Study To Understand Fall Reduction and Vitamin D in You (STURDY)

Tracking Information
First Submitted Date ICMJE	June 16, 2014
First Posted Date ICMJE	June 18, 2014
Last Update Posted Date	August 6, 2018
Actual Study Start Date ICMJE	June 30, 2015
Estimated Primary Completion Date	March 31, 2020 (Final data collection date for primary outcome measure)
Current Primary Outcome Measures ICMJE; (submitted: January 19, 2018)	Time to first fall (or death)-recorded in months [ Time Frame: 24 months ]
Original Primary Outcome Measures ICMJE; (submitted: June 16, 2014)	Time to first fall [ Time Frame: A daily fall diary will be collected monthly for 36 months after randomization. ]
Change History	Complete list of historical versions of study NCT02166333 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures ICMJE; (submitted: January 19, 2018)	Change in gait speed [ Time Frame: 2 years ]
Original Secondary Outcome Measures ICMJE	Not Provided
Current Other Outcome Measures ICMJE	Not Provided
Original Other Outcome Measures ICMJE	Not Provided
Descriptive Information
Brief Title ICMJE	Study To Understand Fall Reduction and Vitamin D in You
Official Title ICMJE	Vitamin D Supplements to Prevent Falls in Older Adults: A Dose-Response Trial
Brief Summary	Vitamin D supplements might substantially reduce the risk of falls, potentially by more than 25%. The proposed study is a clinical trial that will determine the effects of 4 doses of vitamin D (200 International Units [IU]/day, 1000 IU/day, 2000 IU/d and 4000 IU/d) as a means to prevent falls in high-risk adults, ages 70 and older. Results of this trial will be directly relevant to public health and clinical guidelines, and will immediately influence policy.
Detailed Description	The public health burden of falls in older persons is substantial. Several lines of evidence suggest that vitamin D supplements might reduce the risk of falls, potentially by 25% or more in persons with low serum 25-hydroxyvitamin D [25(OH)D] levels. However, existing evidence is inconsistent and insufficient to guide policy. The trial is a seamless two-stage, Bayesian response-adaptive, randomized dose-finding trial designed to select the best dose of vitamin D supplementation and to potentially confirm the efficacy of that dose for fall prevention and other related outcomes. Participants will be community-dwelling adults, aged 70+ (goal of ~40% black, ~60% women), with a baseline serum 25(OH)D level of 10-29 ng/ml, who are at high risk for falling. In Stage 1 of the adaptive design, participants will be randomly assigned to one of four vitamin D3 (cholecalciferol) doses: 200 IU/d, 1000 IU/d, 2000 IU/d, or 4000 IU/d, with assignment probabilities that will vary as falls are reported. Participants will take their assigned pills for two years, or until the study ends, whichever comes first. This stage of the design will select the best dose of vitamin D for prevention of falls, or confirm the futility of distinguishing any differences among the doses for fall prevention. If a best dose is selected, subsequent participants will be randomized in Stage 2 of the trial into the comparison (200 IU/d) or best dose group, and all participants (Stage 1 and Stage 2) will continue to be followed to potentially confirm efficacy. The investigators anticipate enrolling approximately 1,200 participants over the entire length of the project. The primary outcome is time to first fall (or death) over two years of therapy. Next in importance is the outcome of gait speed. Other outcomes include fall rates, types of falls, balance, muscle strength, frailty, Short Physical Performance Battery (SPPB) score, 6-minute walk time, and physical activity assessed by accelerometry. Falls will be ascertained from fall calendars completed daily by participants and from self-report by phone. In-person follow-up visits will occur at 3, 12, and 24 months, with telephone visits occurring at 1, 6, 9, 15, 18, and 21 months after randomization. Subgroups with potential for greater benefit from vitamin D supplementation are blacks, those with baseline 25(OH)D of 10-19 ng/ml, and those with objective evidence of low physical function.
