D-Vitamin and BPPV

By:Karl Nordfalk

BPPV is caused by calcium-carbonate crystals that dislodges from the utricle and move into the semi-circular canals. The crystals contain calcium and D-Vitamin is important for regulating calcium. Because of this several studies have examined the relation between D-Vitamin levels and BPPV.

Vitamin levels are measured in 25(OH)D
(=sum of 25(OH)D2 + 25(OH)D3) and can be reported in ng/ml or nmol/l. All values are converted to nmol/l in this report since this is the current standard in the Nordic countries. For conversion: ng/ml x 2.5 = nmol/l.

Jeong et al. reported that patients with BPPV have significantly lower D-Vitamin levels (36 nmol/l) than a general population (47.5 nmol/l). Since this is cross-sectional study it is not possible to say if low D-Vitamin is the cause or effect of BPPV in the study group.

Talaat et al. examined individuals who both had BPPV and low D-Vitamin levels (<25 nmol/l). They gave D-Vitamin supplement and found that individuals who responded well to treatment and increased their 25(OH)D level by more than 25 nmol/l had fewer BPPV attacks.

Should we administer supplementary D-Vitamin to BPPV patients?
– The evidence level that D-Vitamin helps reduce BPPV attacks is quite low (IIb/3) but small studies indicate that increasing D-Vitamin might decrease the risk for recurrent BPPV. If a patient suffers from recurrent BPPV it is possible, but not proved, that increasing the D-Vitamin levels might help reduce attacks.

What serum level 25(OH)D should we aim for in BPPV patients?
– The optimal D-Vitamin level is, as of June 2017, still controversial. A 2017 review concluded that the most advantageous serum levels for 25(OH)D for all outcomes appeared to be close to 75 nmol/l. This level is also recommended by D-Vitamin producers. A Nordic consensus group from 2017 recommended 50 nmol/l as goal level.

Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim
Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo.
J Neurol. 2013 Mar;260(3):832-8. Pubmed link

Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS.
Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency.
Auris Nasus Larynx. 2016 Jun;43(3):237-41. Pubmed link

Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Advances in Experimental Medicine and Biology (Review). 2014. 810: 500–25.
Pubmed link

Brustad M, Meyer HE.
Vitamin D–how much is enough, and is more better for your Health?

Tidsskr Nor Laegeforen. 2014 Apr 8;134(7):726-8. doi:10.4045/tidsskr.13.1513.
Tidsskriftet link