CONCLUSIONS Dietary calcium intake is not associated with risk of fracture , and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures .
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures .
Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial
Summary Sunlight exposure by improving vitamin D status could be a simple public health strategy in reducing falls  among frail elder people . In a r and omised controlled trial , adherence to sunlight exposure was low ( median adherence , 26 % ) and no effect of increased UV exposure on falls risk was observed ( incidence rate ratio ( IRR ) 1.06 , P = 0.73 ) . Introduction This study aim ed to determine whether increased sunlight exposure was effective to improve vitamin D status and reduce falls in the elderly . Methods In a cluster r and omised controlled trial ( NCT00322166 at Clinical Trials.gov ) , 602 residents aged 70 or more ( mean age , 86.4 years ; 71 % female ) were recruited from 51 aged care facilities in Northern Sydney , Australia . Participants were r and omised by facility to receive either increased sunlight exposure ( additional 30–40 min/day in the early morning ) with ( UV+ ) or without ( UV ) calcium supplementation ( 600 mg/day ) or neither ( control ) for a year . The co- primary endpoints were change in serum 25 hydroxy vitamin D ( 25OHD ) and falls incidence after 12 months . Results  Adherence to sunlight exposure  was low ( median adherence , 26 % ; IQR , 7%–45 % ) . Serum 25OHD levels were low at baseline ( median , 32.9 nmol/L ) and increased only slightly depending on the number of sunlight sessions attended over 12 months ( P = 0.04 ) . During the study , 327 falls occurred in 111 ( 54 % ) subjects in the control group , 326 falls in 111 ( 58 % ) subjects in the UV only group and 335 falls in 108 ( 52 % ) subjects in the UV+ group . By intention-to-treat analysis , there was no significant effect of  increased UV exposure on falls risk ( IRR , 1.06 ; 95 % CI , 0.76–1.48 ; P = 0.73 ) . However , in 66 participants who attended ≥130 sessions per year ( adherence , ≥50 % of 260 sessions – five per week ) , falls were significantly reduced ( IRR , 0.52 ; 95 % CI , 0.31–0.88 ; P = 0.01 ) compared with the control group . Conclusions Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people . This public health strategy was not effective most likely due to poor adherence to the intervention
CONCLUSIONS Dietary calcium intake is not associated with risk of fracture , and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures .
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures .