25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study

  • D. LelliEmail author
  • L. M. Pérez Bazan
  • A. Calle Egusquiza
  • G. Onder
  • A. Morandi
  • E. Ortolani
  • M. Mesas Cervilla
  • C. Pedone
  • M. Inzitari
Original Article



Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for “deficiency”). An early 25(OH)D dosage may be advisable for this population.


Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units.


We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models.


We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5–18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67–5.33]; Q3, OR [95% CI] = 4.01 [1.35–13.48]; Q4, OR [95% CI] = 2.18 [0.81–6.21]).


In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for “deficiency.” Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.


Aged Barthel index Functional recovery Rehabilitation Vitamin D 


Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

198_2019_4845_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Area di GeriatriaUniversità Campus Bio-Medico di RomaRomeItaly
  2. 2.Parc Sanitari Pere VirgiliBarcelonaSpain
  3. 3.Vall d’Hebrón Institute of ResearchBarcelonaSpain
  4. 4.Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
  5. 5.Centro Medicina dell’InvecchiamentoUniversità Cattolica del Sacro CuoreRomeItaly
  6. 6.Department of Rehabilitation and Aged Care of the Fondazione CamplaniAncelle HospitalCremonaItaly

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