Effect of continuous combined therapy with vitamin K(2) and vitamin D(3) on bone mineral density and coagulofibrinolysis function in postmenopausal women. Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation Multivitamin and mineral supplementation is associated with the reduction of fracture risk and hospitalization rate in Chinese adult males: a randomized controlled study Vitamin K Supplement Along with Vitamin D and Calcium Reduced Serum Concentration of Undercarboxylated Osteocalcin While Increasing Bone Mineral Density in Korean Postmenopausal Women over Sixty-Years-Old Youth: a health plan-based lifestyle intervention increases bone mineral density in adolescent girls. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO Trial): A Randomized Controlled Trial 
Vitamin K1 Supplementation Retards Bone Loss in Postmenopausal Women Between 50 and 60 Years of Age
 Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis. [Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Calcium plus vitamin D supplementation and the risk of fractures. VITAL-Bone Health: rationale and design of two ancillary studies evaluating the effects of vitamin D and/or omega-3 fatty acid supplements on incident fractures and bone health outcomes in the VITamin D and OmegA-3 TriaL (VITAL). Effect of vitamin D(3) and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial--the OSTPRE-FPS.
OBJECTIVES To investigate the therapeutic effect of combined use of vitamin K(2 ) and D(3 ) on vertebral bone mineral density in postmenopausal women with osteopenia and osteoporosis . SUBJECTS AND METHODS We enrolled 172 women with vertebral bone mineral density < 0.98 g/cm(2 ) ( osteopenia and osteoporosis ) as measured by dual-energy X-ray absorptiometry . In this study , we employed the criteria for diagnosis of osteopenia and osteoporosis using dual energy X-ray absorptiometry proposed by the Japan Society of Bone Metabolism in 1996 . Subjects were r and omized into four groups ( each having 43 subjects in vitamin K(2 ) therapy group , vitamin D(3 ) therapy group , vitamin K(2 ) and D(3 ) combined therapy group , or a control group receiving dietary therapy alone ) and treated with respective agents for 2 years , with bone mineral density was measured prior to therapy and after 6 , 12 , 18 , and 24 months of treatment . The bone metabolism markers analyzed were serum type 1 collagen carboxyterminal propeptide ( P1CP ) , serum intact osteocalcin , and urinary pyridinoline . Tests of blood coagulation function consisted of measurement of activated partial thromboplastin time ( APTT ) and analysis of concentrations of antithrombin III ( AT III ) , fibrinogen , and plasminogen . RESULTS Combined therapy with vitamin K(2 ) and D(3 ) for 24 months markedly increased bone mineral density ( 4.92 + /- 7.89 % ) , while vitamin K(2 ) alone increased it only 0.135 + /- 5.44 % . The bone markers measured , revealed stimulation of both bone formation and resorption activity . We observed an increase in coagulation and fibrinolytic activity that was within the normal range , suggesting that balance was maintained in the fibrinolysis-coagulation system . CONCLUSIONS Continuous combination therapy with vitamin K(2 ) and D(3 ) may be useful for increasing vertebral bone mass in postmenopausal women . Furthermore , the increase in coagulation function observed during this therapy was within the physiological range , and no adverse reactions were observed Introduction Osteoporotic fractures in older people are a major and increasing public health problem . We examined the effect of vitamin D supplementation on fracture rate in people living in sheltered accommodation . Methods In a pragmatic double blind r and omised controlled trial of 3 years duration , we examined 3,440 people ( 2,624 women and 816 men ) living in residential or care home . We used four-monthly oral supplementation using 100,000 IU vitamin D2 ( ergocalciferol ) . As a main outcome measure , we used the incidence of first fracture using an intention to treat analysis . This was a multicentre study in 314 care homes or sheltered accommodation complexes in South Wales , UK . Results The vitamin D and placebo groups had similar baseline characteristics . In intention-to-treat analysis , 205 first fractures occurred in the intervention group during a total of 2,846 person years of follow-up ( 7 fractures per 100 people per year of follow-up ) , with 218 first fractures in the control group over 2,860 person years of follow-up . The hazard ratio of 0.95 ( 95 % confidence interval 0.79–1.15 ) for intervention compared to control was not statistically significant . ConclusionS upplementation with four-monthly 100,000 IU of oral vitamin D2 is not sufficient to affect fracture incidence among older people living in