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Deep Dive: Reducing common vertigo with vitamin D and calcium

This large, long trial found a pretty strong effect of supplementation on benign paroxysmal positional vertigo recurrence. But there are some problems beneath the surface of these promising findings.

Study under review: Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial

Introduction

Benign paroxysmal positional vertigo[1] (BPPV), the most common type of vertigo, is a condition characterized by brief spinning sensations typically lasting less than one minute. BPPF may also result in nausea and vomiting. The vertigo is usually brought on by changes in head position, such as when a person tilts their head backward, bends forward, or gets into or out of bed. The causes of[2] BPPV episodes are not known. However, they can occur after head trauma, being in a recumbent position for a long time (e.g., in a hair salon or a dentist office), or from inner ear disorders. Several studies have shown an increase in incidence of BPPV in elderly people. Episodes of BPPV can be successfully treated with canalith repositioning maneuvers[3], whose effects are shown in Figure 1. These maneuvers are a series of head movements that reposition small calcium carbonate particles in the inner ear that help detect movement. However, recurrences are frequent, with studies citing[4] 1–10 year[5] recurrence[6] rates of 15–56%.

Figure 1: Basic ear anatomy and repositioning of the canalith particles (otoconia)

The vestibular labyrinth is an organ in the ear. This organ includes three loop-shaped structures called semicircular canals. The semicircular canals contain fluid and thin hair-like sensors that monitor the rotation of the head. The ears also contain otolith organs that monitor the position of the head relative to gravity. The otolith organs contain calcium carbonate crystals (called otoconia) that make us sensitive to gravity. BPPV occurs when otoconia shift from the utricle into the semicircular canals and become trapped there. This makes the semicircular canal sensitive to changes in head position that it normally would not respond to, resulting in dizzy spells. In the utricle, the otoconia may become loosened and shift due to an injury, age, or infection.

Studies have shown that people with BPPV have a higher prevalence of vitamin D[7] deficiency or insufficiency and lower bone mineral density[8] than controls. This may be related to the role of vitamin D in bone turnover[9] via the regulation of calcium absorption and resulting in impaired calcium metabolism[10]. A small retrospective pilot study[11] and a small study aiming[12] to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV reported vitamin D supplementation has a preventative effect for BPPV recurrences. However, there has not been a randomized controlled trial conducted to confirm this effect to date. The goal of this study was to assess whether the supplementation of vitamin D and calcium prevents recurrences of BPPV in participants with vitamin D deficiency or insufficiency.

Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo, is a condition characterized by spinning sensations often initiated by a change in head position. Although episodes can be successfully treated with canalith repositioning maneuvers, there is a high recurrence rate. There is evidence[13] that a vitamin D deficiency and decreased calcium levels may be risk factors for BPPV. This randomized controlled trial was designed to assess the efficacy of vitamin D and calcium supplementation for preventing the recurrence of BPPV.

What was studied?

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