title: 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. Vitamin D: do we get enough? Vitamin D3 supplementation has no effect on conventional cardiovascular risk factors: a parallel-group, double-blind, placebo-controlled RCT. Muscle architecture and strength: adaptations to short-term resistance training in older adults. Treatment of Vitamin D Deficiency Increases Lower Limb Muscle Strength in Institutionalized Older People Independently of Regular Physical Activity: A Randomized Double-Blind Controlled Trial Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects The efficacy and safety of calcitriol and/or Caltrate D in elderly Chinese women with low bone mass Calcium intake in health maintenance – a systematic review CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. Combination of alfacalcidol with calcium can improve quadriceps muscle strength in elderly ambulatory Thai women who have hypovitaminosis D: a randomized controlled trial. Physiological effects beyond the significant gain in muscle mass in sarcopenic elderly men: evidence from a randomized clinical trial using a protein-rich food High-dose oral vitamin D3 supplementation in the elderly Effects of Alfacalcidol on Back Extensor Strength Gained Through Back Extensor Exercise in Postmenopausal Women with Osteoporosis Vitamin D supplementation improves neuromuscular function in older people who fall. Once-weekly dose of 8400 IU vitamin D(3) compared with placebo: effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. Effects of vitamin D supplementation on neuroplasticity in older adults: a double-blinded, placebo-controlled randomised trial Low-Dose Vitamin D Prevents Muscular Atrophy and Reduces Falls and Hip Fractures in Women after Stroke: A Randomized Controlled Trial The impact of sarcopenia on a physical activity intervention: The lifestyle interventions and independence for elders pilot study (LIFE-P) Muscle strength and mobility in vitamin D-insufficient female geriatric patients: a randomized controlled trial on vitamin D and calcium supplementation Effects of three-monthly oral 150,000 IU cholecalciferol supplementation on falls, mobility, and muscle strength in older postmenopausal women: a randomized controlled trial. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals Differences in vitamin D3 dosing regimens in a geriatric community-dwelling population. A parallel group double-blind RCT of vitamin D3 assessing physical function: is the biochemical response to treatment affected by overweight and obesity? The effects of calcitriol on falls and fractures and physical performance tests Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men. The role of vitamin D in improving physical performance in the elderly. Estimation of the dietary requirement for vitamin D in free-living adults >=64 y of age. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. Calcium, vitamin D supplementation, and physical function in the Women's Health Initiative. Oral supplementation with 25(OH)D3 versus vitamin D3: effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity. A randomized study on the effect of vitamin D₃ supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women.
abstract: An unexplained loss of muscle strength occurs with aging . Vitamin D deficiency can cause myopathy and administration of 1,25-dihydroxyvitamin D3 [ 1,25-(OH2)D3 ] to persons with low serum concentrations can improve strength . To test the hypothesis that the weakness associated with aging is in part due to inadequate serum concentrations of [ 1,25-(OH2)D3 ] , we conducted a r and omized , controlled , double blinded trial in 98 men and women volunteers over 69 yr old . Treatment consisted of 0.25 micrograms 1,25-(OH)2D3 , orally , twice per day or identical placebo for 6 months .  Leg muscle strength of the quadriceps was measured with an isokinetic dynamometer . There was no difference between the two groups at 1 week , 1 month , or 6 months of treatment in any of the measures of muscle strength . We conclude that oral administration of 0.5 micrograms 1,25-(OH)2D3/day does not improve muscle strength in older persons . Further research is needed to determine the etiology of the decline in muscle strength associated with aging Summary On September 29 , 2011 , acknowledged experts in the field of vitamin D , mainly European , were brought together in order to discuss the recent scientific advances in relation to vitamin D : the current requirements and associations with various health outcomes . In this article , the discussion s result ing from the meeting are summarized . Introduction Several groups at risk for developing vitamin D insufficiency have been identified . Accordingly , review s indicate that a significant percentage of the population worldwide have serum 25-hydroxyvitamin D levels below 50 nmol/l . In addition to the role of vitamin D in bone health , recent studies suggest that it may play a pivotal role in other systems , e.g. , the cardiovascular system , pancreas , muscle , immune system and brain . Most evidence , however , is obtained from observational studies and yet inconclusive . Methods To exchange and broaden knowledge on the requirements for vitamin D and its effect on various health outcomes , a workshop entitled “ Vitamin D Expert Meeting : Do we get enough ? ” , was organized . Results Despite low vitamin D levels worldwide , consensus on the definition of deficiency is not yet reached . In order to define cut-off points for vitamin D whilst taking into account extraskeletal health effects , r and omized controlled trials in these fields are warranted . The experts do emphasize that there is evidence to suggest an important role for vitamin D in the maintenance of optimal bone health at all ages and that vitamin D supplementation , in most studies co-administered with calcium , reduces fracture risk in the senior population . Conclusion To reach a serum 25-hydroxyvitamin D level of 50 nmol/l older adults aged ≥65 years are therefore recommended to meet a mean daily vitamin D intake of 20 μg ( 800 IU ) , which is best achieved with a supplement CONTEXT Observational studies show an association between low vitamin D status assessed by circulating 25-hydroxyvitamin D and cardiovascular events and mortality . Data from r and omized controlled trials are limited . OBJECTIVE The aim of this study was to test whether daily doses of vitamin D(3 ) at 400 or 1000 IU/d for 1 yr affected conventional markers of cardiovascular disease ( CVD ) risk . DESIGN We conducted a parallel-group , double-blind , placebo-controlled r and omized controlled trial . R and omization was computer generated . Participants and study investigators were blinded to intervention groupings throughout the trial . SETTING The study was conducted at the Clinical Research Facility , University of Aberdeen , United Kingdom . PARTICIPANTS A total of 305 healthy postmenopausal women aged 60 - 70 yr were recruited for the study . INTERVENTION Each woman received a daily capsule of 400 or 1000 IU vitamin D(3 ) or placebo r and omly allocated . MAIN OUTCOME MEASURES Primary outcomes were serum lipid profile [ total , high-density lipoprotein , and low-density lipoprotein cholesterol ; triglycerides ; and apolipoproteins A-1 and B100 ] , insulin resistance ( homeostatic model assessment ) , inflammatory biomarkers ( high-sensitivity C-reactive protein , IL-6 , soluble intracellular adhesion molecule-1 ) , and blood pressure . RESULTS A total of 265 ( 87 % ) participants completed all study visits . Small differences between groups for serum apolipoprotein B100 change [ repeated measures ANOVA , P=0.04 ; mean ( sd ) , -1.0 ( 10.0 ) mg/dl ( 400 IU ) ; -1.0 ( 10.0 ) mg/dl ( 1000 IU ) ; and + 0.02 ( 10.0 ) mg/dl ( placebo ) ] were not considered clinical ly significant . Other systemic markers for CVD risk remained unchanged . There was significant seasonal variation in systolic and diastolic blood pressure independent of vitamin D dose ( P<0.001 , linear mixed model ) . Mean ( sd ) reduction in systolic blood pressure from winter to summer was -6.6 ( 10.8 ) mm Hg . CONCLUSIONS Improving vitamin D status through dietary supplementation is unlikely to reduce CVD risk factors . Confounding of seasonality should be recognized and addressed in future studies of vitamin INTRODUCTION Muscle morphology and architecture changes in response to 6 weeks of progressive resistance training were examined in healthy older adults . METHODS In this r and omized , controlled design , muscle strength , quality , and architecture were evaluated with knee extension , DEXA , and ultrasound , respectively , in 25 older adults . RESULTS Resistance training result ed in significant increases in strength and muscle quality of 32 % and 31 % , respectively . Cross-sectional area of the vastus lateralis increased by 7.4 % ( p ≤ 0.05 ) . Physiological cross-sectional area ( PCSA ) of the thigh , a composite measure of muscle architecture , was related significantly to strength ( r = 0.57 ; p ≤ 0.01 ) and demonstrated a significant interaction after training ( p ≤ 0.05 ) . Change in PCSA of the vastus lateralis was associated with change in strength independent of any other measure . CONCLUSIONS Six weeks of resistance training was effective at increasing strength , muscle quality , and muscle morphology in older adult men and women Aims : To investigate the effects of a 6-month supplementation with calcium and cholecalciferol on biochemical parameters and muscle strength of institutionalized elderly . Methods : This prospect i ve , double-blind , placebo-controlled , r and omized trial included Brazilian institutionalized people ≥60 years of age receiving a 6-month supplementation ( December to May ) of daily calcium plus monthly placebo ( calcium/placebo group ) or daily calcium plus oral cholecalciferol ( 150,000 IU once a month during the first 2 months , followed by 90,000 IU once a month for the last 4 months ; calcium/vitamin D group ) . Fasting blood sample s for 25(OH)D , PTH and calcium determination were collected ( n = 56 ) and muscle tests were performed ( n = 46 ) to measure the strength of hip flexors ( SHF ) and knee extensors ( SKE ) before ( baseline ) and after the 6-month intervention ( 6 months ) . Results : Due to seasonal variations , serum 25(OH)D significantly enhanced in both groups after treatment , but the calcium/vitamin D group had significantly higher 25 (OH)D levels than the calcium/placebo group ( 84 vs. 33 % , respectively ; p < 0.0001 ) . No cases of hypercalcemia were observed . While the calcium/placebo group showed no improvement in SHF and SKE at 6 months ( p = 0.93 and p = 0.61 , respectively ) , SHF was increased in the calcium/vitamin D group by 16.4 % ( p = 0.0001 ) and SKE by 24.6 % ( p = 0.0007 ) . Conclusions : The suggested cholecalciferol supplementation was safe and efficient in enhancing 25(OH)D levels and lower limb muscle strength in the elderly , in the absence of any regular physical exercise practice The aim was to assess the effects of resistance training and vitamin D supplementation on physical performance of healthy elderly subjects . Ninety-six subjects , aged 70 years or more with 25 OH vitamin D levels of 16 ng/ml or less , were r and omized to a  resistance training or control group . Trained and control groups were further r and omized to receive in a double blind fashion , vitamin D 400 IU plus 800 mg of calcium per day or calcium alone . Subjects were followed for nine months . Serum 25 OH vitamin D increased from 12.4+/-2.2 to 25.8+/-6.5 ng/ml among subjects supplemented with vitamin D. Trained subjects had significant improvements in quadriceps muscle strength , the short physical performance test and timed up and go . The latter improved more in trained subjects supplemented with vitamin D. At the end of the follow up , gait speed was higher among subjects supplemented with vitamin ( whether trained or not ) than in non-supplemented subjects ( 838+/-147 and 768+/-127 m/12 min , respectively , p=0.02 ) . Romberg ratio was lower among supplemented controls than non-supplemented trained subjects ( 128+/-40 % and 144+/-37 % , respectively , p=0.05 ) . In conclusion , vitamin D supplementation improved gait speed and body sway , and training improved muscle strength Abstract Aim : To observe the efficacy and safety of Rocaltrol ( calcitriol ) and /or Caltrate D ( calicum carbonate plus vitamin D ) in elderly Chinese women with osteopenia or osteoporosis . Methods : One hundred fifty Chinese women aged over 65 years with osteopenia or osteoporosis from three centers were r and omly divided into two groups . Seventy-six participants received Caltrate D as one pill daily ; the other 74 participants received 0.25 μg Caltrate D plus Rocaltrol daily . The changes in bone mineral density ( BMD ) served as primary end-points . Height changes , the presence of new vertebral fractures , muscle strength and balance were evaluated . Results : The following are the mean percentage changes ( and SD ) in BMD over 12 months : at L2-L4 , 0.83±3.88 in the Caltrate D group and 2.84±4.04 in the Rocaltrol+Caltrate D group ( P=0.003 , by ANCOVA ) ; at the femoral neck , 0.04±3.94 in the Caltrate D group and 2.01±5.45 in the Rocaltrol+Caltrate D group ( P=0.085 , by ANCOVA ) ; and in the trochanter , 1.59±4.57 in the Caltrate D group and 3.76±6.25 in the Rocaltrol+Caltrate D group ( P=0.053 , by ANCOVA ) . The st and and maximal forward reach test ( SMFRT ) was significantly enhanced in both groups during the 12 months of treatment , but no significant differences were found between these two groups . No severe adverse event related to these medications occurred throughout the study . Conclusion : Treatment with Rocaltrol plus Caltrate D or Caltrate D for 12 months in elderly Chinese postmenopausal women  effectively increased BMD at the lumbar spine . Rocaltrol plus Caltrate D was more effective at the lumbar spine than Caltrate D alone Background Calcium ( Ca ) is an essential nutrient for the human body . Despite lively research , there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases . Objectives The aim was to conduct a review to up date requirements and desirable or harmful health effects of Ca on the current scientific evidence . Methods We search ed Medline and Swemed from January 2000 to December 2011 and included all systematic review s that reported Ca supplementation or usual Ca intake on health outcomes . Meta-analyses , r and omized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011 . This review concentrated on studies reporting independent effects of Ca , although a few recent trials report sole effects of Ca on health outcomes , most trials use Ca in combination with vitamin D vs. placebo . Results In total , we review ed 38 studies addressing the effects of Ca on bone , pregnancy-related outcomes , cancers , cardiovascular outcomes , obesity , and mortality .  