BPPV (benign paroxysmal positional vertigo) decreased by Vitamin D - RCT Aug 2021
Relation between vitamin D deficiency and benign paroxysmal positional vertigo
Scientific Reports volume 11, Article number: 16855 (2021)
Aida Ahmed Abdelmaksoud, Dalia Fahim Mohammed Fahim, Shamardan Ezzeldin Sayed Bazeed, Mohamed Farouk Alemam & Zaki Farouk Aref
Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. To assess the relation between recurrent attacks BPPV and Vitamin D deficiency. A case control study in which 40 patients were clinically diagnosed as posterior canal BPPV, Serum 25(OH) D was measured at 1st visit. Patients were divided into two groups; group A (20 patients) received Vitamin D supplementation in addition to canal repositioning maneuver and group B (20 patients) treated by canal repositioning maneuver only. Follow up of all patients for 6 months, neuro-otological assessment was repeated and recurrent attacks were recorded. Serum vitamin D was repeated after 6 month. This study included 14 males and 26 females age ranged from 35 to 61 years, Average serum of 25 (OH) D at the first visit was (12.4 ± 2 ng/ml) for group A, and (12.2 ± 1.7 ng/ml) for group B, all patients had low serum level of 25(OH) D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. There is a relation between BPPV recurrence and low serum Vitamin D.
AI summary of study
This study investigates the relationship between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV), focusing particularly on the impact of vitamin D supplementation on the recurrence of BPPV episodes. BPPV is the most common cause of positional vertigo and is characterized by recurrent vertigo attacks induced by head movements. The pathogenesis involves dislodged calcium carbonate crystals (otoconia) in the semicircular canals, primarily the posterior canal. Vitamin D plays a critical role in calcium metabolism, which may influence the formation and stability of otoconia, thus potentially affecting BPPV development and recurrence.
Background and Core Concepts
Benign Paroxysmal Positional Vertigo (BPPV):
The most common vestibular disorder causing vertigo triggered by changes in head position.
Incidence is approximately 10% in the general population and increases with age, especially around 60 years.
Pathophysiology involves displacement of otoconia from the utricle into semicircular canals, disrupting vestibular function.
Vitamin D and Calcium Metabolism:
Vitamin D is essential for calcium absorption in the intestines and kidneys and influences calcium deposition in bones and otoconia.
Otoconia consist of an organic core (glycoproteins) and an inorganic peripheral zone primarily composed of calcium carbonate (CaCO3).
Vitamin D deficiency results in disturbed calcium metabolism, which may reduce otoconia density and increase fragility, contributing to BPPV.
Similarities exist between bone and otoconia biomineralization processes, linking osteoporosis and vitamin D deficiency to BPPV risk.
Vitamin D Deficiency:
Worldwide, around one billion people suffer from vitamin D deficiency or insufficiency.
Factors influencing vitamin D status include geographic location, sun exposure, clothing, skin pigmentation, age, obesity, and chronic diseases.
Treatment of BPPV:
Canal repositioning maneuvers (CRM), such as the Epley maneuver, are effective in relocating displaced otoconia.
However, BPPV often recurs despite successful maneuvers.
Vitamin D receptors are present in the calcium channel transport systems of the inner ear, suggesting vitamin D’s role in vestibular health.
Study Design and Methodology
Objective:To assess vitamin D serum levels in BPPV patients, evaluate the relation between vitamin D deficiency and recurrent BPPV attacks, and assess the effect of vitamin D supplementation on recurrence rate.
Study Type:Case-control study conducted from January 2019 to June 2020 at Qena University Hospital and private clinics, Egypt.
Participants:
40 patients clinically diagnosed with posterior canal BPPV (26 females, 14 males), average age ~48 years.
Inclusion: recurrent BPPV with at least two prior attacks over the previous two years, confirmed by history and Dix-Hallpike test.
Exclusion: secondary BPPV causes (head trauma, surgery, infections), chronic systemic diseases, recent vitamin D or calcium supplementation, or medication altering vitamin D metabolism.
Key Procedures:
Serum 25-hydroxy vitamin D [25(OH)D] measured at baseline and after 6 months.
Patients randomized into two groups:
Group A (n=20): received vitamin D supplementation plus CRM.
Group B (n=20): received CRM only.
