Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo

Assessment of vitamin D deficiency in recurrent BPPV patients: A cross-sectional study

PURPOSE

This study aimed to investigate the vitamin D deficiency of patients with BPPV recurrence and to evaluate the differences of 25-hydroxy vitamin D (25(OH)D) and serum calcium levels among gender and age categories.

METHODS

This cross-sectional study enrolled patients with BPPV. The diagnosis of BPPV was based on positional nystagmus and vertigo induced by certain head positions (The Dix-Hallpike maneuver and head roll tests). All patients' age, serum 25(OH)D, calcium measurements and recurrence data were collected and analyzed.

RESULTS

The median of 25(OH)D was 15.32 (IQR 10.61, 20.90) ng/ml. The recurrent group showed lower 25(OH)D levels than that of non-recurrent group [13.28 (IQR 9.47, 17.57) ng/ml vs 16.21 (IQR 11.49, 21.13) ng/ml]. There were significant differences of 25(OH)D levels among age categories. The proportion of vitamin D deficiency in patients ≥60 years old was lower than that in the other two groups.

CONCLUSION

Our study suggested that BPPV patients had a decreased 25(OH)D level and a high incidence of vitamin D deficiency. The 25(OH)D level of recurrent BPPV patients was lower than that in non-recurrent ones. Among them, the elderly group (≥60 years) took the preponderance, which had the lowest incidence of vitamin D deficiency and the highest incidence of vitamin D sufficiency.

Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis

OBJECTIVES

The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation.

DATA EXTRACTION AND SYNTHESIS

Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV.

RESULTS

The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain.

CONCLUSION

Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further.

PROSPERO REGISTRATION NUMBER

CRD42021271840.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.

Vitamin D Deficiency and the Risk of Recurrent Benign Paroxysmal Positional Vertigo

Background Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. It is a short-lived (seconds) rotatory attack of vertigo in relation to the position of the head. Vitamin D deficiency may be one of the causes leading to BPPV. As there is no relevant local study from Iraq, this study aimed to evaluate the association between BPPV and vitamin D deficiency. Methodology This retrospective, case-control study was conducted at the otolaryngology clinic of Al-Ramadi Teaching Hospital during a 26-month duration. The study included 40 patients clinically diagnosed with BPPV and 80 individuals as controls. Detailed information regarding the demographic and clinical characteristics was obtained from each participant. Serum vitamin D and calcium levels were measured for each participant. Results Both cases and controls were matched regarding age and gender. Serum vitamin D level in cases (15.458 ± 6.14 ng/mL) was lower than controls (23.604 ± 12.58 ng/mL), with a p-value of 0.0001 and large clinical effect size (0.8). Vitamin D deficiency was found in 35 cases and 37 controls, with a highly significant difference (p = 0.0001) and an odds ratio of 8.135. Vitamin D deficiency in BPPV patients with recurrence (12.615 ± 4.096 ng/mL) was lower than those without recurrence (18.3 ± 6.611 ng/mL), with a highly significant difference (p = 0.002) and small clinical effect size (0.3). Older age and vitamin D deficiency were risk factors for recurrence according to the multinominal logistic regression test (p < 0.05). Conclusions Vitamin D deficiency might cause the occurrence and recurrence of BPPV. Older age might be a risk factor for BPPV recurrence.

Role of Serum Markers in Benign Paroxysmal Positional Vertigo: Are They Useful?

Benign Paroxysmal Positional Vertigo is a peripheral labyrinthine disease and is one of the most common causes of dizziness in the general population. The proposed study was conducted in the Department of Otorhinolaryngology - Head and Neck Surgery at Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh for a period of one year. About 44 patients aged between 14 and 60 years who came out positive on Dix Hallpike test and were willing for study were included in case group, whereas 44 patients aged 14-60 years who came out negative on Dix Hallpike test and with no complaint of vertiginous feeling were included in control group. Cases and controls were subjected to blood investigations like complete hemogram, calcium, vitamin D and uric acid. The mean Vitamin D was found to be significantly less in Case group (27.90 ± 15.89) compared to the Control group (39.05 ± 21.15) while no significant difference in mean Serum Calcium was observed between the Case group (8.48 ± 1.28) and Control group (8.88 ± 1.25). Serum uric acid levels were also compared and no significant difference was found between Case group (4.12 ± 1.15) and the Control group (4.06 ± 0.95). Our study found that there is relation between low vitamin D levels and occurrence of BPPV. Which supports the hypothesis that supplementation of Vitamin D might be helpful in preventing the occurrence and more frequent recurrence of BPPV. However in our study no association was found between serum calcium and uric acid levels with BPPV.