Clinical Trial of Vit D and Calcium for Recurrent BPPV

NCT05863949 | Not Yet Recruiting DMC

• 1 other identifier: 20220451-01T
• Study Type: interventional
• Target: 860
• Locations: 0 countries
• Sites: N/A

Brief Summary

Randomized double blind placebo controlled trial of vitamin D supplements, with or without calcium supplementation, versus placebo in reduction of recurrences in BPPV.

Conditions

BPPV; Benign Paroxysmal Positional Vertigo; Vertigo; Vertigo, Peripheral; Dizziness; Dizziness; Epidemic; Vitamin D Deficiency; Calcium Deficiency

Keywords

bppv; benign paroxysmal positional vertigo; vertigo; dizziness; vitamin D

Outcome Measures

Primary Outcomes (1)

• Recurrence rate of BPPV

  how many recurrences of BPPV

  1 year

Secondary Outcomes (7)

• serum vitamin D levels (25(OH)D3)

  1 year

• proportion of serum vitamin D normalization

  1 year

• time to serum vitamin D normalization

  1 year

• proportion of recurrences

  1 year

• duration of recurrences

  1 year

Study Arms (2)

vitamin D +/- calcium supplementation

EXPERIMENTAL

patients given Vitamin D 1000iu daily. Also given calcium 500mg BID daily if calcium deficient.

Dietary Supplement: vitamin D +/- calcium

Placebo arm

PLACEBO COMPARATOR

patients given 3 pills of placebo daily.

Other: Placebo

Interventions

vitamin D +/- calcium DIETARY_SUPPLEMENT

vitamin D 1000iU daily +/- calcium 500mg BID daily

vitamin D +/- calcium supplementation

Placebo OTHER

placebo pill x3 daily

Placebo arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• or more distinct episodes of benign paroxysmal positional vertigo within a 12-month period on history
• At least 1 episode diagnosed based on physical examination by trained study personnel, meeting the diagnostic criteria of the Bárány Society
• Episodes separated in time, with a minimum of 1 week symptom-free between episodes
• Serum evidence of Vitamin D deficiency, as evidenced by 25-hydroxy vitamin D level of \<75 nmol/L (\<30 ng/mL)48
• Subject able to provide informed consent to participate in the study

You may not qualify if:

• Potential subjects will be excluded if they
• have another identifiable cause of vertigo identified on history or physical examination
• have a history of allergy or medically significant adverse reaction to vitamin D or calcium carbonate
• have a chronic medical disorder which is a contraindication to vitamin D or calcium carbonate supplementation, including uncontrolled hyperparathyroidism, nephrolithiasis, or GI malabsorption disorders
• are on loop diuretic agents or thiazides
• have a contraindication to routine bloodwork for study purposes, including being hospitalized with a critical illness, cellulitis at blood draw sites, or presence of vascular grafts.

Sponsors & Collaborators

• Ottawa Hospital Research Institute: lead

Related Publications (43)

• von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015;25(3-4):105-17. doi: 10.3233/VES-150553.

  PMID: 26756126 BACKGROUND

• Luryi AL, Lawrence J, Bojrab DI, LaRouere M, Babu S, Zappia J, Sargent EW, Chan E, Naumann I, Hong RS, Schutt CA. Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study. Otol Neurotol. 2018 Jun;39(5):622-627. doi: 10.1097/MAO.0000000000001800.

  PMID: 29649052 BACKGROUND

• Perez P, Franco V, Cuesta P, Aldama P, Alvarez MJ, Mendez JC. Recurrence of benign paroxysmal positional vertigo. Otol Neurotol. 2012 Apr;33(3):437-43. doi: 10.1097/MAO.0b013e3182487f78.

  PMID: 22388730 BACKGROUND

• Zhu CT, Zhao XQ, Ju Y, Wang Y, Chen MM, Cui Y. Clinical Characteristics and Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol. 2019 Nov 13;10:1190. doi: 10.3389/fneur.2019.01190. eCollection 2019.