institutional care Controversy exists in the literature regarding the efficacy of bone health-related nutrients , especially calcium and vitamin D , in preventing fractures . The aim of our present study was to determine the effect of multivitamin and mineral supplementation on fracture incidence among 3,318 participants from a nutritional intervention trial in Linxian , China . A total of 1,461 men and 1,857 women were enrolled and r and omized to daily supplementation with 26 vitamins and minerals tablet or placebo pills for 6 years , followed by a 16-year post-interventional follow-up . The date s , sites , and causes of the fractures were collected retrospectively via a st and ardized question naire . Cox proportional hazard model was used to estimate hazard ratios and 95 % confidence intervals of fracture incidence in the intervention versus the placebo group . A total of 221 fractures ( 57 in men and 164 in women ) occurred during the entire study period of 21 years and 9 months . In men , the supplement reduced the risk of fracture by 63 % during the trial period , and this protective effect was sustained and statistically significant when analysis included both the trial period and 5- or 10-year post-intervention follow-up ( years 0–11 , P = 0.04 ; years 0–16 , P = 0.02 , respectively ) . The protection against fracture was not apparent > 10 years after cessation of the intervention . In women , no significant effect of supplementation on fracture incidence was seen in any of the study periods . These results demonstrate that a 6-year multivitamin and mineral intervention was associated with significant reduction of fracture risk and fracture-related hospitalization in men , but not in women There are inconsistent findings on the effects of vitamin K on bone mineral density ( BMD ) and undercarboxylated osteocalcin ( UcOC ) . The present intervention study evaluated the effect in subjects over 60-yr-old . The vitamin K group ( vitamin K + vitamin D + calcium supplement ; 15 mg of vitamin K2 [ menatetrenone ] three times daily , 400 IU of vitamin D once a day , and 315 mg of calcium twice daily ) and the control group ( vitamin D + calcium supplement ) were r and omly assigned . During the six months of treatment , seventy eight women participated ( 38 in the vitamin K group and 40 in the control group ) and 45 women completed the study . The baseline characteristics of study participants did not differ between the vitamin K and the control groups . In a per protocol analysis after 6 months , L3 bone mineral density has increased statistically significantly in the vitamin K group compared to the control group ( 0.01 ± 0.03 g/cm2 vs -0.008 ± 0.04 g/cm2 , P = 0.049 ) . UcOC concentration was also significantly decreased in the vitamin K group ( -1.6 ± 1.6 ng/dL vs -0.4 ± 1.1 ng/dL , P = 0.008 ) . In conclusion , addition of vitamin K to vitamin D and calcium supplements in the postmenopausal Korean women increase the L3 BMD and reduce the UcOC concentration OBJECTIVE To test the efficacy of a health plan-based lifestyle intervention to increase bone mineral density  in adolescent girls . DESIGN Two-year r and omized , controlled trial . SETTING Large health maintenance organization . PARTICIPANTS Girls 14 to 16 years old with body mass index below the national median .  Intervention Behavioral intervention ( bimonthly group meetings , quarterly coaching telephone calls , and weekly self-monitoring ) design ed to improve diet and increase physical activity . MAIN OUTCOME MEASURES Total bone mineral density was measured by dual-energy x-ray absorptiometry . Behavioral outcomes included intake of calcium , vitamin D , soda , and fruits and vegetables ; high-impact and strength-training physical activity ; measures of strength and fitness ; and biomarkers ( osteocalcin and naltrexone ) . RESULTS Compared with control subjects , girls in the intervention group had significantly higher bone mineral density in the spine and trochanter regions during the first study year , which was maintained during the second study year . The naltrexone biomarker demonstrated a greater relative decrease in the intervention group compared with the control group , with nonsignificant changes in osteocalcin consistent with more bone building in the intervention group . Participants in the intervention group reported significantly greater consumption of calcium in both study years , vitamin D in the first year , and fruits and vegetables in both years . We found no effect on soda consumption or target exercise rates . CONCLUSIONS A comprehensive health care-based lifestyle intervention can effectively improve dietary intake and increase bone mineral gains in adolescent girls . To our knowledge , this study is the first to significantly improve bone mass in adolescent girls in a non-school-based intervention . Trial Registration Clinical Trials.gov Identifier : NCT00067600 Abstract Objective To assess whether supplementation with calcium and cholecaliferol ( vitamin D3 ) reduces the risk of fracture in women with one or more risk factors for fracture of the hip . Design Pragmatic open r and omised controlled trial . Setting Practice nurse led clinics in primary care . Participants 3314 women aged 70 and over with one or more risk factors for hip fracture : any previous fracture , low body weight ( < 58 kg ) , smoker , family history of hip fracture , or fair or poor self reported health . Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls , or leaflet only ( control group ) . Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment , falls , and quality of life ( measured with the SF-12 ) . Results 69 % of the women who completed the follow-up question naire at 24 months were still taking supplements ( 55 % with inclusion of r and omised participants known to be alive ) . After a median follow-up of 25 months ( range 18 to 42 months ) , clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures ( odds ratio for fracture in supplemented group 1.01 , 95 % confidence interval 0.71 to 1.43 ) . The odds ratio for hip fracture was 0.75 ( 0.31 to 1.78 ) . The odds of a woman having a fall at six and 12 months was 0.99 and 0.98 , respectively . Quality of life did not significantly differ between the groups . Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture . Registration IS RCT N26118436 , controlled trials registry Background Few studies have systematic ally examined whether knowledge translation ( KT ) strategies can be successfully implemented within the long-term care ( LTC ) setting . In this study , we examined the effectiveness of a multifaceted , interdisciplinary KT intervention for improving the prescribing of vitamin D , calcium and osteoporosis medications over 12-months . Methods We conducted a pilot , cluster r and omized controlled trial in 40 LTC homes ( 21 control ; 19 intervention ) in Ontario , Canada . LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider . Participants were interdisciplinary care teams ( physicians , nurses , consultant pharmacists , and other staff ) who met quarterly . Intervention homes participated in three educational meetings over 12 months , including a st and ardized presentation led by expert opinion leaders , action planning for quality improvement , and audit and feedback review . Control homes did not receive any additional intervention  . Resident-level prescribing and clinical outcomes were collected from the pharmacy data base ; data collectors and analysts were blinded . In addition to feasibility measures , study outcomes were the proportion of residents taking vitamin D ( ≥800 IU/daily ; primary ) , calcium ≥500 mg/day and osteoporosis medications ( high-risk residents ) over 12 months . Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes . Results At baseline , 5,478 residents , mean age 84.4 ( st and ard deviation ( SD ) 10.9 ) , 71 % female , resided in 40 LTC homes , mean size = 137 beds ( SD 76.7 ) . In the intention-to-treat analysis ( 21 control ; 19 intervention clusters ) , the intervention result ed in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D ( odds ratio ( OR ) 1.82 , 95 % confidence interval ( CI ) : 1.12 , 2.96 ) and calcium ( OR 1.33 , 95 % CI : 1.01 , 1.74 ) , but not for osteoporosis medications ( OR 1.17 , 95 % CI : 0.91 , 1.51 ) . In secondary analyses , excluding seven nonparticipating intervention homes , ORs were 3.06 ( 95 % CI : 2.18 , 4.29 ) , 1.57 ( 95 % CI : 1.12 , 2.21 ) , 1.20 ( 95 % CI : 0.90 , 1.60 ) for vitamin D , calcium and osteoporosis medications , respectively . Conclusions Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement . Trial Registration Clinical Trials.gov : NCT01398527 . Registered : 19 July 2011 Abstract Objective : To determine the effect of four monthly vitamin D supplementation on the rate of fractures in men and women aged 65 years and over living in the community . Design : R and omised double blind controlled trial of 100 000 IU oral vitamin D3 ( cholecalciferol ) supplementation or matching placebo every four months over five years . Setting and participants : 2686 people ( 2037 men and 649 women ) aged 65 - 85 years living in the general community , recruited from the British doctors register and a general practice register in Suffolk . Main outcome measures : Fracture incidence and total mortality by cause . Results : After five years 268 men and women had incident fractures , of whom 147 had fractures in common osteoporotic sites ( hip , wrist or forearm , or vertebrae ) . Relative risks in the vitamin D group compared with the placebo group were 0.78 ( 95 % confidence interval 0.61 to 0.99 , P=0.04 ) for any first fracture and 0.67 ( 0.48 to 0.93 , P=0.02 ) for first hip , wrist or forearm , or vertebral fracture . 