44–5.75%). Biochemical indices of calcium homeostasis normalized within 6 months of commencement of supplementation. In contrast to the Decalyos studies, the study by Dawson-Hughes et al. [17] involved healthy, elderly, ambulatory men and women aged

over 65 years (n = 389; CHIR 99021 mean age, 71 years) living in the community. Levels of insufficiency were not as profound as those documented in the Decalyos studies. Randomization was 1:1 to calcium 500 mg as calcium citrate malate plus vitamin D 700 IU or placebo, with follow-up and treatment planned for 3 years. Nonvertebral fractures were sustained by 11 (5.6%) patients in the calcium and vitamin D group, compared with 26 (13.3%) in the placebo group (RR of first fracture, 0.5; 95% CI, 0.2–0.9; p = 0.02). As in the Decalyos studies, supplementation

also led to significant improvements in biochemical parameters and BMD. Results of trials assessing fracture reduction with vitamin D alone have been equivocal [18–20]. In a OSI-027 cost recent randomized, double-blind, placebo-controlled study, vitamin D 100,000 IU every 4 months reduced the risk of first hip, wrist Torin 2 or forearm, or vertebral fractures by 33% (RR, 0.67; 95% CI, 0.48–0.93; p = 0.02) [19]. Similarly, in a controlled trial in elderly Finnish subjects, annual intramuscular injections of high doses of vitamin D (150,000–300,000 IU) reduced fracture rates by approximately 25% (RR, 0.75; 95% CI not indicated; p = 0.03) [20], although the benefits were limited to fractures of the upper limbs and ribs and to women only. No reduction in the risk of hip fractures was seen in a randomized, double-blind, placebo-controlled trial of vitamin D (400 IU/day) alone in an elderly community-dwelling population

(n = 2,578; mean age, 80 years) in the Netherlands (RR, 1.18; 95% CI, 0.81–1.71; p = 0.31) [18]. More recently, meta-analyses have confirmed that the combination Digestive enzyme of calcium and vitamin D supplementation decreases the fracture risk for postmenopausal women [21, 22]. The analyses provided evidence that these beneficial effects were not attributable to either calcium or vitamin D alone with, for example, Bischoff-Ferrari et al. and Boonen et al., suggesting that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added [21, 22]. In the meta-analysis by Bischoff-Ferrari et al., the effectiveness of vitamin D supplementation in preventing hip and nonvertebral fractures in older persons was estimated [21]. Heterogeneity among studies for both hip and nonvertebral fracture prevention was observed, which disappeared after pooling RCTs with low-dose (400 IU/day) and higher-dose vitamin D (700–800 IU/day), separately. A vitamin D dose of 700 to 800 IU/day reduced the relative risk (RR) of hip fracture by 26% (three RCTs with 5,572 persons; pooled RR, 0.74; 95% CI, 0.61–0.88) and any nonvertebral fracture by 23% (five RCTs with 6,098 persons; pooled RR, 0.77; 95% CI, 0.68–0.87) vs. calcium or placebo.