Two regimens , each represented by one large trial , which showed limited evidence of efficacy in reducing the incidence of hip or other appendicular skeleton fractures were : 1 ) Oral Vitamin D when accompanied by calcium supplementation .
2 ) 1,25 dihydroxy Vitamin D ( calcitriol ) .
This appeared more effective than calcium in a direct comparison .
Hypercalcaemia and gastro-intestinal symptoms , reported in less than 5 % of participants , were slightly more common when Vitamin D analogues were taken .
However , the risk of death was marginally less .
REVIEW ER 'S CONCLUSIONS Uncertainty remains about the efficacy of regimens which include Vitamin D or its analogues in fracture prevention .
Particularly if co-supplementation of calcium is required , significant cost differences are likely to exist between regimens .
BACKGROUND Due to their known effects on bone metabolism , Vitamin D and related compounds have been proposed for the prevention of osteoporosis and fractures .
OBJECTIVES To determine the effects of supplementation with Vitamin D or a Vitamin D analogue in the prevention of fractures of the axial and appendicular skeleton in elderly men or women with involutional or post-menopausal osteoporosis .
Histomorphometric effects of calcium or calcium plus 25-hydroxyvitamin D3 therapy in senile osteoporosis.
To evaluate the effects of calcium and 25-OHD in the therapy of senile osteoporosis , we studied a group of 39 women aged 69 + /- 7 ( st and ard deviation , SD ) years with severe osteoporosis . The group was characterized histomorphometrically by depressed bone remodeling rates without hyperosteoidosis . No subject had risk factors for osteopenia other than their age and postmenopausal status , and no subject was receiving therapy for bone disease at the onset of the study . Subjects were followed for 2 years after r and omization to receive either 1200 mg/day of calcium ( as calcium carbonate ) and 40 micrograms/day of 25-OHD ( calcium-25-OHD group ) , or 1200 mg/day of calcium plus placebo ( calcium-placebo group ) . Calcium-25-OHD result ed in a clear increase in 25-OHD levels ( p less than 0.001 ) and an increase in calcium absorption as indicated by urinary calcium excretion . Nevertheless , there was no significant change in fasting serum calcium , phosphorus , alkaline phosphatase , PTH , or 1,25-(OH)2D in either group . Radial and phalangeal bone mineral content and trabecular bone volume in the biopsied patients remained stable in both groups over the 2 year period . Unexpectedly , repeat bone biopsies revealed a clear improvement in the rate of mineralization in both groups , presumably as a result of the calcium supplementation alone . In summary , calcium-placebo and calcium-25-OHD treatment were both associated with stable appendicular bone mineral content in women with senile osteopenia . The finding of an effect of calcium supplementation on the rate of mineralization indicates that relative calcium deficiency may impair the mineralization phase of remodeling . ( ABSTRACT TRUNCATED AT 250 WORDS
Two regimens , each represented by one large trial , which showed limited evidence of efficacy in reducing the incidence of hip or other appendicular skeleton fractures were : 1 ) Oral Vitamin D when accompanied by calcium supplementation .
2 ) 1,25 dihydroxy Vitamin D ( calcitriol ) .
This appeared more effective than calcium in a direct comparison .
Hypercalcaemia and gastro-intestinal symptoms , reported in less than 5 % of participants , were slightly more common when Vitamin D analogues were taken .
However , the risk of death was marginally less .
REVIEW ER 'S CONCLUSIONS Uncertainty remains about the efficacy of regimens which include Vitamin D or its analogues in fracture prevention .
Particularly if co-supplementation of calcium is required , significant cost differences are likely to exist between regimens .
BACKGROUND Due to their known effects on bone metabolism , Vitamin D and related compounds have been proposed for the prevention of osteoporosis and fractures .
OBJECTIVES To determine the effects of supplementation with Vitamin D or a Vitamin D analogue in the prevention of fractures of the axial and appendicular skeleton in elderly men or women with involutional or post-menopausal osteoporosis .