471 participants died . The relative risk for total mortality in the vitamin D group compared with the placebo group was 0.88 ( 0.74 to 1.06 , P=0.18 ) . Findings were consistent in men and women and in doctors and the general practice population . Conclusion : Four monthly supplementation with 100 000 IU oral vitamin D may prevent fractures without adverse effects in men and women living in the general community . What is already known in this topic Vitamin D and calcium supplements are effective in preventing fractures in elderly women Whether isolated vitamin D supplementation prevents fractures is not clear What this paper adds Four monthly oral supplementation with 100 000 IU vitamin D reduces fractures in men and women aged over 65 living in the general community  Total fracture incidence was reduced by 22 % and fractures in major osteoporotic sites by 33 CONTEXT There has been a resurgence of vitamin D deficiency rickets throughout the developed world , with infants and adolescents being primarily affected . Adolescence is a crucial period for muscle and bone mineral accumulation . OBJECTIVE The aim was to determine the effect of vitamin D supplementation on the adolescent musculoskeletal system . DESIGN AND SETTING We conducted a community-based , double-blind , r and omized controlled trial in a secondary school . PARTICIPANTS Postmenarchal 12- to 14-yr-old females participated in the trial . Ninety-nine were screened , 73 were included in r and omized controlled trial , and 69 completed the trial . There were no adverse events . INTERVENTION Four doses of 150,000 IU vitamin D(2 ) ( ergocalciferol ) were given over 1 yr . MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry , peripheral quantitative computed tomography , and jumping mechanography were used . RESULTS At follow-up , 25-hydroxyvitamin D [ 25(OH)D ] status was 56.0 ± 8.9 nmol/liter in the intervention group and 15.8 ± 6.6 nmol/liter in controls . There were no effects of supplementation on bone ; however , for muscle function , efficiency of movement improved in the vitamin D-treated group . There was an interaction between baseline 25(OH)D concentration and response to vitamin D supplementation for muscle jump velocity . CONCLUSIONS Despite improvements in 25(OH)D status , treatment with vitamin D(2 ) was not shown to increase mineral accretion , bone geometry or strength , muscle force , or power . There were greater increases in jump velocity in girls with the lowest baseline 25(OH)D concentrations . Lack of effect of intervention after the period of peak mineral and muscle mass accretion suggests that earlier action is required Background Vitamin K has been widely promoted as a supplement for decreasing bone loss in postmenopausal women , but the long-term benefits and potential harms are unknown . This study was conducted to determine whether daily high-dose vitamin K1 supplementation safely reduces bone loss , bone turnover , and fractures . Methods and Findings This single-center study was design ed as a 2-y r and omized , placebo-controlled , double-blind trial , extended for earlier participants for up to an additional 2 y because of interest in long-term safety and fractures . A total of 440 postmenopausal women with osteopenia were r and omized to either 5 mg of vitamin K1 or placebo daily . Primary outcomes were changes in BMD at the lumbar spine and total hip at 2 y. Secondary outcomes included changes in BMD at other sites and other time points , bone turnover markers , height , fractures , adverse effects , and health-related quality of life . This study has a power of 90 % to detect 3 % differences in BMD between the two groups . The women in this study were vitamin D replete , with a mean serum 25-hydroxyvitamin D level of 77 nmol/l at baseline . Over 2 y , BMD decreased by −1.28 % and −1.22 % ( p = 0.84 ) ( difference of −0.06 % ; 95 % confidence interval [ CI ] −0.67 % to 0.54 % ) at the lumbar spine and −0.69 % and −0.88 % ( p = 0.51 ) ( difference of 0.19 % ; 95 % CI −0.37 % to 0.75 % ) at the total hip in the vitamin K and placebo groups , respectively . There were no significant differences in changes in BMD at any site between the two groups over the 2- to 4-y period . Daily vitamin K1 supplementation  increased serum vitamin K1 levels by 10-fold , and decreased the percentage of undercarboxylated osteocalcin and total osteocalcin levels ( bone formation marker ) . However , C-telopeptide levels ( bone resorption marker ) were not significantly different between the two groups . Fewer women in the vitamin K group had clinical fractures ( nine versus 20 , p = 0.04 ) and fewer had cancers ( three versus 12 , p = 0.02 ) . Vitamin K supplements  were well-tolerated over the 4-y period . There were no significant differences in adverse effects or health-related quality of life between the two groups . The study was not powered to examine fractures or cancers , and their numbers were small . Conclusions Daily 5 mg of vitamin K1 supplementation for 2 to 4 y does not protect against age-related decline in BMD , but may protect against fractures and cancers in postmenopausal women with osteopenia . More studies are needed to further examine the effect of vitamin K on fractures and cancers . Trial registration : Clinical Trials.gov ( # NCT00150969 ) and Current Controlled Trials ( # IS RCT N61708241 Although several observational studies have demonstrated an association between vitamin K status and bone mineral density ( BMD ) in postmenopausal women , no placebo-controlled intervention trials of the effect of vitamin K1 supplementation on bone loss have been reported thus far . In the trial presented here we have investigated the potential complementary effect of vitamin K1 ( 1 mg/day ) and a mineral + vitamin D supplement ( 8 µg/day ) on postmenopausal bone loss . The design of our study was a r and omized , double-blind , placebo-controlled intervention study ; 181 healthy postmenopausal women between 50 and 60 years old were recruited , 155 of whom completed the study . During the 3-year treatment period , participants received a daily supplement containing either placebo , or calcium , magnesium , zinc , and vitamin D ( MD group ) , or the same formulation with additional vitamin K1 ( MDK group ) . The main outcome was the change in BMD of the femoral neck and lumbar spine after 3 years , as measured by DXA . The group receiving the supplement containing additional vitamin K1  showed reduced bone loss of the femoral neck : after 3 years the difference between the MDK and the placebo group was 1.7 % ( 95 % Cl : 0.35–3.44 ) and that between the MDK and MD group was 1.3 % ( 95 % Cl : 0.10–3.41 ) . No significant differences were observed among the three groups with respect to change of BMD at the site of the lumbar spine . If co-administered with minerals and vitamin D , vitamin K1 may substantially contribute to reducing postmenopausal bone loss at the site of the femoral neck Summary Vitamin K mediates the synthesis of proteins regulating bone metabolism . We have tested whether high vitamin K2 intake promotes bone mineral density and bone strength . Results showed that K2 improved BMC and femoral neck width , but not DXA-BMD . Hence high vitamin K2 intake may contribute to preventing postmenopausal bone loss . Introduction Vitamin K is involved in the synthesis of several proteins in bone . The importance of K vitamins for optimal bone health has been suggested by population -based studies , but intervention studies with DXA-BMD as a clinical endpoint have shown contradicting results . Unlike BMC , DXA-BMD does not take into account the geometry ( size , thickness ) of bone , which has an independent contribution to bone strength and fracture risk . Here we have tested whether BMC and femoral neck width are affected by high vitamin K intake . Methods A r and omized clinical intervention study among 325 postmenopausal women receiving either placebo or 45 mg/day of vitamin K2 ( MK-4 , menatetrenone ) during three years .  BMC and hip geometry were assessed by DXA . Bone strength indices were calculated from DXA-BMD , femoral neck width ( FNW ) and hip axis length ( HAL ) . Results K2 did not affect the DXA-BMD , but BMC and the FNW had increased relative to placebo . In the K2-treated group hip bone strength remained unchanged during the 3-year intervention period , whereas in the placebo group bone strength decreased significantly . Conclusions Vitamin K2 helps maintaining bone strength at the site of the femoral neck in postmenopausal women by improving BMC and FNW , whereas it has little effect on DXA-BMD INTRODUCTION It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation . AIM To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation , using clinical parameters like gingival index ( GI ) , oral hygiene index-simplified ( OHIS ) , probing pocket depth ( PPD ) , clinical attachment level ( CAL ) and bone density ( BD ) . Also , to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density ( BD ) . DESIGN AND SETTING S A nonr and omised clinical trial done in Amrita School of dentistry , Kochi , India . MATERIAL S AND METHODS Group A taking vitamin D ( 250IU/day ) and calcium ( 500 mg/day ) supplementation  , and Group B were not taking oral supplementation . All subjects had at least one or more teeth with chronic moderate periodontitis . Digital Orthopantomogram images were taken to assess bone density . Data were collected at baseline and three months . STATISTICAL ANALYSIS USED OHI-S , GI , PPD , CAL , and Bone Densities ( BD ) were calculated per group . Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test . Intragroup comparison of parameters at recall interval was done using Paired sample t-test . The results were considered statistically significant when p-value was < 0.05 . RESULTS Both Groups showed significant change in the periodontal parameters and bone density after three months and intragroup comparison showed highly significant results for vitamin D group in relation to GI , OHI S and bone density . CONCLUSION Calcium and vitamin D supplementation has got a positive effect on periodontal health and it can be used as an adjunct to non surgical periodontal therapy One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo .  Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . ) RATIONALE Although vitamin D is widely used to promote skeletal health , definitive data on benefits and risks of supplemental vitamin D alone on bone are lacking . Results from large , r and omized controlled trials in the general population are sparse . Data on the effects of supplemental omega-3 fatty acids ( FAs ) on bone are also limited . DESIGN The VITamin D and OmegA-3 TriaL ( VITAL ) is a double-blind , placebo-controlled trial assessing the role of vitamin D3 ( 2000 IU/d ) and omega-3 FA ( 1g/d ) supplements in reducing risks of cancer and cardiovascular disease among U.S. men aged ≥50 and women aged ≥55 . To comprehensively test effects of supplemental vitamin D and /or omega-3 FAs on skeletal health , the VITAL : Effects on Fractures ancillary study is determining the effects of these supplements on incident fractures among 25,875 participants enrolled in the parent trial . Study investigators adjudicate fractures through a detailed review of medical records and radiological images ( hip and femur ) . In a complementary ancillary , VITAL : Effects on Structure and Architecture is determining the effects of supplemental vitamin D and /or omega-3 FAs on bone with detailed phenotyping during in-person visits . Comprehensive assessment s of bone density , turnover , structure/architecture , body composition , and physical performance are being performed at baseline and 2 years post-r and omization . CONCLUSION Results from these studies will clarify the relationship between supplemental vitamin D and /or omega-3 FAs on bone health outcomes , and inform clinical care and public health guidelines on the use of supplemental vitamin D for the primary prevention of fractures in women and men Antifracture efficacy of high-dose vitamin D ( 800 IU ) and calcium ( 1000 mg ) remains controversial . To determine whether daily 800 IU of vitamin D and 1000 mg of calcium supplementation prevents fractures , we r and omized 3432 women of the population -based Osteoporosis Risk Factor and Prevention ( OSTPRE ) Study cohort ( ages 65 to 71 years ) living in the region of northern Savonia , Finl and ( latitude 62 degrees to 64 degrees N ) for 3 years to receive 800 IU of cholecalciferol and 1000 mg of calcium as calcium carbonate or to a control group that did not receive placebo . The main outcome measure was incident fractures . Fracture data were collected in telephone interviews and vali date d. Data on 3195 women , 1586 in the intervention group and 1609 in the control group , were available for analysis . In adjusted Cox proportional hazards models , the risk of any fracture decreased in the vitamin D and calcium group by 17 % [ adjusted hazard ratio ( aHR ) = 0.83 ; 95 % confidence interval ( CI ) 0.61 - 1.12 ] , and the risk of any nonvertebral fracture decreased by 13 % ( aHR = 0.87 ; 95 % CI 0.63 - 1.19 ) . The risk of distal forearm fractures decreased by 30 % ( aHR = 0.70 ; 95 % CI 0.41 - 1.20 ) , and the risk of any upper extremity fractures decreased by 25 % ( aHR = 0.75 ; 95 % CI 0.49 - 1.16 ) , whereas the risk of lower extremity fractures remained essentially equal ( aHR = 1.02 ; 95 % CI 0.58 - 1.80 ) . None of these effects reached statistical significance . In conclusion , this study did not produce statistically significant evidence that vitamin D and calcium supplementation prevents fractures in a 65- to 71-year-old general population of postmenopausal women
Summary Vitamin K may affect  bone mineral density and fracture incidence .
Since publication of a previous systematic review the integrity of some of the previous evidence has been question ed and further trials have been published .
Introduction This systematic review was design ed to assess the effectiveness of oral vitamin K supplementation for increasing bone mineral density  and reducing fractures in adults .