ORIGINAL ARTICLE: EPIDEMIOLOGY,
CLINICAL, PRACTICE AND HEALTH
Combination of alfacalcidol and calcium improved handgrip
strength and mobility among Indonesian older women:
A randomized controlled trial
Jane E Fransiska,
Tirza Z Tamin
and Rahmi Istanti
Medicine, Department of Internal Medicine and
Department of Medical Rehabilitation, University of Indonesia, Cipto
Mangunkusumo Hospital, Jakarta, Indonesia
Aim: To determine the effect of alfacalcidol on muscle strength and functional mobility in Indonesian older
women whose handgrip strength was low.
Methods: A randomized, double-blind controlled trial was carried out among 95 older women whose handgrip
strength was ≤22 kg. Participants were randomized into two groups: 47 participants received alfacalcidol 0.5 μg/day
and 48 participants received a placebo. Each participant in both groups was given calcium 500 mg/day. Handgrip
strength as well as the Timed-Up and Go test were measured before and after 90 days of intervention. Per protocol
analysis after intervention between two groups was carried out.
Results: There was a signiﬁcant improvement of handgrip strength in the group that received alfacalcidol com-
pared with the placebo group (15.50 vs 13.75; P = 0.003). The median time for the Timed-Up and Go test in the
alfacalcidol group also improved signiﬁcantly compared with the placebo group (9.01 vs 10.07, P = 0.028).
Conclusions: Alfacalcidol with daily doses of 0.5 μg signiﬁcantly improved muscle strength and functional mobil-
ity in Indonesian older women. Geriatr Gerontol Int 2018; 18: 434–440.
Keywords: alfacalcidol, elderly, handgrip, Indonesia, mobility.
Falls are a major threat among the older population, as
they cause morbidity and mortality, as well as expensive
After menopause, women have a
greater risk of falls than men.
intrinsic factor is reduced muscle strength.
muscle mass occurs in almost 30% of the population
aged >60 years, and more than 50% in those who aged
Some studies have shown the correlation
between vitamin D deﬁciency and the loss of muscle
strength, as well as its function in older people. A study
in Indonesia by Rinaldi et al. found a positive correla-
tion between 25(OH)D
serum level and muscle
strength of femoral quadriceps in older women
(r = 0.327; P = 0.009).
Despite being located in a region with supposedly
abundant sunlight exposure, older adults in Indonesia
are still at great risk of vitamin D deﬁciency, as they
have reduced synthesis of 25(OH)D
in their skin, low
vitamin D in their diet, lack of sunlight exposure,
reduced hydroxylation in their kidneys and polymor-
phism of vitamin D receptors (VDR).
A study carried
out by Setiati et al. found that the prevalence of vitamin
Ddeﬁciency in Indonesian older women living in nurs-
ing homes was 35.1%.
However, a recent meta-
analysis showed equivocal ﬁndings regarding the effect
of vitamin D supplementation on muscle strength.
addition, several studies also found vitamin D supple-
mentation ability to improve functional mobility. Dukas
and Schacht et al.
found intervention of 1 μg
alfacalcidol/day increased muscle power and balance
(as measured by the Times Up and Go test [TUG] and
the chair rising test), thus leading to a signiﬁcant
decrease in falls.
) has different pharmacoki-
netics compared with plain vitamin D. It bypasses the
renal 1-α-hydroxylase, and is 25-hydroxylated in the
liver to yield the active form of 1-α.25(OH)
Accepted for publication 12 September 2017.
Correspondence: Professor Siti Setiati MD PhD, Division of
Geriatrics, Faculty of Medicine, Department of Internal Medicine,
Universitas Indonesia-Cipto Mangunkusumo Hospital (RSCM),
Jalan Pangeran Diponegoro No. 71, Jakarta 10430, Indonesia.
| doi: 10.1111/ggi.13201 © 2017 Japan Geriatrics Society
Geriatr Gerontol Int 2018; 18: 434–440