  PMID: 31798518 BACKGROUND

• Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017 Mar;156(3_suppl):S1-S47. doi: 10.1177/0194599816689667.

  PMID: 28248609 BACKGROUND

• von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420. Epub 2006 Nov 29.

  PMID: 17135456 BACKGROUND

• Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000 May;122(5):630-4. doi: 10.1016/S0194-5998(00)70187-2.

  PMID: 10793337 BACKGROUND

• Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 Sep 30;169(7):681-93.

  PMID: 14517129 BACKGROUND

• Lins U, Farina M, Kurc M, Riordan G, Thalmann R, Thalmann I, Kachar B. The otoconia of the guinea pig utricle: internal structure, surface exposure, and interactions with the filament matrix. J Struct Biol. 2000 Jul;131(1):67-78. doi: 10.1006/jsbi.2000.4260.

  PMID: 10945971 BACKGROUND

• Lundberg YW, Zhao X, Yamoah EN. Assembly of the otoconia complex to the macular sensory epithelium of the vestibule. Brain Res. 2006 May 26;1091(1):47-57. doi: 10.1016/j.brainres.2006.02.083. Epub 2006 Apr 4.

  PMID: 16600187 BACKGROUND

• Zhao X, Yang H, Yamoah EN, Lundberg YW. Gene targeting reveals the role of Oc90 as the essential organizer of the otoconial organic matrix. Dev Biol. 2007 Apr 15;304(2):508-24. doi: 10.1016/j.ydbio.2007.01.013. Epub 2007 Jan 12.

  PMID: 17300776 BACKGROUND

• Xu Y, Zhang H, Yang H, Zhao X, Lovas S, Lundberg YW. Expression, functional, and structural analysis of proteins critical for otoconia development. Dev Dyn. 2010 Oct;239(10):2659-73. doi: 10.1002/dvdy.22405.

  PMID: 20803598 BACKGROUND

• Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology. 2009 Mar 24;72(12):1069-76. doi: 10.1212/01.wnl.0000345016.33983.e0.

  PMID: 19307540 BACKGROUND

• Vibert D, Kompis M, Hausler R. Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol. 2003 Oct;112(10):885-9. doi: 10.1177/000348940311201010.

  PMID: 14587980 BACKGROUND

• Vibert D, Sans A, Kompis M, Travo C, Muhlbauer RC, Tschudi I, Boukhaddaoui H, Hausler R. Ultrastructural changes in otoconia of osteoporotic rats. Audiol Neurootol. 2008;13(5):293-301. doi: 10.1159/000124277. Epub 2008 Apr 7.

  PMID: 18391565 BACKGROUND

• Yang B, Lu Y, Xing D, Zhong W, Tang Q, Liu J, Yang X. Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies. Eur Arch Otorhinolaryngol. 2020 Jan;277(1):169-177. doi: 10.1007/s00405-019-05694-0. Epub 2019 Oct 19.

  PMID: 31630244 BACKGROUND

• Jeong SH, Lee SU, Kim JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol. 2022 Feb;269(2):619-626. doi: 10.1007/s00415-020-09952-8. Epub 2020 Aug 7.

  PMID: 32767116 BACKGROUND

• Buki B, Ecker M, Junger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses. 2013 Feb;80(2):201-4. doi: 10.1016/j.mehy.2012.11.029. Epub 2012 Dec 14.

  PMID: 23245911 BACKGROUND

• Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Monadi M, Bakhshi E. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study. Caspian J Intern Med. 2016 Spring;7(2):93-8.

  PMID: 27386060 BACKGROUND

• Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016 Jun;43(3):237-41. doi: 10.1016/j.anl.2015.08.009. Epub 2015 Sep 16.

