Vitamin deficiency vertigo. Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Comprehensive Analysis

27.07.202308.07.2023 by alexxlab

How does vitamin D supplementation affect benign paroxysmal positional vertigo. What are the implications of vitamin D deficiency on BPPV intensity and recurrence. Can vitamin D improve balance and muscle strength in BPPV patients. How does seasonal variation impact vitamin D levels and BPPV symptoms.

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Understanding Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of vertigo triggered by changes in head position. This condition can significantly impact an individual’s quality of life and daily activities. But what exactly causes BPPV, and how prevalent is it?

BPPV occurs when calcium carbonate crystals (otoconia) become dislodged from the utricle and migrate into the semicircular canals of the inner ear. These misplaced crystals disrupt the normal fluid movement in the canals, leading to false sensations of movement and vertigo. The condition is more common in older adults, with studies showing an increased incidence in individuals over 60 years of age.

Prevalence and Impact of BPPV

Research indicates that BPPV affects a significant portion of the population, particularly among older adults. A study by Silva et al. (2015) reviewed 101 cases of BPPV, highlighting its prevalence and impact on patients’ lives. The condition not only causes discomfort but can also lead to balance issues and an increased risk of falls, especially in the elderly population.

Is BPPV a chronic condition? While BPPV can resolve spontaneously in some cases, many patients experience recurrent episodes. Lopez-Escamez et al. (2005) conducted a long-term study on BPPV patients, revealing that the condition can have a lasting impact on health-related quality of life. This underscores the importance of effective management strategies for BPPV.

The Role of Vitamin D in Vestibular Health

Vitamin D has long been recognized for its crucial role in bone health and calcium metabolism. However, recent research has shed light on its potential influence on vestibular function and balance. How does vitamin D contribute to inner ear health and overall balance?

Vitamin D receptors are present in various tissues of the inner ear, including the otolith organs and semicircular canals. These receptors suggest that vitamin D may play a role in maintaining the integrity and function of the vestibular system. Additionally, vitamin D is known to influence calcium metabolism, which is essential for the proper formation and maintenance of otoconia in the inner ear.

Vitamin D Deficiency and BPPV

Emerging evidence suggests a potential link between vitamin D deficiency and the occurrence or severity of BPPV. A study by Jeong et al. (2013) found decreased serum vitamin D levels in patients with idiopathic BPPV compared to healthy controls. This finding raises an intriguing question: Could vitamin D deficiency be a contributing factor to the development or recurrence of BPPV?

The relationship between vitamin D and BPPV is further supported by the work of Talaat et al. (2015), who observed a reduction in the recurrence rate of BPPV in patients treated for severe vitamin D deficiency. These findings suggest that addressing vitamin D deficiency may be a valuable approach in managing BPPV and preventing its recurrence.

Vitamin D Supplementation and BPPV Intensity

Given the potential link between vitamin D deficiency and BPPV, researchers have begun to investigate the effects of vitamin D supplementation on the intensity and frequency of BPPV episodes. Can vitamin D supplementation alleviate BPPV symptoms and reduce their intensity?

Several studies have explored this question, with promising results. Talaat et al. (2015) found that treating severe vitamin D deficiency in BPPV patients led to a significant reduction in the recurrence rate of vertigo episodes. This suggests that vitamin D supplementation may play a role in managing BPPV and improving long-term outcomes for patients.

Mechanisms of Action

The potential benefits of vitamin D supplementation in BPPV patients may be attributed to several mechanisms:

Improved calcium metabolism in the inner ear
Enhanced otoconia formation and maintenance
Strengthened vestibular hair cells
Improved overall balance and muscle strength

These mechanisms collectively contribute to better vestibular function and may help reduce the frequency and intensity of BPPV episodes. However, more research is needed to fully elucidate the precise pathways through which vitamin D influences BPPV symptoms.

Vitamin D and Muscle Strength in BPPV Patients

Beyond its potential direct effects on the vestibular system, vitamin D may also influence BPPV symptoms through its impact on muscle strength and balance. How does vitamin D affect muscle function, and what implications does this have for BPPV patients?

Vitamin D plays a crucial role in muscle metabolism and function. Rejnmark (2011) reviewed evidence from randomized controlled trials and found that vitamin D supplementation can improve muscle function and performance, particularly in individuals with vitamin D deficiency. This is especially relevant for BPPV patients, as improved muscle strength can contribute to better balance and reduced risk of falls.

Impact on Balance and Fall Risk

The relationship between vitamin D, muscle strength, and balance has significant implications for BPPV patients, especially older adults. Muir and Montero-Odasso (2011) conducted a systematic review and meta-analysis on the effect of vitamin D supplementation on muscle strength, gait, and balance in older adults. Their findings suggest that vitamin D supplementation can improve muscle strength and balance, potentially reducing the risk of falls in this population.

For BPPV patients, improved muscle strength and balance can complement other treatment approaches, such as the Epley maneuver, in managing symptoms and reducing the impact of vertigo on daily activities. This holistic approach to BPPV management highlights the importance of considering vitamin D status in the overall treatment plan.

Seasonal Variations in Vitamin D and BPPV

An interesting aspect of the relationship between vitamin D and BPPV is the potential influence of seasonal variations in vitamin D levels. Do BPPV symptoms fluctuate with seasonal changes in vitamin D status?

Heidari and Haji Mirghassemi (2012) investigated seasonal variations in serum vitamin D levels according to age and sex. Their findings revealed significant fluctuations in vitamin D levels throughout the year, with lower levels typically observed during winter months when sunlight exposure is reduced.

Implications for BPPV Management

The seasonal variation in vitamin D levels may have important implications for BPPV management:

Increased vigilance during winter months
Potential need for supplementation during low-sunlight periods
Consideration of seasonal factors in BPPV treatment plans
Education of patients about the potential impact of seasonal changes on their symptoms

Understanding these seasonal patterns can help healthcare providers and patients better manage BPPV symptoms throughout the year. It may also inform decisions about vitamin D supplementation and other preventive measures to minimize the impact of seasonal variations on BPPV intensity and recurrence.

Optimizing Vitamin D Levels for BPPV Management

Given the potential benefits of vitamin D in managing BPPV, it’s important to consider optimal vitamin D levels and supplementation strategies. What are the recommended vitamin D levels for BPPV patients, and how can they be achieved?

While there is no consensus on the optimal vitamin D level specifically for BPPV management, general recommendations for vitamin D sufficiency can serve as a guide. The Endocrine Society suggests that serum 25-hydroxyvitamin D levels of 30 ng/mL (75 nmol/L) or higher are considered sufficient for overall health.

Supplementation Strategies

Achieving and maintaining optimal vitamin D levels may involve a combination of approaches:

Sunlight exposure: Safe, moderate sun exposure can help boost vitamin D production
Dietary sources: Incorporating vitamin D-rich foods such as fatty fish, egg yolks, and fortified products
Supplementation: Under medical supervision, vitamin D supplements may be recommended, especially for those with deficiency

It’s crucial to note that vitamin D supplementation should be tailored to individual needs and monitored by a healthcare professional. Factors such as age, skin tone, geographical location, and overall health status can influence vitamin D requirements and absorption.

Integrating Vitamin D Therapy with Traditional BPPV Treatments

While vitamin D supplementation shows promise in managing BPPV, it should be considered as part of a comprehensive treatment approach. How can vitamin D therapy be integrated with traditional BPPV treatments for optimal outcomes?

Traditional BPPV treatments, such as the Epley maneuver, have been well-established as effective interventions for repositioning displaced otoconia. Hilton and Pinder (2004) reviewed the efficacy of the Epley maneuver in treating BPPV, confirming its effectiveness in many cases. However, combining these physical treatments with vitamin D therapy may offer additional benefits.

A Multimodal Approach

An integrated approach to BPPV management might include:

Canalith repositioning procedures (e.g., Epley maneuver)
Vitamin D status assessment and optimization
Balance and strength training exercises
Patient education on BPPV management and prevention
Regular follow-ups to monitor progress and adjust treatment as needed

This comprehensive strategy addresses both the immediate symptoms of BPPV and potential underlying factors that may contribute to its recurrence or severity. By combining traditional treatments with vitamin D optimization, patients may experience improved outcomes and a reduced risk of BPPV recurrence.

Future Directions in BPPV and Vitamin D Research

As the relationship between vitamin D and BPPV continues to be explored, several avenues for future research emerge. What are the key questions that remain to be answered in this field?

Future studies should focus on elucidating the precise mechanisms by which vitamin D influences BPPV symptoms and recurrence. Additionally, large-scale, long-term clinical trials are needed to definitively establish the efficacy of vitamin D supplementation in BPPV management and to determine optimal dosing strategies.

Potential Areas of Investigation

Some promising areas for future research include:

The role of vitamin D in otoconia metabolism and vestibular hair cell function
Genetic factors influencing vitamin D metabolism and BPPV susceptibility
The impact of vitamin D on other vestibular disorders
Development of personalized vitamin D supplementation protocols for BPPV patients
Exploration of potential synergistic effects between vitamin D and other micronutrients in vestibular health

As research in this field progresses, it may lead to more targeted and effective strategies for managing BPPV and other vestibular disorders, ultimately improving the quality of life for patients affected by these conditions.

Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study

1. Heidari B, Heidari P, Samari E, Jalali MR. Frequency of vitamin D deficiency in common musculoskeletal conditions. J Babol Univ Med Sci. 2014;16:7–15. [in Persian] [Google Scholar]

2. Heidari B, Heidari P, Hajian-Tilaki K. High prevalence of vitamin D deficiency in women presenting to rheumatology clinic in north of Iran: An inverse relation with age. J Women’s Health Care. 2013;2:123. [Google Scholar]

3. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2:205–12. [PMC free article] [PubMed] [Google Scholar]

4. Heidari B. Muscle strength, vitamin D deficiency and knee osteoarthritis. J Babol Univ Med Sci. 2012;14:84–91. [Google Scholar]

5. Heidari B. Knee osteoarthritis diagnosis, treatment and associated factors of progression: Part II. Casp J Intern Med. 2011;2:249–55. [PMC free article] [PubMed] [Google Scholar]

6. Heidari B, Heidari P, Tilaki KH. Relationship between unexplained arthralgia and vitamin D deficiency: a case control study. Acta Med Iran. 2014;52:400–5. [PubMed] [Google Scholar]

7. Heidari B, Javadian Y, Babaei M, Yousef Ghahari B. Restorative effect of vitamin D deficiency on knee pain and quadriceps muscle strength in knee osteoarthritis. Acta Med Iran. 2015;53:460–70. [PubMed] [Google Scholar]

8. Heidari B, Monadi M, Asgharpour M, et al. Efficiency of supplemental vitamin D in patients with chronic obstructive pulmonary disease. Br J Med Med Res. 2014;4:3031–41. [Google Scholar]

9. Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo–a review of 101 cases. Acta Otorrinolaringol Esp. 2015;66:205–9. [PubMed] [Google Scholar]

10. Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Fiñana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262:507–11. [PubMed] [Google Scholar]

11. Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Dis. 2014;6:38–47. [PMC free article] [PubMed] [Google Scholar]

12. Rejnmark L. Effects of vitamin D on muscle function and performance: a review of evidence from randomized controlled trials. Ther Adv Chronic Dis. 2011;2:25–37. [PMC free article] [PubMed] [Google Scholar]

13. Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011;59:2291–300. [PubMed] [Google Scholar]

14. Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2004;2:CD003162. [PubMed] [Google Scholar]

15. Nunez RA, Cass SP, Furman JM. Short- and long-termoutcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647–52. [PubMed] [Google Scholar]

16. West N, Hansen S, Møller MN, Bloch SL, Klokker M. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol. 2015 Mar 7; [Epub ahead of print] [PubMed] [Google Scholar]

17. Heidari B, Haji Mirghassemi MB. Seasonal variations in serum vitamin D according to age and sex. Caspian J Intern Med. 2012;3:535–40. [PMC free article] [PubMed] [Google Scholar]

18. Talaat HS, Kabel AH, 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. 2015 Sep 16; pii: S0385-8146(15)00203-5. doi: 10.1016/j.anl.2015.08.009. [Epub ahead of print] [PubMed] [Google Scholar]

19. Jeong SH, Kim JS, Shin JW, et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260:832–8. [PubMed] [Google Scholar]

20. Suzuki T. Frontiers in vitamin D; basic research and clinical application Vitamin D and falls. Clin Calcium. 2011;21:71–9. [PubMed] [Google Scholar]

21. Mastaglia SR, Seijo M, Muzio D, et al. Effect of vitamin D nutritional status on muscle function and strength in healthy women aged over sixty-five years. J Nutr Health Aging. 2011;15:349–54. [PubMed] [Google Scholar]

22. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692. [PMC free article] [PubMed] [Google Scholar]

23. Boersma D, Demontiero O, Mohtasham Amiri Z, et al. Vitamin D status in relation to postural stability in the elderly. J Nutr Health Aging. 2012;16:270–5. [PubMed] [Google Scholar]

24. Cangussu LM, Nahas-Neto J, Orsatti CL, et al. Effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers: a randomized, double-blind, placebo-controlled trial. Menopause. 2015 Nov 2; [Epub ahead of print] [PubMed] [Google Scholar]

25. Parham K, Leonard G, Feinn RS, et al. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. Laryngoscope. 2013;123:2834–9. [PubMed] [Google Scholar]

26. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol. 2015;272:2249–53. [PubMed] [Google Scholar]

27. Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol. 2014;14:110. [PMC free article] [PubMed] [Google Scholar]

28. Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO. Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med. 2013;58:389–94. [PubMed] [Google Scholar]

29. Heidari B, Hoshmand S, Hajian K, Heidari P. Comparing bone mineral density in postmenopausal women with and without vertebral fracture and its value in recognizing high-risk individuals. East Mediterr Health J. 2010;16:868–73. [PubMed] [Google Scholar]

30. Heidari B, Javadian Y, Monadi M, Dankob Y, Firouzjahi A. Vitamin D status and distribution in patients with chronic obstructive pulmonary disease versus healthy controls. Caspian J Intern Med. 2015;6:93–7. [PMC free article] [PubMed] [Google Scholar]

31. Hajian-Tilaki K, Heidari B, Firouzjahi A, et al. Prevalence of metabolic syndrome and the association with socio-demographic characteristics and physical activity in urban population of Iranian adults: a population-based study. Diabetes Metab Syndr. 2014;8:170–6. [PubMed] [Google Scholar]

32. Prasad P, Kochhar A. Interplay of vitamin D and metabolic syndrome: A review. Diabetes Metab Syndr. 2015 Mar 6; pii: S1871-4021(15)00027-2. doi: 10.1016/j.dsx.2015 .02.014. [Epub ahead of print] [PubMed] [Google Scholar]

33. Hajian-Tilaki K, Heidari B. Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years, in the north of Iran: a population-based study and regression approach. Obes Rev. 2007;8:3–10. [PubMed] [Google Scholar]

34. Hajian-Tilaki K, Heidari B. Childhood obesity, overweight, sociodemographic and life style determinants among preschool children in Babol, Northern Iran. Iran Public Health. 2013;42:1283–91. [PMC free article] [PubMed] [Google Scholar]

35. Hajian-Tilaki K, Heidari B. Prevalence of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12-17 years. Public Health Nutr. 2012;15:2246–52. [PMC free article] [PubMed] [Google Scholar]

36. Waringhoff JC, Bayer O, Ferrari U, Straube A. Co-morbidities of vertiginous disease. BMC Neurol. 2009;9:29. [PMC free article] [PubMed] [Google Scholar]

37. Yamanka T, Fukuda T, Shirota S, et al. The prevalence and characteristics of metabolic syndrome in patients with vertigo. Plos One. 2013;8:e80176. [PMC free article] [PubMed] [Google Scholar]

Two Common Nutrients Might Keep Vertigo at Bay

WEDNESDAY, Aug. 5, 2020 (HealthDay News) — Taking in extra vitamin D plus calcium might cut your odds of getting a debilitating form of vertigo, new research shows.

The Korean study focused on benign paroxysmal positional vertigo (BPPV), a sudden spinning sensation that’s commonly triggered by changing your head position. According to the study authors, about 86% of people who have this type of vertigo find that it affects their life, even resulting in missed days at work.

Often, the condition can be remedied by undergoing a specific type of head movement under a doctor’s supervision, according to researcher Dr. Ji-Soo Kim, of Seoul National University College of Medicine.

But the new findings now suggest that for folks with BPPV, “taking a supplement of vitamin D and calcium is a simple, low-risk way to prevent vertigo from recurring,” he said in a news release from the American Academy of Neurology.

Kim added that the treatment “is especially effective if you have low vitamin D levels to begin with.”

One U.S. expert said the study adds to prior data supporting the therapy.

The study “represents the best evidence to date that a simple over-the-counter treatment of this common condition affecting adults over the age of 50 is safe and effective,” said Dr. Anthony Geraci. He directs neuromuscular medicine for Northwell Health in Great Neck, N.Y.

In their study, Kim’s team recruited more than 900 people with BPPV. Participants were divided into two groups. In the first group, those with low vitamin D levels (below 20 nanograms per milliliter) were given supplements with 400 international units of vitamin D and 500 milligrams of calcium, twice daily, while those with healthier vitamin D levels (equal to or greater than 20 ng/mL) were not given supplements.

The second group was not given supplements regardless of their vitamin D levels.

The result: People taking the supplements experienced a 24% reduction in their rate of vertigo compared with those not taking supplements, the researchers found.

The greatest benefit was seen in those who were more deficient in vitamin D to begin with. People whose vitamin D levels were lower than 10 ng/mL saw a 45% reduction in vertigo recurrence, while those with vitamin D levels of 10 to 20 ng/mL saw only a 14% reduction, the researchers found.