There was a lot of heterogeneity in the study protocol s , which made it difficult to draw any strong conclusions . According to the literature , high Ca intake seems to have a small positive effect on bone mineral content ( BMC ) or bone mineral density ( BMD ) in children and postmenopausal women . We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men . Also , the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent . Maternal diet may influence the peak bone mass of offspring but more studies are required . There was no overall effect of Ca intake on cancers . Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies . No associations were found with other cancers . We found no consistent association between cardiovascular outcomes and  Ca  intake except for blood pressure . A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation . Review ed studies did not show consistent evidence relating Ca intake to either mortality or obesity . Conclusion Based on this evidence , there is no need to change the Nordic recommendations for Ca intake . However , due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . CONTEXT Improving vitamin D status may be an important modifiable risk factor to reduce falls and fractures ; however , adherence to daily supplementation is typically poor . OBJECTIVE To determine whether a single annual dose of 500,000 IU of cholecalciferol administered orally to older women in autumn or winter would improve adherence and reduce the risk of falls and fracture . DESIGN , SETTING , AND PARTICIPANTS A double-blind , placebo-controlled trial of 2256 community-dwelling women , aged 70 years or older , considered to be at high risk of fracture were recruited from June 2003 to June 2005 and were r and omly assigned to receive cholecalciferol or placebo each autumn to winter for 3 to 5 years . The study concluded in 2008 . INTERVENTION 500,000 IU of cholecalciferol or placebo . MAIN OUTCOME MEASURES Falls and fractures were ascertained using monthly calendars ; details were confirmed by telephone interview . Fractures were radiologically confirmed . In a sub study , 137 r and omly selected participants underwent serial blood sampling for 25-hydroxycholecalciferol and parathyroid hormone levels . RESULTS Women in the cholecalciferol ( vitamin D ) group had 171 fractures vs 135 in the placebo group ; 837 women in the vitamin D group fell 2892 times ( rate , 83.4 per 100 person-years ) while 769 women in the placebo group fell 2512 times ( rate , 72.7 per 100 person-years ; incidence rate ratio [ RR ] , 1.15 ; 95 % confidence interval [ CI ] , 1.02 - 1.30 ; P = .03 ) . The incidence RR for fracture in the vitamin D group was 1.26 ( 95 % CI , 1.00 - 1.59 ; P = .047 ) vs the placebo group ( rates per 100 person-years , 4.9 vitamin D vs 3.9 placebo ) . A temporal pattern was observed in a post hoc analysis of falls . The incidence RR of falling in the vitamin D group vs the placebo group was 1.31 in the first 3 months after dosing and 1.13 during the following 9 months ( test for homogeneity ; P = .02 ) . In the sub study , the median baseline serum 25-hydroxycholecalciferol was 49 nmol/L. Less than 3 % of the sub study participants had 25-hydroxycholecalciferol levels lower than 25 nmol/L. In the vitamin D group , 25-hydroxycholecalciferol levels increased at 1 month after dosing to approximately 120 nmol/L , were approximately 90 nmol/L at 3 months , and remained higher than the placebo group 12 months after dosing . CONCLUSION Among older community-dwelling women , annual oral administration of high-dose cholecalciferol result ed in an increased risk of falls and fractures . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12605000658617 ; is rct n.org Identifier : IS RCT N83409867 OBJECTIVE The purpose of this study was to evaluate the efficacy of alfacalcidol and calcium on the improvement of muscle strength in ambulatory elderly Thai women in age group of 65 or more who have hypovitaminosis D. MATERIAL AND METHOD Seventy-two postmenopausal women age 65 years or more were enrolled to this study . Blood was collected from all participants for measured of 25(OH)D3 , intact PTH and vitamin D receptor ( VDR ) genotypes . After blood collection , the quadriceps muscle strength was measured using the isokinetic dynamometer device . There were 42 subjects who satisfy the eligible criteria and agreed to participate in the experimental r and omized controlled study . These subjects were r and omized into two groups , one received calcium 1500 g/day combined with alfacalcidol 0.5 mg/day . Another group received calcium 1500 g/day with placebo . RESULTS After 12 weeks of intervention , 40 subjects had the second muscle strength measurement ( 2 dropped out ) . By ANCOVA analysis , there were significant improvement of muscle strength in the group that received alfacalcidol compared to placebo in both 30 degrees/sec ( 20.28 vs.16.29 , p = 0.025 ) and 60 degrees/sec ( 20.32 vs. 15.05 , p = 0.002 ) angular velocities . CONCLUSION Daily doses of 0.5 mg alfacalcidol with calcium effectively improved muscle strength in elderly Thai women who had low level of 25(OH)D3 compared to calcium alone Background Sarcopenia is strongly associated with an inadequate intake of dietary protein . Dietary protein supplementation boosts muscle-protein synthesis and increases muscle mass in the elderly . This study tested whether adding a protein-rich food , ricotta cheese , to the habitual diet increased total appendicular skeletal muscle mass and strength in elderly people . Methods Participants ( n = 40 ) , were sarcopenic elderly men and women over 60 years of age . Two comparison groups were formed at r and om and followed for 3 months : the intervention group received 210 g/day of ricotta cheese plus the habitual diet , while the control group followed the habitual diet with no additional intervention . Total appendicular skeletal muscle ( TASM ) was assessed by dual-energy X-ray absorptiometry , while strength was measured using a h and held dynamometer at baseline and after the intervention period . The primary outcomes were the percentage of relative change in TASM and strength . Results The percentage of relative change in TASM was not significant between the groups after the intervention period . Muscle strength improved in the intervention group , but showed only a tendency towards significance ( P = 0.06 ) . Secondary analysis showed that the men in the intervention group gained 270 g in TASM compared to those in the control group , and improved their fasting insulin levels ( P = 0.05 ) , muscle strength , lean body mass in the arms , and body weight variables . Conclusion The results of this study indicate that a nutritional intervention using a high- quality protein food , specifically ricotta cheese , in order to increase the amount of protein intake might not be regarded as fully promising in elderly men and women with sarcopenia . However , the gender effects on muscle strength , lean tissue in the arms , homeostatic assessment of insulin resistance , and body weight detected in this study suggest that additional research is needed on elderly male subjects with sarcopenia Summary Daily dosing with vitamin D often fails to achieve optimal outcomes , and it is uncertain what the target level of 25-hydroxyvitamin D should be . This study found that large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels , and that monthly dosing is similarly effective after 3–5 months . With baseline 25OHD > 50 nmol/L , vitamin D supplementation does not reduce PTH levels . Introduction There is concern that vitamin D supplementation doses are frequently inadequate , and that compliance with daily medication is likely to be suboptimal . Methods This r and omized double-blind trial compares responses to three high-dose vitamin D3 regimens and estimates optimal 25-hydroxyvitamin D ( 25OHD ) levels , from changes in parathyroid hormone ( PTH ) , and procollagen type I amino-terminal propeptide ( P1NP ) in relation to baseline 25OHD . Sixty-three elderly participants were r and omized to three regimens of vitamin D supplementation : a 500,000-IU loading dose ; the loading dose plus 50,000 IU/month ; or 50,000 IU/month . Results The Loading and Loading + Monthly groups showed increases in 25OHD of 58 ± 28 nmol/L from baseline to 1 month . Thereafter , levels gradually declined to plateaus of 69 ± 5 nmol/L and 91 ± 4 nmol/l , respectively . In the Monthly group , 25OHD reached a plateau of ~80 ± 20 nmol/L at 3–5 months . There were no changes in serum calcium concentrations . PTH and P1NP were only suppressed by vitamin D treatment in those with baseline 25OHD levels < 50 and < 30 nmol/L , respectively . Conclusions Large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels in the frail elderly . Monthly dosing is similarly effective and safe , but takes 3–5 months for plateau 25OHD levels to be reached Objective The aim of this study was to investigate the additive effect of the active form of vitamin D3 on the gain in back extensor strength through a back extensor exercise . Design A total of 107 postmenopausal women with osteoporosis were r and omly divided into two groups : the D3 group and the control group . Both groups were treated with calcium and alendronate and undertook the back extensor exercise . Alfacalcidol was prescribed only to the D3 group . Results There was no significant difference in the demographic data between the two groups . Ninety-four participants who completed a 4-mo intervention were subjected to per- protocol analysis . There was no significant difference in the improvement in back extensor strength between two the groups ( P = 0.349 ) . All subjects were further categorized into two subgroups by age . In the older subgroup ( ≥68 yrs ) , no significant difference was found in the improvement in back extensor strength ( P = 0.316 ) . In the younger subgroup ( < 68 yrs ) , the back extensor strength in the D3 group was significantly more improved than in the control group ( P = 0.034 ) . Conclusions The results of this study suggest that the administration of the active form of vitamin D3 enhances the beneficial effects of the back extensor exercise in patients younger than those in their late 60s BACKGROUND vitamin D supplementation reduces the incidence of fractures in older adults . This may be partly mediated by effects of vitamin D on neuromuscular function . OBJECTIVE to determine the effects of vitamin D supplementation on aspects of neuromuscular function known to be risk factors for falls and fractures . DESIGN r and omised , double-blind , placebo-controlled study . SETTING falls clinic taking referrals from general practitioners and accident and emergency department . SUBJECTS 139 ambulatory subjects ( > /=65 years ) with a history of falls and 25-hydroxyvitamin D ( 25OHD ) < /=12 microg/l . INTERVENTION patients were r and omised to receive a single intramuscular injection of 600,000 i.u . ergocalciferol or placebo . OUTCOME MEASURES assessment s including biochemistry , postural sway , choice reaction time ( CRT ) , aggregate functional performance time ( AFPT ) , and quadriceps strength were carried out at baseline and 6 months post-intervention . RESULTS baseline characteristics were comparable between both groups . 25OHD in the treatment group increased significantly at 6 months . AFPT deteriorated in the control group and improved in the intervention group , representing a significant difference between groups ( + 6.6 s versus -2.0 s , t = 2.80 , P < 0.05 ) . Similar changes were observed for CRT ( -0.06 s versus + 0.41 s , t = -2.52 , P < 0.01 ) and postural sway ( + 0.0025 versus -0.0138 , t = 2.35 , P < 0.02 ) . There was no significant difference in muscle strength change between groups ( -10 N versus -2 N , t = -1.26 , ns ) . A significant correlation between change in AFPT and change in 25OHD levels was observed ( r = 0.19 , P = 0.03 ) . There was no significant difference in the number of falls ( 0.39 versus 0.24 , t = 1.08 , P = 0.28 ) or fallers ( 14 versus 11 , P = 0.52 ) between two groups . CONCLUSIONS vitamin D supplementation , in fallers with vitamin D insufficiency , has a significant beneficial effect on functional performance , reaction time and balance , but not muscle strength . This suggests that vitamin D supplementation improves neuromuscular or neuroprotective function , which may in part explain the mechanism whereby vitamin D reduces falls and fractures BACKGROUND Vitamin D insufficiency , which is prevalent in older individuals , is associated with bone and muscle weakness and falls . OBJECTIVE We examined the effects of a weekly dose of 8400 IU vitamin D(3 ) on postural stability , muscle strength , and safety . DESIGN In this double-blind trial , subjects aged > or = 70 y with serum 25-hydroxyvitamin D [ 25(OH)D ] concentrations < or = 20 but > or = 6 ng/mL were r and omly assigned to receive a weekly dose of 8400 IU  vitamin D(3 ) ( n = 114 ) or a placebo ( n = 112 ) . Mediolateral body sway with eyes open ( assessed with the AccuSway(PLUS ) platform ; Advanced Medical Technology Inc , Watertown , MA ) was the primary endpoint . Secondary endpoints included the short physical performance battery ( SPPB ) and serum 25(OH)D concentrations . An analysis of covariance model was used for treatment comparisons . Safety and tolerability were monitored . RESULTS Serum 25(OH)D concentrations rose significantly ( from 13.9 to 26.2 ng/mL , P < 0.001 ) in patients treated with 8400 IU vitamin D(3 ) but not in patients treated with the placebo . After 16 wk , neither mediolateral sway nor SPPB differed significantly between treatment groups . However , in the post hoc analysis of patients subgrouped by baseline sway ( > or = 0.46 compared with < 0.46 cm ) , treatment with 8400 IU vitamin D(3 ) significantly reduced sway compared with treatment with placebo ( P = 0.047 ) in patients with elevated baseline sway but not in patients with normal baseline sway . Adverse experiences and incidences of hypercalcemia , hypercalciuria , and elevated creatinine were similar with both treatments . In patients treated with 8400 IU vitamin D(3 ) , but not in placebo-treated patients , parathyroid hormone decreased significantly . CONCLUSIONS Weekly treatment with 8400 IU vitamin D(3 ) raised 25(OH)D concentrations in elderly , vitamin D-insufficient individuals . Treatment with 8400 IU vitamin D(3 ) did not reduce mediolateral sway significantly compared with treatment with placebo in this population , although in post hoc analysis , treatment with 8400 IU vitamin D(3 ) reduced sway in the subgroup of patients who had elevated sway at baseline . Weekly treatment with 8400 IU vitamin D(3 ) was well tolerated . This trial was registered at clinical trials.gov as NCT00242476 Summary Vitamin D can improve muscle function and reduce  falls  , but whether it can strengthen neural connections within the brain and nervous system is not known . This 10-week r and omised controlled trial indicates that treatment with 2,000 IU/day vitamin D3 does not significantly alter neuroplasticity relative to placebo in older adults . Introduction The purpose of this study was to examine the effects of vitamin D supplementation on neuroplasticity , serum brain-derived neurotrophic factor ( BDNF ) and muscle strength and function in older adults . Methods This was a 10-week double-blinded , placebo-controlled r and omised trial in which 26 older adults with 25-hydroxyvitamin D [ 25OHD ] concentrations 25–60 nmol/L were r and omised to 2,000 IU/day vitamin D3 or matched placebo .  