Journal of Neurology

, Volume 260, Issue 3, pp 832–838 | Cite as

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo

  • Seong-Hae Jeong
  • Ji-Soo KimEmail author
  • Jong Wook Shin
  • Sungbo Kim
  • Hajeong Lee
  • Ae Young Lee
  • Jae-Moon Kim
  • Hyunjin Jo
  • Junghan Song
  • Yuna Ghim
Original Communication


Previous studies have demonstrated an association of osteopenia/osteoporosis with idiopathic benign paroxysmal positional vertigo (BPPV). Since vitamin D takes part in the regulation of calcium and phosphorus found in the body and plays an important role in maintaining proper bone structure, decreased bone mineral density in patients with BPPV may be related to decreased serum vitamin D. We measured the serum levels of 25-hydroxyvitamin D in 100 patients (63 women and 37 men, mean age ± SD = 61.8 ± 11.6) with idiopathic BPPV and compared the data with those of 192 controls (101 women and 91 men, mean age ± SD = 60.3 ± 11.3) who had lived in the same community without dizziness or imbalance during the preceding year. The selection of the controls and acquisition of clinical information were done using the data from the Fourth Korean National Health and Nutrition Examination Survey, 2008. The serum level of 25-hydroxyvitamin D was lower in the patients with BPPV than in the controls (mean ± SD = 14.4 ± 8.4 versus 19.1 ± 6.8 ng/ml, p = 0.001). Furthermore, patients with BPPV showed a higher prevalence of decreased serum vitamin D (<20 ng/ml, 80.0 vs. 60.1 %, p < 0.001) than the controls. Multiple logistic regression analyses adjusted for age, sex, body mass index, hypertension, diabetes, proteinuria, regular exercise and the existence of decreased bone mineral density demonstrated that vitamin D insufficiency (10–20 ng/ml) and deficiency (<10 ng/ml) were associated with BPPV with the odds ratios of 3.8 (95 % confidence interval = 1.51–9.38, p = 0.004) and 23.0 (95 % confidence interval = 6.88–77.05, p < 0.001). Our study demonstrated an association between idiopathic BPPV and decreased serum vitamin D. Decreased serum vitamin D may be a risk factor of BPPV.


Benign paroxysmal positional vertigo Vertigo Nystagmus Vitamin D 



Dr. J.S. Kim was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A080750). Dr. S-H. Jeong conducted the statistical analyses with the help of the Chungnam National University Hospital Research Institute of Clinical Medicine (Prof. Suk-Hoon Lee and Jieun Shin).

Conflicts of interest

All authors have no conflicts of interest.

Ethical standard

All human study must state that have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


