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The role of calcium metabolism and disorders of bone mineral density in the evolution and recurrence of BPPV has been debated over the years. As a contribution to this debate, the authors undertook a prospective study into the correlation between osteoporosis (diagnosed with femoral and lumbar T-scores as defined by the WHO), vitamin D deficiency, and recurrent BPPV. Seventy-three consecutive adult patients diagnosed with posterior or lateral canal BPPV were recruited. They were all treated with the appropriate particle repositioning manoeuvre. Recurrence was defined as a new episode of BPPV at least 15 days after the complete resolution of the previous one. All patients were tested for bone mineral density (BMD), femoral and lumbar T-scores and vitamin D levels (normal >30 ng/mL, insufficient 20-29 ng/mL, and deficient <20 ng/mL). The study found that, deficient vitamin D was statistically significantly more common in the recurrent group, as were low lumbar and femoral T-scores. Furthermore, there was a correlation between osteopenia and osteoporosis with recurrent BPPV. There was a linear correlation between femoral T-score and vitamin D levels: high levels of vitamin D and high T-scores were associated with isolated BPPV, and vice-versa. In 66% of cases, combining vitamin D levels and T-scores could predict the risk of recurrence, a finding the authors argued, if confirmed by further studies, could be valuable for counselling patients about recurrence risk and to guide vitamin D supplementation. They concluded that the findings supported a correlation between recurrent BPPV and calcium metabolism alterations, such as in conditions like osteoporosis. They acknowledged that to define the precise relationship between calcium metabolism and BPPV and the efficacy of potential therapies targeting these pathways in preventing BPPV recurrence, further studies would be necessary, citing promising results of studies showing that vitamin D supplementation can prevent BPPV recurrence. There is the potential for this study to persuade some sceptics to consider vitamin D supplementation in recurrent BPPV cases. After all, many people are taking vitamin D in the current SARS Cov-2 pandemic anyway.

Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population.
Melis A, Rizzo D, Gallus R, et al.
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Victor Osei-Lah

Bournemouth, UK.

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