Single- and paired-pulse transcranial magnetic stimulation applied over the motor cortex was used to assess changes in motor-evoked potentials ( MEPs ) and short-interval intracortical inhibition ( SICI ) , as measures of corticospinal excitability and inhibition respectively , by recording electromyography ( EMG ) responses to stimulation from the wrist extensors . Changes in muscle strength , stair climbing power , gait ( timed-up- and -go ) , dynamic balance ( four square step test ) , serum 25(OH)D and BDNF concentrations were also measured . Results After 10 weeks , mean 25(OH)D levels increased from 46 to 81 nmol/L in the vitamin D group with no change in the placebo group . The vitamin D group experienced a significant 8–11 % increase in muscle strength and a reduction in cortical excitability ( MEP amplitude ) and SICI relative to baseline ( all P < 0.05 ) , but these changes were not significantly different from placebo . There was no effect of  vitamin D  on muscle power , function or BDNF . Conclusions Daily supplementation with 2,000 IU vitamin D3 for 10 weeks had no significant effect on neuroplasticity compared to placebo , but the finding that vitamin D treatment alone was associated with a decrease in corticospinal excitability and intracortical inhibition warrants further investigation as this suggests that it may improve the efficacy of neural transmission within the corticospinal pathway OBJECTIVE Vitamin D supplementation is suggested to reduce the risk of falls among ambulatory or institutionalized elderly subjects . The present study was undertaken to address the reduced risk of falls and hip fractures in patients with long-st and ing stroke by vitamin D supplementation . METHODS Ninety-six elderly women with poststroke hemiplegia were followed for two years . Patients were r and omly assigned to one of the two groups , and 48 patients received 1,000 IU ergocalciferol daily , and the remaining 48 received placebo . The number of falls per person and incidence of hip fractures were compared between the two groups . Strength and tissue ATPase of skeletal muscles on the nonparetic side were assessed before and after the study . RESULTS At baseline , serum 25-hydroxyvitamin D levels were in the deficient range ( < 10 ng/ml ) in all patients ; and vitamin D treatment enhanced serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels .  Vitamin D treatment accounted for a 59 % reduction in falls ( 95 % CI , 28 - 81 % ; p = 0.003 ) . There were increases in the relative number and size of type II muscle fibers and improved muscle strength in the vitamin D-treated group . Hip fractures occurred in 4 of 48 placebo group and 0 in 48 vitamin D2 group during the 2-year study period ( log-rank , p = 0.049 ) . CONCLUSION Vitamin D may increase muscle strength by improving atrophy of type II muscle fibers , which may lead to decreased falls and hip fractures Objective To determine if sarcopenia modulates the response to a physical activity intervention in functionally limited older adults . Design Secondary analysis of a r and omized controlled trial . Setting Three academic centers . Participants Elders aged 70 to 89 years at risk for mobility disability who underwent dualenergy x-ray absorptiometry ( DXA ) for body composition at enrollment and follow-up at twelve months ( N = 177 ) . InterventionS ubjects participated in a physical activity program ( PA ) featuring aerobic , strength , balance , and flexibility training , or a successful aging ( SA ) educational program about healthy aging . Measurements Sarcopenia as determined by measuring appendicular lean mass and adjusting for height and total body fat mass ( residuals method ) , Short Physical Performance Battery score ( SPPB ) , and gait speed determined on 400 meter course . Results At twelve months , sarcopenic and non-sarcopenic subjects in PA tended to have higher mean SPPB scores ( 8.7±0.5 and 8.7±0.2 points ) compared to sarcopenic and non-sarcopenic subjects in SA ( 8.3±0.5 and 8.4±0.2 points , p = 0.24 and 0.10 ) , although the differences were not statistically significant . At twelve months , faster mean gait speeds were observed in PA : 0.93±0.4 and 0.95±0.03 meters/second in sarcopenic and non-sarcopenic PA subjects , and 0.89±0.4 and 0.91±0.03 meters/second in sarcopenic and non-sarcopenic SA subjects ( p = 0.98 and 0.26 ) , although not statistically significant . There was no difference between the sarcopenic and non-sarcopenic groups in intervention adherence or number of adverse events . Conclusion These data suggest that older adults with sarcopenia , who represent a vulnerable segment of the elder population , are capable of improvements in physical performance after a physical activity intervention Background and aims : Insufficient vitamin D status , commonly found in older people , has been associated with muscle weakness which , in old age , impairs mobility and is a risk factor for falling . In a r and omized , double-blind placebo-controlled trial , we tested the hypothesis that vitamin D + calcium supplementation improves muscle strength and mobility , compared with calcium mono-therapy in vitamin D-insufficient female geriatric patients . Methods : Seventy female geriatric patients > 65 years of age with serum 25-hydroxyvitamin D3 ( 25OHD ) concentrations between 20 and 50 nmol/L , visiting an outpatient geriatric department , were included . Participants received either cholecalciferol 400 IU/day + calcium 500 mg/day ( D/Cal group ) or a placebo + calcium 500 mg/day ( Plac/Cal group ) for 6 months . At baseline and 6 months , muscle strength , power and functional mobility were tested . Results : At baseline , 25OHD was significantly ( p<0.05 ) associated with knee extension strength ( r=0.42 ) , h and grip strength ( r=0.28 ) , leg extension power ( r=0.34 ) , Timed Get Up and Go ( r=−0.31 ) and Modified Cooper test ( r=0.44 ) . At 6 months , a significant difference in 25OHD ( 77.2 vs 41.6 nmol/L , p<0.001 ) and 1,25OHD was found between the two groups . Significantly improving vitamin D status in the D/Cal group compared with the Plac/Cal group did not result in a significant difference in strength or functional mobility between the two groups . Conclusions : Daily 400IU vitamin D + 500 mg calcium supplementation is not enough to significantly improve strength or mobility in vitamin D-insufficient female geriatric patients Daily vitamin D in addition to calcium supplementation reduces falls and fractures in older women . However , poor adherence to therapy is a common clinical problem . To examine the effects of supervised oral 3-monthly vitamin D therapy on falls , muscle strength , and mobility , we conducted a 9-month r and omized , double-blind , placebo-controlled trial in 686 community-dwelling ambulant women aged over 70 years . Participants received either oral cholecalciferol 150,000 IU every 3 months ( n = 353 ) or an identical placebo ( n = 333 ) . All participants were advised to increase dietary calcium intake . Falls data were collected 3-monthly . At baseline , 3 , 6 , and 9 months , muscle strength was measured by a h and held dynamometer and mobility by the Timed Up and Go ( TUG ) test . Serum 25 hydroxyvitamin D ( 25OHD ) was measured in a subgroup of 40 subjects . Mean age at baseline was 76.7 ± 4.1 years . The average serum 25OHD value at baseline was 65.8 ± 22.7 nmol/L. By 3 , 6 , and 9 months after supplementation , 25OHD levels of the vitamin D group were approximately 15 nmol/L higher than the placebo group . Calcium intake did not change significantly between baseline ( 864 ± 412 mg/day ) and 9 months ( 855 ± 357 mg/day ) . Faller rates in the two groups did not differ : vitamin D group , 102 of 353 ( 29 % ) ; placebo group , 89 of 333 ( 27 % ) . At 9 months , compared to placebo or baseline , muscle strength , and TUG were not altered by vitamin D. In conclusion , oral cholecalciferol 150,000 IU therapy administered 3-monthly had neither beneficial nor adverse effects on falls or physical function . These data together with previous findings confirm that intermittent large doses of vitamin D are ineffective or have a deleterious effect on falls . Thus despite adherence issues with daily vitamin D replacement , an intermittent , high-dose vitamin D regimen can not be supported as a strategy to reduce falls and fractures The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging , also called sarcopenia . The aim of this prospect i ve study was to investigate whether low serum 25-hydroxyvitamin D ( 25-OHD ) and high serum PTH concentration were associated with sarcopenia . In men and women aged 65 yr and older , participants of the Longitudinal Aging Study Amsterdam , grip strength ( n = 1008 ) and appendicular skeletal muscle mass ( n = 331 , using dual-energy x-ray absorptiometry ) were measured in 1995 - 1996 and after a 3-yr follow-up . Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort , translating into a loss of grip strength greater than 40 % or a loss of muscle mass greater than 3 % . After adjustment for physical activity level , season of data collection , serum creatinine concentration , chronic disease , smoking , and body mass index , persons with low ( < 25 nmol/liter ) baseline 25-OHD levels were 2.57 ( 95 % confidence interval 1.40 - 4.70 , based on grip strength ) and 2.14 ( 0.73 - 6.33 , based on muscle mass ) times more likely to experience sarcopenia , compared with those with high ( > 50 nmol/liter ) levels . High PTH levels ( > or=4.0 pmol/liter ) were associated with an increased risk of sarcopenia , compared with low PTH ( < 3.0 pmol/liter ) : odds ratio = 1.71 ( 1.07 - 2.73 ) based on grip strength , odds ratio = 2.35 ( 1.05 - 5.28 ) based on muscle mass . The associations were similar in men and women . The results of this prospect i ve , population -based study show that lower  25-OHD  and higher  PTH levels increase the risk of sarcopenia in older men and women Summary In 242 community-dwelling seniors , supplementation with either 1000 mg of calcium or 1000 mg of calcium plus vitamin D result ed in a decrease in the number of subjects with first falls of 27 % at month 12 and 39 % at month 20 . Additionally , parameters of muscle function improved significantly . Introduction The efficacy of vitamin D and calcium supplementation on risk of falling in the elderly is discussed controversially . R and omized controlled trials using falls as primary outcome are needed . We investigated long-term effects of calcium and vitamin D on falls and parameters of muscle function in community-dwelling elderly women and men . Methods Our study population consisted of 242 individuals recruited by advertisements and mailing lists ( mean [ ± SD ] age , 77 ± 4 years ) . All serum 25-hydroxyvitamin D ( 25[OH]D ) levels were below 78 nmol/l . Individuals received in a double blinded fashion either 1000 mg of calcium or 1000 mg of calcium plus 800 IU of vitamin D per day over a treatment period of 12 months , which was followed by a treatment-free but still blinded observation period of 8 months . Falls were documented using diaries . The study took place in Bad Pyrmont , Germany ( latitude 52 ° ) and Graz , Austria ( latitude 46 ° ) . Results Compared to calcium mono , supplementation with calcium plus vitamin D result ed in a significant decrease in the number of subjects with first falls of 27 % at month 12 ( RR = 0.73 ; CI = 0.54–0.96 ) and 39 % at month 20 ( RR = 0.61 ; CI = 0.34–0.76 ) . Concerning secondary endpoints , we observed significant improvements in quadriceps strength of 8 % , a decrease in body sway of 28 % , and a decrease in time needed to perform the TUG test of 11 % . Discussion Combined calcium and vitamin D supplementation proved superior to calcium alone in reducing the number of falls and improving muscle function in community-dwelling older individuals OBJECTIVE The adequate dose of vitamin D supplementation for community-dwelling elderly people has not been thoroughly investigated . This study aims to determine the efficacy of a low-dose and a higher dose of vitamin D3 in maintaining 25-hydroxyvitamin D [ 25(OH)D ] levels at or above 30 ng/mL. METHODS This was a single site , double-blind , r and omized exploratory clinical trial that enrolled adults 65 years of age and older . Within strata of baseline 25(OH)D levels ( < 30 versus ≥ 30 ng/mL ) subjects were r and omized in a 1:2 ratio to receive either 400 or 2,000 IU vitamin D3 daily for 6 months . The main outcome measures were changes in serum 25(OH)D levels according to baseline 25(OH)D levels and dose of vitamin D3 . RESULTS At baseline , 41 of 105 participants ( 39 % ) had low 25(OH)D levels ( < 30 ng/mL ) . After 6 months of vitamin D3 supplementation , 21 of 32 participants ( 66 % ) receiving 400 IU and 14 of 59 participants ( 24 % ) receiving 2,000 IU of vitamin D3 still had low 25(OH)D levels . The largest increases in serum 25(OH)D levels were observed in subjects with baseline levels < 30 ng/mL who received 2,000 IU of vitamin D daily . CONCLUSION Regardless of baseline 25(OH)D level , in persons 65 years of age and older , 6-month vitamin D3 supplementation with 400 IU daily result ed in low 25(OH)D in most individuals , while 2,000 IU daily maintained 25(OH)D levels within an acceptable range in most people on this regimen Summary Vitamin D may affect skeletal muscle function . In a double-blind , r and omised , placebo-controlled trial , we found that vitamin D3 supplementation ( 400 or 1,000 I.U. vs. placebo daily for 1 year with bimonthly study visits ) does not improve grip strength or reduce falls . Introduction This study aim ed to test the supplementation effects of vitamin D3 on physical function and examine associations between overweight/obesity and the biochemical response to