had taken vitamin D 400 IU and 500 mg of calcium carbonate twice a day for 1 year when serum vitamin D level was lower than 20 ng/mL. Patients in the observation group were assigned to follow-ups without further vitamin D evaluation or supplementation.

RESULTS

The intervention group showed a reduction in the ARR (0.83 [95% confidence interval (CI), 0.74-0.92] vs 1.10 [95% CI, 1.00-1.19] recurrences per 1 person-year) with an incidence rate ratio of 0.76 (95% CI, 0.66-0.87, < 0.001) and an absolute rate ratio of -0.27 (-0.40 to -0.14) from intention-to-treat analysis. The number needed to treat was 3.70 (95% CI, 2.50-7.14). The proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs 46.7%, = 0.005).

CONCLUSIONS

Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV.

Address: From the Department of Neurology (S.-H.J.), Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon; Departments of Neurology (J.-S.K.) and Otolaryngology (J.-W.K.), Seoul National University College of Medicine; Dizziness Center (J.-S.K., J.-Y.C., J.-W.K.), Research Administration Team (H.-J.K.), and Medical Research Collaborating Center (S.A., S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (K.-D.C., S.-Y.C.), Pusan National University Hospital, Pusan National University School of Medicine; Department of Neurology (J.-Y.P.), Ulsan University College of Medicine, Ulsan University Hospital; Department of Neurology (S.-H.L.), Chonnam National University Medical School, Gwangju; Department of Neurology (S.-Y.O., T.-H.Y.), Chonbuk National University School of Medicine, Jeonju; Department of Neurology (J.H.P.), School of Medicine, Catholic University of Daegu, Korea; and Department of Neurology (I.J.), Korea University Ansan Hospital.; From the Department of Neurology (S.-H.J.), Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon; Departments of Neurology (J.-S.K.) and Otolaryngology (J.-W.K.), Seoul National University College of Medicine; Dizziness Center (J.-S.K., J.-Y.C., J.-W.K.), Research Administration Team (H.-J.K.), and Medical Research Collaborating Center (S.A., S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (K.-D.C., S.-Y.C.), Pusan National University Hospital, Pusan National University School of Medicine; Department of Neurology (J.-Y.P.), Ulsan University College of Medicine, Ulsan University Hospital; Department of Neurology (S.-H.L.), Chonnam National University Medical School, Gwangju; Department of Neurology (S.-Y.O., T.-H.Y.), Chonbuk National University School of Medicine, Jeonju; Department of Neurology (J.H.P.), School of Medicine, Catholic University of Daegu, Korea; and Department of Neurology (I.J.), Korea University Ansan Hospital. [email protected].

DOI: 10.1212/WNL.0000000000010343

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MeSH Terms: Accidental Falls, Aged, Benign Paroxysmal Positional Vertigo, Calcium, Calcium Carbonate, Dietary Supplements, Female, Fractures, Bone, Humans, Male, Middle Aged, Otolithic Membrane, Parathyroid Hormone, Patient Positioning, Phosphorus, Recurrence, Secondary Prevention, Vitamin D, Vitamin D Deficiency, Vitamins