Randomized controlled trial in support of vitamin D and calcium supplementation for BPPV

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and frequently seen in clinical practice.1 In BPPV, otoconia become dislodged from the utricular macule entering the semicircular canals, where certain head movements will cause movement of the canaliths (malpositioned otoconia). Movement of these canaliths causes displacement of the semicircular canal cupula and the sensation of rotary vertigo. First-line therapy for BPPV includes canalith repositioning exercises such as the Epley maneuver. Taking the patient through a series of head movements allows the canaliths to move around the canal away from the cupula and back into the vestibule.2 Whereas the Epley maneuver and other canalith repositioning maneuvers have a high success rate, BPPV commonly recurs.3 Several groups have suggested vitamin D and calcium metabolism play a role in the pathogenesis of BPPV based on observation data showing an association between the rate of BPPV recurrence and osteopenia, osteoporosis, and decreased serum vitamin D.4,5 A previous nonrandomized study of 93 adults with BPPV and low vitamin D (<10 ng/mL) found lower likelihood of recurrence among those who increased their vitamin D levels to above 10 ng/mL after supplementation.6