treatment . Methods In a parallel group double-blind RCT , healthy postmenopausal women from North East Scotl and ( latitude—57 ° N ) aged 60–70 years ( body mass index ( BMI ) , 18–45 kg/m2 ) were assigned ( computer r and omisation ) to daily vitamin D3 ( 400 I.U. ( n = 102)/1,000 I.U. ( n = 101 ) ) or matching placebo ( n = 102 ) ( 97 , 96 and 100 participants analysed for outcomes , respectively ) from identical coded containers for 1 year . Grip strength ( primary outcome ) , falls , diet , physical activity and ultraviolet B radiation exposure were measured bimonthly , as were serum 25(OH)D , adjusted calcium ( ACa ) and phosphate . Fat/lean mass ( dual energy X-ray absorptiometry ) , anthropometry , 1,25-dihydroxyvitamin D and parathyroid hormone were measured at baseline and 12 months . Participants and research ers were blinded throughout intervention and analysis . Results Treatment had no effect on grip strength ( mean change (SD)/year = −0.5 ( 2.5 ) , −0.9 ( 2.7 ) and −0.4 ( 3.3 ) kg force for 400/1,000 I.U. vitamin D3 and placebo groups , respectively ( P = .10 , ANOVA ) ) or falls ( P = .65 , chi-squared test ) . Biochemical responses were similar across BMI categories ( < 25.25–29.99 , ≥30 kg/m2 ) with the exception of a small change at 12-months in serum ACa in overweight compared to non-overweight participants ( P = .01 , ANOVA ; 1,000 I.U. group ) . In the  placebo group , 25(OH)D peak concentration change ( winter to summer ) was negatively associated with weight ( r = −.268 ) , BMI ( r = −.198 ) , total ( r = −.278 ) and trunk fat mass ( r = −.251 ) , with total and trunk fat mass predictive of winter to summer 25(OH)D change ( P = .01/.004 respectively , linear regression ) . Conclusion We found no evidence of an improvement in physical function following vitamin D3 supplementation for 1 year There is an increase in the incidence of falls with aging and about 10 % of falls lead to fractures . Nearly all hip fractures are due to falls and hip fractures are the most severe of the osteoporotic fractures because they lead to a 20 % mortality rate and a loss of independent living in 50 % of cases . Although there are multiple factors associated with falls , our interest is the role that vitamin D metabolism plays in the pathogenesis of falls . Recent clinical trials show that both vitamin D and the metabolite calcitriol reduce the number of falls by 30 - 40 % in elderly subjects . This should also reduce the number of fractures . In European studies , the decrease in falls could be attributed to an improvement in the muscle weakness that often accompanies vitamin D deficiency . However , in the studies using calcitriol there was no vitamin D deficiency , so the mechanism of its efficacy is less clear . It could be due to increased muscle strength , an improvement in the neurological control of balance or both . Underst and ing these mechanisms would allow us to search for analogs of vitamin D that act more selectively on muscle and on the central nervous system OBJECTIVES To study the effects of vitamin D supplementation in healthier population s of men . DESIGN : R and omized , controlled trial . SETTING General clinical research center . PARTICIPANTS Sixty-five healthy , community-dwelling men ( mean age+/-st and ard deviation=76+/-4 , range 65 - 87 ) . INTERVENTION Cholecalciferol ( 1,000 IU/d ) or placebo supplementation for 6 months ; all received 500 mg supplemental calcium . MEASUREMENTS Upper and lower extremity muscle strength and power , physical performance and activity , health perception , calcium and vitamin D intake , and biochemical assessment , including 25-hydroxyvitamin D ( 25OHD ) , parathyroid hormone ( PTH ) , and ionized calcium levels . RESULTS The levels of 25OHD increased and PTH decreased in the cholecalciferol group , whereas there were no significant changes in the control group ( P<.001 ) . Baseline 25OHD levels correlated with baseline single-leg stance time and physical activity score . Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score . No significant difference in strength , power , physical performance , or health perception was found between groups . CONCLUSION The 25OHD or PTH levels correlated with physical activity and physical performance in older , community-dwelling men with normal 25OHD status . Vitamin D supplementation increased 25OHD levels and decreased PTH levels but did not increase muscle strength or improve physical performance or health perception in this group of healthy , older men . Further investigations of the effects of vitamin D supplementation should focus on individuals with low levels of vitamin There is an ongoing debate over the role of serum 25(OH ) vitamin D [ 25(OH)D ] levels in maintaining or improving physical performance and muscle strength . Much of the controversy is because of the variability between studies in participants ' characteristics , baseline serum 25(OH)D levels , and baseline physical functioning . The aim of this ancillary study conducted within a r and omized controlled clinical trial was to investigate whether supplementation with 400 or 2000 IU vitamin D3 daily for 6 months would improve measures of physical performance and muscle strength in a community-dwelling elderly population aged 65 to 95 years . Those with the slowest gait speed improved their ability to do chair-st and tests after vitamin D supplementation . This finding remained significant after controlling for potential confounding variables . There was also an inverse correlation between serum 25(OH)D levels and fat mass index ( FMI ) among women , suggesting that higher supplementation with vitamin D is needed as weight increases . The results of this study suggest that supplementation with vitamin D may be most beneficial in older population s who have low baseline physical functioning BACKGROUND Older adults may be more prone to developing vitamin D deficiency than younger adults . Dietary requirements for vitamin D in older adults are based on limited evidence . OBJECTIVE The objective was to establish the dietary intake of vitamin D required to maintain serum 25-hydroxyvitamin D [ 25(OH)D ] concentrations above various cutoffs between 25 and 80 nmol/L during wintertime , which accounted for the effect of summer sunshine exposure and diet . DESIGN A r and omized , placebo-controlled , double-blind , 22-wk intervention was conducted in men and women aged > /=64 y ( n = 225 ) at supplemental levels of 0 , 5 , 10 , and 15 microg vitamin D(3)/d from October 2007 to March 2008 . RESULTS Clear dose-related increments ( P < 0.0001 ) in serum 25(OH)D were observed with increasing supplemental vitamin D(3 ) intakes . The slope of the relation between total vitamin D intake and serum 25(OH)D was 1.97 nmol . L(-1 ) . microg intake(-1 ) . The vitamin D intake that maintained serum 25(OH)D concentrations > 25 nmol/L in 97.5 % of the sample was 8.6 microg/d . Intakes were 7.9 and 11.4 microg/d in those who reported a minimum of 15 min daily summer sunshine exposure or less , respectively . The intakes required to maintain serum 25(OH)D concentrations of > 37.5 , > 50 , and > 80 nmol/L in 97.5 % of the sample were 17.2 , 24.7 , and 38.7 microg/d , respectively . CONCLUSION To ensure that the vitamin D requirement is met by the vast majority ( > 97.5 % ) of adults aged > /=64 y during winter , between 7.9 and 42.8 microg vitamin