In all, 38% of people who took vitamin D/calcium experienced another episode of vertigo, compared with 47% of those who weren’t taking them.

“Our results are exciting because, so far, going to the doctor to have them perform head movements has been the main way we treat benign paroxysmal positional vertigo,” Kim said. “Our study suggests an inexpensive, low-risk treatment like vitamin D and calcium tablets may be effective at preventing this common, and commonly recurring, disorder.”

Geraci noted there are already good reasons to get more vitamin D and calcium into your diet.

“The beneficial effects of vitamin D and calcium supplementation have previously been shown to improve cardiovascular health, bone health and reduction in fractures due to falls in the elderly,” he noted.

Dr. Sami Saba is a neurologist at Lenox Hill Hospital in Great Neck, N.Y. He said that “the standard treatment for BPPV is a repositioning maneuver that puts the crystals in the inner ear that have been displaced back where they belong.”

However, Saba added, “the symptoms often recur after such a maneuver, and until now there hasn’t been any proven treatment to prevent recurrence.”

Vitamin D plus calcium might change all that, Saba said — and there’s logic behind the treatment.

“The inner ear crystals, or otoconia, are partially made of calcium carbonate, and vitamin D is essential for calcium metabolism, so the mechanism of the treatment makes sense,” he said.

The report was published online Aug. 5 in the journal Neurology.

More information

For more on vertigo, head to the U.S. National Library of Medicine.

SOURCES: AnthonyGeraci, MD, director, neuromuscular medicine, Northwell Health, Great Neck, N.Y.; Sami Saba, MD, neurologist, Lenox Hill Hospital, New York City; American Academy of Neurology, news release, Aug. 5, 2020

Vitamin D deficiency can cause dizziness attacks

Health

To find out, Egyptian scientists conducted a study on 40 patients diagnosed with benign paroxysmal positional vertigo. Translated into human – dizzy with a sharp change in posture.

August 24, 2021

Source:: iStock/Getty Images

About 20 percent of adults complain of dizziness. Many of them are not due to problems with neurology, but with disorders in the vestibular apparatus. Calcium carbonate crystals (otoconia) enter the semicircular canals and cause benign paroxysmal positional vertigo (BPPV). It occurs most often due to a change in the position of the head, tilting, turning when you get out of bed or lie down in it. Therefore, the disease has another name – positional vertigo. It can be accompanied by mild nausea, even vomiting, and does not last long – a few minutes. Scientists have suggested that the process may be affected by a lack of vitamin D.

“We set out to evaluate the association between recurrent BPPV attacks and vitamin D deficiency,” Aida Ahmed Abdelmaqsoud, co-author of the ENT department at the University of the South Valley School of Medicine, Egypt, explained the purpose of the study in the journal Nature.

Vitamin D and benign paroxysmal positional vertigo

PUBLICATIONS

Relevance

Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases of the peripheral part of the vestibular analyzer. The main clinical manifestation of BPPV is intermittent short-term attacks of dizziness when the head position changes. It is believed that BPPV is the most common cause of dizziness (18-25% of all cases of dizziness).

Despite the benign nature of the disease, the presence of BPPV is associated with a decrease in the quality of life. However, there are no effective methods to prevent BPPV. Several observational studies have found that BPPV patients are more likely than the general population to have vitamin D deficiency and decreased bone mineral density. In this connection, the purpose of the study under discussion was to evaluate the effectiveness of vitamin D in the prevention of BPPV.

Methods

The randomized trial was performed in 8 hospitals in South Korea between December 2013 and May 2017.

Its participants were patients with BPPV. All of them were randomized into two groups: vitamin D therapy 400 IU in combination with 500 mg calcium carbonate twice a day (if the concentration of vitamin D was less than 20 ng/ml) and standard observation.

The primary end point was the annual recurrence rate. The mean follow-up period for participants was 1 year.

Results

The study participants were 1050 patients with BPPV.
It was found that, on average, during the study period, relapses of dizziness were observed with a frequency of 0.83 cases per year in the vitamin D group and 1.1 cases per year in the standard observation group (hazard ratio 0.76; 95% confidence interval 0.66-0.87; p<0.001. In addition , in the active therapy group, BPPV relapses were reported in fewer patients (37.8% vs. 46.7%; p=0.005).
The estimated number of patients who needed to be treated with vitamin D to prevent recurrence of BPPV was 3.7 (95% CI 2.5-7.14).

Conclusion

Thus, the results of the present study demonstrate that in patients with BPPV, vitamin D and calcium supplementation reduces the frequency of relapses.