Study Type ICMJE	Interventional
Study Phase	Not Applicable
Study Design ICMJE	Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Triple (Participant, Care Provider, Investigator); Primary Purpose: Prevention
Condition ICMJE	Vitamin D Deficiency; Falls
Intervention ICMJE	Dietary Supplement: 200 IU/d cholecalciferol Other Name: vitamin D3; Dietary Supplement: 1000 IU/d cholecalciferol Other Name: vitamin D3; Dietary Supplement: 2000 IU/d cholecalciferol Other Name: vitamin D3; Dietary Supplement: 4000 IU/d cholecalciferol Other Name: vitamin D3
Study Arms	Active Comparator: 200 IU/d 200 IU/d cholecalciferol (vitamin D3) tablets that can be swallowed or consumed sublingually Intervention: Dietary Supplement: 200 IU/d cholecalciferol; Active Comparator: 1000 IU/d 1000 IU/d cholecalciferol (vitamin D3) tablets that can be swallowed or consumed sublingually Intervention: Dietary Supplement: 1000 IU/d cholecalciferol; Active Comparator: 2000 IU/d 2000 IU/d cholecalciferol (vitamin D3) tablets that can be swallowed or consumed sublingually Intervention: Dietary Supplement: 2000 IU/d cholecalciferol; Active Comparator: 4000 IU/d 4000 IU/d cholecalciferol (vitamin D3) tablets that can be swallowed or consumed sublingually Intervention: Dietary Supplement: 4000 IU/d cholecalciferol
Publications *	Michos ED, Mitchell CM, Miller ER 3rd, Sternberg AL, Juraschek SP, Schrack JA, Szanton SL, Walston JD, Kalyani RR, Plante TB, Christenson RH, Shade D, Tonascia J, Roth DL, Appel LJ; STURDY Collaborative Research Group, Appel LJ, Cronin N, Juraschek SP, McClure S, Mitchell CM, Plante TB, Kalyani RR, Roth DL, Schrack JA, Szanton SL, Urbanek J, Walston J, Baksh S, Blackford AL, Chattopadhyay S, Dodge J, Ewing C, Jackson R, Lears A, Meinert C, Shade D, Smith M, Sternberg AL, Tonascia J, Van Natta ML, Wagoner A, Michos ED, Bowers P, Coresh J, Crunkleton T, Dick B, Evans R, Godwin M, Hammann L, Hawks D, Horning K, Minotti M, Myers M, Raley L, Reid C, Spikes A, Stouffer R, Weicht K, Miller ER 3rd, Carey B, Charleston J, DeRoche-Brown N, Gayles D, Glenn-Smith I, Johnson D, Johnson M, Keyes E, McArthur K, Santiago D, Sapun C, Sneed V, Thomas L, Christenson RH, Duh SH, Rebuck H, Rosen C, Cook T, Duncan P, Hansen K, Kenny A, Shapses S, Hannah J, Romashkan S, Davis CD, Guralnik JM, Gallagher JC. Rationale and design of the Study to Understand Fall Reduction and vitamin D in You (STURDY): A randomized clinical trial of vitamin D supplement doses for the prevention of falls in older adults. Contemp Clin Trials. 2018 Aug 20. pii: S1551-7144(18)30316-1. doi: 10.1016/j.cct.2018.08.004. [Epub ahead of print]
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status ICMJE	Recruiting
Estimated Enrollment ICMJE; (submitted: June 16, 2014)	1200
Original Estimated Enrollment ICMJE	Same as current
Estimated Study Completion Date	March 31, 2020
Estimated Primary Completion Date	March 31, 2020 (Final data collection date for primary outcome measure)
Eligibility Criteria ICMJE	Inclusion Criteria: Age 70 and older; Non-institutionalized; High risk for falling, defined by a 'yes' response to at least one of the following:; 1. Have you fallen and hurt yourself in the past year?; 2. Have you fallen 2 or more times in the past year?; 3. Are you afraid that you might fall because of balance or walking problems?; 4. Do you have difficulty maintaining your balance when bathing, dressing, or getting in and out of a chair?; 5. Do you use a cane, walker, or other device when walking inside or outside your home?; Serum vitamin D [25(OH)D] level of 10-29 ng/ml; Able to provide informed consent; Willing to accept randomization to each vitamin D dose; One of the following:; 1. No vitamin D supplementation at baseline; 2. Average daily vitamin D supplementation judged by study staff as being consistent with the goal of 1000 IU/day or less at screening and willing to continue the dose unchanged throughout the trial; One of the following:; 1. No calcium supplementation at baseline; 2. Average daily calcium supplementation judged by study staff as being consistent with the goal of 1200 mg/day or less at screening and willing to continue the dose unchanged throughout the trial Exclusion Criteria: Cognitive impairment, defined by Mini-Mental State Exam (MMSE) score <24; Hypercalcemia, serum Ca++ 11.0 mg/dl or higher or >10.5 mg/dl (confirmed); Hypocalcemia, serum Ca++ <8.5 mg/dl; Kidney, ureteral, or bladder stones made of calcium compounds (2 or more in lifetime, or 1 in the last 2 years); in the absence of information on the type of stone, stones will be assumed to be made of calcium compounds; Planning to move out of area within 2 years, where plans would prevent compliance with the study protocol; Disease or condition expected to cause death or to prevent compliance with the study protocol in the next 2 years; Participation in another trial of vitamin D or falls, or any trial that might affect the risk of falls; Lactose allergy (lactose intolerance is okay); Use of any form of oral or injected calcitriol (brand names: Rocaltrol (R), Calcijex (R), and Zemplar (R); generic names: calcitriol, paricalcitol, doxycalcitriol, 22-oxacalcitriol)
Sex/Gender	Sexes Eligible for Study: All
Ages	70 Years and older (Older Adult)
Accepts Healthy Volunteers	Yes
Contacts ICMJE	Contact: Lawrence J Appel, MD, MPH 410-955-4156 lappel@jhmi.edu Contact: Christine Mitchell, ScM ccarson4@jhmi.edu
Listed Location Countries ICMJE	United States
Removed Location Countries
Administrative Information
NCT Number ICMJE	NCT02166333
Other Study ID Numbers ICMJE	IRB00063914; U01AG047837 ( U.S. NIH Grant/Contract )
Has Data Monitoring Committee	Yes
U.S. FDA-regulated Product	Not Provided
IPD Sharing Statement	Not Provided
Responsible Party	Johns Hopkins University
Study Sponsor ICMJE	Johns Hopkins University
Collaborators ICMJE	National Institute on Aging (NIA)
Investigators ICMJE	Not Provided
PRS Account	Johns Hopkins University
Verification Date	August 2018
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP