c ACKNOWLEDGEMENTS CONCLUSION OBJECTIVES BACKGROUND REFERENCES The aim of this systematic review was to measure the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in older people. METHODS RESULTS THE IMPACT OF DAILY ORAL SUPPLEMENTATION OF VITAMIN D3 PLUS CALCIUM ON THE INCIDENCE OF HIP FRACTURE IN OLDER PEOPLE : A SYSTEMATIC REVIEW Preethy Manoj1 ,Dr .Rosemarie Derwin 2,Dr. Sherly George3 1 Royal College of Surgeons in Ireland, Dublin 2, 2Lecturer, School of Nursing & Midwifery, RCSI, Dublin 2 3 Lecturer & Programme Director, School of Nursing & Midwifery , RCSI, Dublin 2 Hip fractures reduce the quality of life and increase mortality. Osteoporosis is the biggest cause of fracture in older people (Nowson 2010).. It is estimated that by 2025, there will be approximately 28,000 new fragility fracture cases in Ireland costing €320 million (The Irish Times 2018)..The role of Vitamin D3 and Calcium in bone health is well known. The efficacy of daily oral supplementation of calcium plus vitamin D3 on the incidence of hip fracture and non-vertebral fracture in older men and women with or without risk of fracture remain equivocal. This review aims to fill this gap in the understanding. A systematic review with meta-analysis. was carried out. The databases such as CINAHL, MEDLINE, PubMed, Embase, and Cochrane Library were used to search the key terms along with Wiley Online library, HSE online library and Google Scholar. Also, the reference list of the retrieved articles was scanned to identify more studies. The search was conducted from October 2019- January 2020. The Cochrane risk of bias tool was used to check the quality of the included studies. A meta-analysis using Revman 5.3 was used to analyse the data. You probably won’t have any symptoms in early-stage osteoporosis. Once your bones get weak enough, you might start having back pain from fractured or collapsed vertebrae. You may also start leaning forward in a stooped position and measure an inch or two less than before your bone loss. Figure 1 forest plot on the incidence of hip fracture A total of 12,620 older people, both men and women participated in seven RCTs evaluating the impact of combined daily oral supplementation of cholecalciferol and calcium on the incidence of hip fracture in older adults. This review identified a 25% reduction in hip fracture and a 20% reduction in all non-vertebral fractures among older adults who received Vitamin D3 and Calcium supplementation. Vitamin D3 plus calcium supplementation did not show any remarkable increase in the femoral neck bone mineral density. The subgroup analysis identified that daily oral supplementation of 800 IU of vitamin D3 plus 1200 mg of calcium is more effective in reducing hip fracture compared to 800 IU vitamin D3 plus 1000 mg of calcium. The findings of this review serve as a guideline in practice, education, research, and policy. Nonetheless, there is need for well-structured randomised controlled trials evaluating the effectiveness of Vitamin D3 plus calcium on the incidence of hip fracture and other fractures in older people. Nowson, C.A. (2010) Prevention of fractures in older people with calcium and vitamin D. Nutrients, 2(9), pp.975 The Irish Times. (2018) Retrieved from https://www.irishtimes.com/life-and-style/health-family/fitness/the- osteoporosis-time-bomb-1.3425377 on 30/10/2019. 984. I would like to extend my sincere gratitude to the exceptional Staff in the School of Nursing and Midwifery in the Royal College of Surgeons in Ireland whose lectures, guidance and supervision helped me to complete this project.