Vitamin D supplementation protocol: 8000 IU cholecalciferol daily for 2 weeks, then 4000 IU daily for 2 weeks, followed by 8000 IU weekly for 3 months.
Follow-up at 1, 2, 3, and 6 months with assessment of vertigo recurrence and serum vitamin D.
Vitamin D Status Classification:
Deficiency: <10 ng/ml
Insufficiency: 11–20 ng/ml
Optimal: >20 ng/ml
Outcome Measures:
Recurrence of BPPV episodes, defined as vertigo and positional nystagmus occurring one month or more after complete recovery.
Serum vitamin D levels before and after treatment.
Quantitative Data and Statistical Findings
VariableGroup A (Vitamin D + CRM, n=20)Group B (CRM only, n=20)P-valueAge (mean ± SD)49.9 ± 7.450.2 ± 9.60.9Sex (Male/Female)6 (30%) / 14 (70%)8 (40%) / 12 (60%)0.6Baseline Vitamin D (ng/ml)12.4 ± 212.2 ± 1.70.8Vitamin D after 6 months (ng/ml)26.3 ± 4.112.2 ± 1.7<0.001*Recurrence rate (mean episodes)0.2 ± 0.41.5 ± 0.7<0.001*
*Highly significant.
Recurrence Episodes (6 months)Group A (n=20)Group B (n=20)P-value0 episodes16 (80%)0 (0%)0.003*1 episode4 (20%)12 (60%)2 episodes0 (0%)6 (30%)3 episodes0 (0%)2 (10%)
*Highly significant.
Correlation between vitamin D levels and recurrence rate:
- Strong negative correlation (R = −0.806, p < 0.001), indicating that lower vitamin D levels are associated with higher recurrence of BPPV.
Key Insights and Conclusions
Vitamin D deficiency is prevalent among BPPV patients:All study participants had vitamin D levels below 20 ng/ml, indicating deficiency or insufficiency.
Vitamin D supplementation significantly increases serum vitamin D levels in BPPV patients:Group A showed a rise from ~12 ng/ml to ~26 ng/ml after supplementation.
Vitamin D supplementation is associated with a marked reduction in BPPV recurrence:Patients receiving vitamin D supplements along with CRM had significantly fewer recurrent episodes compared to those receiving CRM alone.
Strong inverse relationship between vitamin D levels and BPPV recurrence:Lower vitamin D serum levels correlate with increased frequency of BPPV attacks.
Vitamin D may play a protective role in otoconia stability:By regulating calcium metabolism and deposition in otoconia, vitamin D deficiency could contribute to the fragility and dislodgement of these crystals, leading to BPPV.
Findings align with existing literature:
Prior studies have linked vitamin D deficiency and osteoporosis with higher BPPV incidence and recurrence.
Vitamin D supplementation has been shown to reduce BPPV recurrence rates in several populations.
Seasonal and geographical variations in BPPV incidence have been linked to variations in vitamin D status.
Vitamin D receptors in the inner ear support the biological plausibility of vitamin D’s role in vestibular function and BPPV pathogenesis.
Limitations
Sample size:The study included only 40 patients, which may limit the generalizability of the findings.
Confounding factors:Vestibular migraine and other causes of positional vertigo could confound diagnosis and recurrence evaluation.
Vitamin D baseline heterogeneity:While all patients had low vitamin D, the degree of deficiency and its interactions with other risk factors were not fully explored.
Recommendations
Conduct larger-scale studies to confirm the relationship between vitamin D deficiency and BPPV recurrence and to evaluate the therapeutic benefits of supplementation.
Consider routine assessment of vitamin D levels in patients presenting with BPPV, particularly those with recurrent episodes.
Explore vitamin D supplementation as an adjunct therapy to canal repositioning maneuvers to reduce BPPV recurrence rates.
Investigate other potential confounders such as vestibular migraine and their interaction with vitamin D status in positional vertigo.
34 references to the study in Google Scholar as of Dec 2025
- Association between vitamin D, vitamin D supplementation and benign paroxysmal positional vertigo: a systematic review and meta-analysis- April 2025
- A Prospective Analysis on Association Between Vitamin D3 Levels and Benign Paroxysmal Positional Vertigo and its Correlation with Vestibular Evoked Myogenic Potentials - September 2025 PDF behind paywall