  1. 1.
    Hotson JR, Baloh RW (1998) Acute vestibular syndrome. N Engl J Med 339(10):680–685PubMedCrossRefGoogle Scholar
  2. 2.
    Hall SF, Ruby RR, McClure JA (1979) The mechanics of benign paroxysmal vertigo. J Otolaryngol 8(2):151–158PubMedGoogle Scholar
  3. 3.
    Schuknecht HF (1969) Cupulolithiasis. Arch Otolaryngol 90(6):765–778PubMedCrossRefGoogle Scholar
  4. 4.
    Ross MD, Pote KG, Rarey KE, Verma LM (1981) Microdisc gel electrophoresis in sodium dodecyl sulfate of organic material from rat otoconial complexes. Ann N Y Acad Sci 374:808–819PubMedCrossRefGoogle Scholar
  5. 5.
    Johnsson LG, Rouse RC, Wright CG, Henry PJ, Hawkins JE Jr (1982) Pathology of neuroepithelial suprastructures of the human inner ear. Am J Otolaryngol 3(2):77–90PubMedCrossRefGoogle Scholar
  6. 6.
    Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS (2009) Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 72(12):1069–1076PubMedCrossRefGoogle Scholar
  7. 7.
    Hoenderop JG, Nilius B, Bindels RJ (2005) Calcium absorption across epithelia. Physiol Rev 85(1):373–422PubMedCrossRefGoogle Scholar
  8. 8.
    Thalmann R, Ignatova E, Kachar B, Ornitz DM, Thalmann I (2001) Development and maintenance of otoconia: biochemical considerations. Ann N Y Acad Sci 942:162–178PubMedCrossRefGoogle Scholar
  9. 9.
    Ross MD (1979) Calcium ion uptake and exchange in otoconia. Adv Otorhinolaryngol 25:26–33PubMedGoogle Scholar
  10. 10.
    Yamauchi D, Raveendran NN, Pondugula SR, Kampalli SB, Sanneman JD, Harbidge DG, Marcus DC (2005) Vitamin D upregulates expression of ECaC1 mRNA in semicircular canal. Biochem Biophys Res Commun 331(4):1353–1357PubMedCrossRefGoogle Scholar
  11. 11.
    CLSI method comparison and bias estimation using patient samples; approved guideline, 2nd edn. (Interim Revision). CLSI document EP09-A2-IR, Wayne. PA: Clinical and Laboratory Standards Institute: 2010Google Scholar
  12. 12.
    Thacher TD, Clarke BL (2011) Vitamin D insufficiency. Mayo Clin Proc 86(1):50–60PubMedCrossRefGoogle Scholar
  13. 13.
    Tangpricha V, Pearce EN, Chen TC, Holick MF (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112(8):659–662PubMedCrossRefGoogle Scholar
  14. 14.
    Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B (2000) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85(11):4125–4130PubMedCrossRefGoogle Scholar
  15. 15.
    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. (1994) World Health Organ Tech Rep Ser 843:1–129Google Scholar
  16. 16.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281PubMedCrossRefGoogle Scholar
  17. 17.
    Arabi A, El Rassi R, El-Hajj Fuleihan G (2010) Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes. Nat Rev Endocrinol 6(10):550–561PubMedCrossRefGoogle Scholar
  18. 18.
    de Boer IH, Levin G, Robinson-Cohen C, Biggs ML, Hoofnagle AN, Siscovick DS, Kestenbaum B (2012) Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study. Ann Intern Med 156(9):627–634PubMedGoogle Scholar
  19. 19.
    Gardner GM, Shaari CM, Parnes SM (1992) Long-term morbidity and mortality in patients undergoing surgery for unilateral vocal cord paralysis. Laryngoscope 102(5):501–508PubMedCrossRefGoogle Scholar
  20. 20.
    Parnes LS, McClure JA (1992) Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 102(9):988–992PubMedCrossRefGoogle Scholar
  21. 21.
    Hughes I, Thalmann I, Thalmann R (1091) Ornitz DM (2006) Mixing model systems: using zebrafish and mouse inner ear mutants and other organ systems to unravel the mystery of otoconial development. Brain Res 1:58–74Google Scholar
  22. 22.
    Vibert D, Kompis M, Hausler R (2003) Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol 112(10):885–889PubMedGoogle Scholar
  23. 23.
    Zucca G, Valli S, Valli P, Perin P, Mira E (1998) Why do benign paroxysmal positional vertigo episodes recover spontaneously? J Vestib Res 8(4):325–329PubMedCrossRefGoogle Scholar
  24. 24.
    Nagpal S, Na S, Rathnachalam R (2005) Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 26(5):662–687PubMedCrossRefGoogle Scholar
  25. 25.
    Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvala H, Lou YR, Kalueff AV, Pyykko I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114(3–5):161–166PubMedCrossRefGoogle Scholar
  26. 26.
    Jang YS, Kang MK (2009) Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo. Otol Neurotol: Official Pub Am Otol Soc, Am Neurotol Soc Eur Academy Otol Neurotol 30(1):95–100CrossRefGoogle Scholar
  27. 27.
    von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78(7):710–715CrossRefGoogle Scholar
  28. 28.
    Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips P (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90(7):4119–4123PubMedCrossRefGoogle Scholar
  29. 29.
    DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin nutr 80(6 Suppl):1689S–1696SPubMedGoogle Scholar
  30. 30.
    Zemel MB (2002) Regulation of adiposity and obesity risk by dietary calcium: mechanisms and implications. J Am Coll Nutr 21(2):146S–151SPubMedGoogle Scholar
  31. 31.
    Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, Robins SJ, O’Donnell CJ, Hoffmann U, Jacques PF, Booth SL, Vasan RS, Wolf M, Wang TJ (2010) Adiposity, cardiometabolic risk, and vitamin D status: the Framingham heart study. Diabetes 59(1):242–248PubMedCrossRefGoogle Scholar
  32. 32.
    Vieth R (2006) What is the optimal vitamin D status for health? Prog Biophys Mol Biol 92(1):26–32PubMedCrossRefGoogle Scholar
  33. 33.
    Lips P (2010) Worldwide status of vitamin D nutrition. J steroid biochem mol biol 121(1–2):297–300PubMedCrossRefGoogle Scholar
  34. 34.
    Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, Kim KJ, Rhee Y, Lim SK (2008) Vitamin D insufficiency in Korea—a greater threat to younger generation: the Korea national health and nutrition examination survey (KNHANES). J Clin Endocrinol Metab 96(3):643–651CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Seong-Hae Jeong
    • 1
  • Ji-Soo Kim
    • 2
    Email author
  • Jong Wook Shin
    • 1
  • Sungbo Kim
    • 1
  • Hajeong Lee
    • 3
  • Ae Young Lee
    • 1
  • Jae-Moon Kim
    • 1
  • Hyunjin Jo
    • 1
  • Junghan Song
    • 4
  • Yuna Ghim
    • 5
  1. 1.Department of Neurology, Chungnam National University College of MedicineChungnam National University HospitalDaejeonKorea
  2. 2.Department of Neurology, Seoul National University College of MedicineSeoul National University Bundang HospitalGyeonggi-doKorea
  3. 3.Department of Internal MedicineSeoul National University HospitalSeoulKorea
  4. 4.Department of Laboratory Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  5. 5.Division of Health and Nutrition SurveyOsong Health Technology Administration ComplexChungbukKorea

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