Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis
Mohammed A. AlGarni, Ahmad A. Mirza, Awwadh A. Althobaiti, Hanan H. Al-Nemari & Lamees S. Bakhsh
https://link.springer.com/article/10.1007%2Fs00405-018-5146-6
On my Internal Medicine rotation, I was part of the stroke team evaluating an older woman for stroke. She had complained about waking up that morning, experiencing significant dizziness that was constant, felt as if the room was spinning, and lessened when she laid down, but exacerbated when attempting to sit up. She also had associated chest pressure, nausea, and diaphoresis. The emergency physician called for the evaluation based on the patient’s complaints, as well as her history of HTN, HLD, and stroke x 2. After interviewing the patient and applying the NIH Stroke Scale, stroke was ruled out but Benign Paroxysmal Positional Vertigo (BPPV) was high on the differential list. I was interested to find a journal article on BPPV.
The otolith particles that cause BPPV are typically made out of calcium carbonate crystals. Since vitamin D is involved with the absorption of calcium, the article I found wanted to see how vitamin D levels are associated with the occurrence and recurrence of BPPV. In other words: does vitamin D deficiency risk a patient for BPPV? The article was titled “Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis”. Relevant articles were searched for in multiple databases, where 7 were found for the systematic review and 4 for the meta-analysis. The researchers wanted to compare the vitamin D levels in patients with BPPV, versus those of healthy patient controls; as well as vitamin D levels in patients with a single episode of BPPV, versus those with recurrent BPPV. The article found no significant difference of vitamin D levels of BPPV patients versus healthy patients. However, there was a significant decrease of vitamin D levels seen in those patients with recurrent BPPV, versus those with only the single episode of BPPV.
There were possible design flaws noted in some of the included studies, however. The presence of subjects having osteoporosis was not considered. This could cause inaccuracies in the conclusions, since patients with this disease may have elevated calcium in the blood, or vitamin D deficiency. There was also another study where all subjects were sick with URIs, including the control group. This was a poor control, as those unhealthy with URI may be associated with low vitamin D levels.
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