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 .
Effects of alendronate plus alfacalcidol in osteoporosis patients with a high risk of fracture: the Japanese Osteoporosis Intervention Trial (JOINT) – 02
Abstract Objectives : The authors conducted a r and omized controlled trial to clarify the efficacy and safety of alendronate plus alfacalcidol versus alendronate alone in a clinical setting . Research design and methods : Eligible patients were postmenopausal women with severe osteoporosis who were aged 70 years or older and had several risk factors for incident fractures . The primary endpoint was prevention of incident fractures , and the anti-fracture efficacy was evaluated in relation to the baseline serum 25(OH)D level . Results : A total of 2164 patients were r and omized to alendronate plus alfacalcidol ( combination therapy ) or alendronate alone ( monotherapy ) . Although the overall difference in the incidence of vertebral fracture between the two groups was not significant , the combination therapy group had a significantly reduced risk of vertebral fractures after the first 6 months ( HR , 0.53 ) . In subgroup analyses , the combination therapy group was superior in the strata of number of prevalent vertebral fractures of ≥2 ( HR , 0.51 ) and grade 3 of prevalent vertebral fractures ( HR , 0.55 ) . The rate of non-vertebral weight-bearing bone fractures was significantly lower in the combination therapy group than in the monotherapy group during the follow-up period ( HR , 0.31 ) . A lower baseline 25(OH)D level was associated with a higher incidence of non-vertebral weight-bearing bone fractures ( HR , 3.42 ) despite alendronate use . Although one patient given the combination therapy had mild hypercalcemia , serious hypercalcemia and unknown adverse events were not encountered . Because of the limitations presented in this study , these results may not apply to female patients with longer than 2 years of treatments , and to male osteoporosis patients . Conclusions : The combination therapy was no more effective for overall vertebral fracture prevention . However , subgroup analysis has shown that it was more effective for fracture prevention in patients with severe vertebral deformity , multiple prevalent vertebral fractures , and for non-vertebral weight-bearing bone fracture prevention
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 .