  PMID: 26386496 BACKGROUND

• Jeong SH, Kim JS, Kim HJ, Choi JY, Koo JW, Choi KD, Park JY, Lee SH, Choi SY, Oh SY, Yang TH, Park JH, Jung I, Ahn S, Kim S. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial. Neurology. 2020 Sep 1;95(9):e1117-e1125. doi: 10.1212/WNL.0000000000010343. Epub 2020 Aug 5.

  PMID: 32759193 BACKGROUND

• Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919. doi: 10.1136/bmj.i4919.

  PMID: 27733354 BACKGROUND

• Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J; IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009 Nov;20(11):1807-20. doi: 10.1007/s00198-009-0954-6. Epub 2009 Jun 19.

  PMID: 19543765 BACKGROUND

• Hagenau T, Vest R, Gissel TN, Poulsen CS, Erlandsen M, Mosekilde L, Vestergaard P. Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis. Osteoporos Int. 2009 Jan;20(1):133-40. doi: 10.1007/s00198-008-0626-y. Epub 2008 May 6.

  PMID: 18458986 BACKGROUND

• Parva NR, Tadepalli S, Singh P, Qian A, Joshi R, Kandala H, Nookala VK, Cheriyath P. Prevalence of Vitamin D Deficiency and Associated Risk Factors in the US Population (2011-2012). Cureus. 2018 Jun 5;10(6):e2741. doi: 10.7759/cureus.2741.

  PMID: 30087817 BACKGROUND

• Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr. 2005 Feb;135(2):332-7. doi: 10.1093/jn/135.2.332.

  PMID: 15671237 BACKGROUND

• Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2010 Jul;21(7):1121-32. doi: 10.1007/s00198-009-1119-3. Epub 2009 Dec 3.

  PMID: 19957164 BACKGROUND

• Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev. 2014 Jun 23;2014(6):CD007469. doi: 10.1002/14651858.CD007469.pub2.

  PMID: 24953955 BACKGROUND

• Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014 Apr 14;2014(4):CD000227. doi: 10.1002/14651858.CD000227.pub4.

  PMID: 24729336 BACKGROUND

• Malihi Z, Wu Z, Stewart AW, Lawes CM, Scragg R. Hypercalcemia, hypercalciuria, and kidney stones in long-term studies of vitamin D supplementation: a systematic review and meta-analysis. Am J Clin Nutr. 2016 Oct;104(4):1039-1051. doi: 10.3945/ajcn.116.134981. Epub 2016 Sep 7.

  PMID: 27604776 BACKGROUND

• Reid IR. Efficacy, effectiveness and side effects of medications used to prevent fractures. J Intern Med. 2015 Jun;277(6):690-706. doi: 10.1111/joim.12339.

  PMID: 25495429 BACKGROUND

• Brazier M, Grados F, Kamel S, Mathieu M, Morel A, Maamer M, Sebert JL, Fardellone P. Clinical and laboratory safety of one year's use of a combination calcium + vitamin D tablet in ambulatory elderly women with vitamin D insufficiency: results of a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2005 Dec;27(12):1885-93. doi: 10.1016/j.clinthera.2005.12.010.

  PMID: 16507374 BACKGROUND

• Lewis JR, Zhu K, Prince RL. Adverse events from calcium supplementation: relationship to errors in myocardial infarction self-reporting in randomized controlled trials of calcium supplementation. J Bone Miner Res. 2012 Mar;27(3):719-22. doi: 10.1002/jbmr.1484.

  PMID: 22139587 BACKGROUND

• Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.

  PMID: 21646368 BACKGROUND

• Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008 Aug;88(2):582S-586S. doi: 10.1093/ajcn/88.2.582S.

  PMID: 18689406 BACKGROUND

• Gallagher JC, Smith LM, Yalamanchili V. Incidence of hypercalciuria and hypercalcemia during vitamin D and calcium supplementation in older women. Menopause. 2014 Nov;21(11):1173-80. doi: 10.1097/GME.0000000000000270.

