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 .
Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min
We previously observed that a creatinine clearance ( CrCl ) of < 65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels . To test our hypothesis , we investigated in a post hoc analysis of a double-blind r and omized study whether treatment with alfacalcidol , a synthetic prodrug of the D-hormone , can reduce the high incidence of fallers and the high risk of falls associated with low CrCl . Of 378 Swiss community-dwelling women ( n=191 ) and men ( n=187 ) , aged 70 years and older , 191 received r and omly 1 μg capsules of alfacalcidol ( AlphaD3 : Teva ) , and 187 received one capsule of placebo daily . With the help of question naires we regularly assessed the incidence and frequency of falls . The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min . The presented results are from ITT analyses . In participants with a CrCl of < 65 ml/min , the 36 weeks of treatment with alfacalcidol was , compared with placebo , associated with a significant reduction in the number of fallers ( 14/72 versus 25/70 ; OR 0.26 , 95 % CI 0.08–0.80 , P=0.019 ) , and a significant reduction of the number of falls ( 16/72 versus 28/70 ; OR 0.29 , 95 % CI 0.09–0.88 , P=0.028 ) . No such association was observed in participants with a CrCl of ≥65 ml/min ( for fallers 26/120 versus 21/116 ; OR 0.92 95 % CI 0.34–2.52 , P=0.875 ; for falls 32/120 versus 23/116 ; OR 0.93 95 % CI 0.34–2.54 , P=0.885 ) . In the  placebo group frequency of falls was dependent on CrCl ( P=0.006 ) , whereas in the alfacalcidol  treatment group frequency of falls was independent of CrCl ( P=0.494 ) . No cases of clinical ly relevant hypercalcemia were observed . In a community-dwelling population of elderly men and women with a CrCl of < 65 ml/min , treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls
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 .