There is high quality evidence that vitamin D plus calcium is associated with a statistically significant reduction in incidence of new non-vertebral fractures .
Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people .
Supplements of vitamin D and calcium may prevent hip or any type of fracture .
There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium .
This review found that there was no increased risk of death from taking calcium and vitamin
BACKGROUND Vitamin D and related compounds have been used to prevent  osteoporotic fractures in older people .
This is the third up date of a Cochrane review first published in 1996 .
OBJECTIVES To determine the effects of vitamin D or related compounds , with or without calcium , for preventing  fractures in post-menopausal women and older men .
Evaluation of ergocalciferol or cholecalciferol dosing, 1,600 IU daily or 50,000 IU monthly in older adults.
CONTEXT Whether ergocalciferol ( D(2 ) ) and cholecalciferol ( D(3 ) ) are equally effective to increase and maintain serum 25-hydroxyvitamin D [ 25(OH)D ] concentration is controversial . OBJECTIVE The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2 ) or D(3 ) on circulating 25(OH)D and serum and urinary calcium . DESIGN , SETTING AND PARTICIPANTS In a university clinical research setting , 64 community dwelling adults age 65 + were r and omly assigned to receive daily ( 1,600 IU ) or once-monthly ( 50,000 IU ) D(2 ) or D(3 ) for 1 yr . MAIN OUTCOME MEASURES Serum 25(OH)D , serum calcium , and 24-h urinary calcium were measured at months 0 , 1 , 2 , 3 , 6 , 9 , and 12 . Serum PTH , bone-specific alkaline phosphatase , and N-telopeptide were measured at months 0 , 3 , 6 , and 12 . RESULTS Serum 25(OH)D was less than 30 ng/ml in 40 % of subjects at baseline ; after 12 months of vitamin D dosing , levels in 19 % of subjects ( n = 12 , seven receiving daily doses and five monthly doses ) remained low , despite compliance of more than 91 % . D(2 ) dosing increased 25(OH)D(2 ) but produced a decline ( P < 0.0001 ) in 25(OH)D(3 ) . Substantial between-individual variation in 25(OH)D response was observed for both D(2 ) and D(3 ) . The highest 25(OH)D observed was 72.5 ng/ml . Vitamin D administration did not alter serum calcium , PTH , bone-specific alkaline phosphatase , N-telopeptide , or 24-h urine calcium . CONCLUSIONS Overall , D(3 ) is slightly , but significantly , more effective than D(2 ) to increase serum 25(OH)D. One year of D(2 ) or D(3 ) dosing ( 1,600 IU daily or 50,000 IU monthly ) does not produce toxicity , and 25(OH)D levels of less than 30 ng/ml persist in approximately 20 % of individuals . Substantial between-individual response to administered vitamin D(2 ) or D(3 ) is observed
There is high quality evidence that vitamin D plus calcium is associated with a statistically significant reduction in incidence of new non-vertebral fractures .
Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people .
Supplements of vitamin D and calcium may prevent hip or any type of fracture .
There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium .
This review found that there was no increased risk of death from taking calcium and vitamin
BACKGROUND Vitamin D and related compounds have been used to prevent  osteoporotic fractures in older people .
This is the third up date of a Cochrane review first published in 1996 .
OBJECTIVES To determine the effects of vitamin D or related compounds , with or without calcium , for preventing  fractures in post-menopausal women and older men .