  PMID: 24937025 BACKGROUND

• Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN, Nam BH, Nguyen LT, Park M, Rivers AL, McManus C, Kokkotou E, Drossman DA, Goldman P, Lembo AJ. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008 May 3;336(7651):999-1003. doi: 10.1136/bmj.39524.439618.25. Epub 2008 Apr 3.

  PMID: 18390493 BACKGROUND

• Hrobjartsson A, Gotzsche PC. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD003974. doi: 10.1002/14651858.CD003974.pub3.

  PMID: 20091554 BACKGROUND

• Kaptchuk TJ. Powerful placebo: the dark side of the randomised controlled trial. Lancet. 1998 Jun 6;351(9117):1722-5. doi: 10.1016/S0140-6736(97)10111-8. No abstract available.

  PMID: 9734904 BACKGROUND

• Miller FG, Kaptchuk TJ. The power of context: reconceptualizing the placebo effect. J R Soc Med. 2008 May;101(5):222-5. doi: 10.1258/jrsm.2008.070466. No abstract available.

  PMID: 18463276 BACKGROUND

• Hrobjartsson A. What are the main methodological problems in the estimation of placebo effects? J Clin Epidemiol. 2002 May;55(5):430-5. doi: 10.1016/s0895-4356(01)00496-6.

  PMID: 12007544 BACKGROUND

• Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Kostenberger M, Tmava Berisha A, Martucci G, Pilz S, Malle O. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020 Nov;74(11):1498-1513. doi: 10.1038/s41430-020-0558-y. Epub 2020 Jan 20.

  PMID: 31959942 BACKGROUND

• Pietras SM, Obayan BK, Cai MH, Holick MF. Vitamin D2 treatment for vitamin D deficiency and insufficiency for up to 6 years. Arch Intern Med. 2009 Oct 26;169(19):1806-8. doi: 10.1001/archinternmed.2009.361. No abstract available.

  PMID: 19858440 BACKGROUND

MeSH Terms

Conditions

Benign Paroxysmal Positional Vertigo; Vertigo; Dizziness; Vitamin D Deficiency

Interventions

S100 Calcium Binding Protein G

Condition Hierarchy (Ancestors)

Vestibular Diseases; Labyrinth Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Sensation Disorders; Avitaminosis; Deficiency Diseases; Malnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases

Intervention Hierarchy (Ancestors)

Calbindins; Calcium-Binding Proteins; Carrier Proteins; Proteins; Amino Acids, Peptides, and Proteins; S100 Proteins

Study Officials

• Darren Tse, MD

  Ottawa Hospita Research Institute

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Darren Tse, MD

CONTACT

6137997838; dtse88@gmail.com

Darren Tse

CONTACT

6137997838; dtse88@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: Enrolled subjects will be blinded to their treatment assignment. Both study staff and trial investigators will be blinded to treatment assignments and will remain blinded throughout the course of the trial. Randomization (treatment assignment) will be performed via computer algorithm based on subject ID. Randomization codes will be maintained in a password protected, encrypted file available only to the single unmasked investigator at each site, in order to prevent accidental unmasking of other trial personnel. All care will be taken to ensure that the study team are kept blinded. Pills, which will be dispensed at 3-month intervals, will be indistinguishable between groups. They will be dispensed in kits that are labeled as outlined in section 6.2 Study Drug Packaging and Labeling.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Physician

Model Details: This is an off-label, multicenter, randomized, clinical trial in vitamin D deficient adults aged 18 and above with recurrent BPPV. Its goal is to determine whether vitamin D supplementation, with or without calcium supplementation, compared with placebo will decrease the frequency of recurrent episodes of BPPV. A total of 860 vitamin D deficient adults diagnosed with recurrent BPPV will be enrolled at participating clinical study sites.

Study Record Dates

• First Submitted: April 28, 2023
• First Posted: May 18, 2023
• Study Start: August 1, 2025
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: June 25, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share