D/d is required , depending on summer sun exposure and the threshold of adequacy of 25(OH)D. This trial was registered at http://www.controlled-trials.com/IS RCT N20236112 as IS RCT N registration no. IS RCT N20236112 OBJECTIVES To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge . DESIGN Multicenter , r and omized , controlled trial with a factorial design . SETTING Five hospitals in Auckl and , New Zeal and , and Sydney , Australia . PARTICIPANTS Two hundred forty-three frail older people . INTERVENTIONS Patients were r and omized to receive a single dose of vitamin D ( calciferol , 300,000 IU ) or placebo tablets and 10 weeks of high-intensity home-based quadriceps resistance exercise or frequency-matched visits . MEASUREMENTS The primary endpoints were physical health according to the short-form health survey at 3 months and falls over 6 months . Physical performance and self-rated function were secondary endpoints . Assessment s took place in the participants ' homes at 3 and 6 months after r and omization and were performed by blinded assessors . RESULTS There was no effect of either intervention on physical health or falls , but patients in the exercise group were at increased risk of musculoskeletal injury ( risk ratio = 3.6 , 95 % confidence interval = 1.5 - 8.0 ) . Vitamin D supplementation did not improve physical performance , even in those who were vitamin D deficient ( < 12 ng/mL ) at baseline . CONCLUSION Neither vitamin D supplementation nor a home-based program of high-intensity quadriceps resistance exercise improved rehabilitation outcomes in frail older people after hospitalization . There was no effect of vitamin D on physical performance , and the exercises increased the risk of musculoskeletal injury . These findings do not support the routine use of these interventions at these dosages in the rehabilitation of frail older people OBJECTIVES To evaluate the effects of vitamin D treatment on muscle strength and mobility in older women with vitamin D insufficiency . DESIGN One-year population -based , double-blind , r and omized , controlled trial . SETTING Perth , Australia ( latitude 32 ° S ) . PARTICIPANTS Three hundred two community-dwelling ambulant elderly women aged 70 to 90 with a serum 25-hydroxyvitamin D ( 25(OH)D ) concentration less than 24 ng/mL. INTERVENTION Vitamin D(2 ) 1,000 IU/d or identical placebo ; calcium citrate ( 1 g calcium/d ) in both groups . MEASUREMENTS Lower limb muscle strength and mobility as assessed using the Timed Up and Go Test ( TUAG ) . RESULTS At baseline , mean ± st and ard deviation serum 25(OH)D was 17.7 ± 4.2 ng/mL ; this increased to 24.0 ± 5.6 ng/mL in the vitamin D group after 1 year but remained the same in the placebo group . For hip extensor and adductor strength and TUAG , but not for other muscle groups , a significant interaction between treatment group and baseline values was noted . In those with baseline values in the lowest tertile , vitamin D  improved muscle strength and TUAG more than calcium alone ( mean ( st and ard error ) : hip extensors 22.6 % ( 9.5 % ) ; hip adductors 13.5 % ( 6.7 % ) , TUAG 17.5 % ( 7.6 % ) , P < .05 ) . Baseline 25(OH)D levels did not influence patient response to supplementation . CONCLUSION Vitamin D therapy was observed to increase muscle function in those who were the weakest and slowest at baseline . Vitamin D should be given to people with insufficiency or deficiency to improve muscle strength and mobility OBJECTIVES The Women 's Health Initiative ( WHI ) r and omized trial of calcium/vitamin D supplementation found reduced bone loss with active treatment compared to placebo . Now we examine whether the treatment affected self-reported physical functioning and objective measures of physical functioning . DESIGN A r and omized , double-blind , placebo-controlled trial of 1,000 mg calcium carbonate plus 400 IU vitamin D(3 ) per day or matching placebo pills . SUBJECTS/ SETTING The study included 33,067 women ( 50 to 79 years old ) at 40 US study centers . MAIN OUTCOME MEASURES Physical functioning was assessed by question naire at enrollment in WHI , 1 year prior to calcium/vitamin D trial r and omization and at study close-out ( average follow-up 7.1 years ) . Objective physical performance and self-reported exercise measures were collected at WHI baseline ( 1 year prior to calcium/vitamin D enrollment ) and 2 years and 4 years after calcium/vitamin D trial enrollment in a sub sample ( n=3,137 ) . STATISTICAL ANALYSES PERFORMED Calcium/vitamin D effects were tested in unadjusted and interaction linear models for each of the physical function measures . Covariates were baseline total calcium intake , fracture risk score , treatment arm in the hormone therapy and dietary modification trials ( ie , active drug or placebo , low-fat diet intervention or usual diet , respectively ) and age . RESULTS Neither intention to treat nor high adherence analyses produced substantial effects of calcium/vitamin D  compared to placebo on physical functioning or performance . The interaction analyses also did not result in differences because of calcium/vitamin D. CONCLUSIONS As the first long-term r and omized trial to examine the effectiveness of calcium and vitamin D in protecting against decline of physical functioning in older women , the results did not support benefit To test the effect of 25(OH)D(3 ) ( HyD ) compared to vitamin D(3 )  on serum 25-hydroxyvitamin D levels ( 25(OH)D ) , lower extremity function , blood pressure , and markers of innate immunity . Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 ± 3.9 ng/mL ( mean ± SD ) and a mean age of 61.5 ± 7.2 years were r and omized to either 20 µg of HyD or 20 µg ( 800 IU ) of vitamin D(3 ) per day in a double-blind manner . We measured on 14 visits over 4 months , 25(OH)D serum levels , blood pressure , and seven markers of innate immunity ( eotaxin , interleukin [IL]-8 , IL-12 , interferon gamma-induced protein 10 kDa [ IP-10 ] , monocyte chemotactic protein-1 [ MCP-1 ] , macrophage inflammatory protein beta [ MIP-1β ] , and " Regulated upon Activation , Normal T-cell Expressed , and Secreted " [ RANTES ] ) . At baseline and at 4 months , a test battery for lower extremity function ( knee extensor and flexor strength , timed up and go , repeated sit-to-st and ) was assessed . All analyses were adjusted for baseline measurement , age , and body mass index . Mean 25(OH)D levels increased to 69.5 ng/mL in the HyD group . This rise was immediate and sustained . Mean 25(OH)D levels increased to 31.0 ng/mL with a slow increase in the vitamin D(3 ) group . Women on HyD compared with vitamin D(3 ) had a 2.8-fold increased odds of maintained or improved lower extremity function ( odds ratio [ OR ] = 2.79 ; 95 % confidence interval [ CI ] , 1.18 - 6.58 ) , and a 5.7-mmHg decrease in systolic blood pressure ( p = 0.0002 ) . Both types of vitamin D contributed to a decrease in five out of seven markers of innate immunity , significantly more pronounced with HyD for eotaxin , IL-12 , MCP-1 , and MIP-1 β . There were no cases of hypercalcemia at any time point . Twenty micrograms ( 20 µg ) of HyD per day result ed in a safe , immediate , and sustained increase in 25(OH)D serum levels in all participants , which may explain its significant benefit on lower extremity function , systolic blood pressure , and innate immune response compared with vitamin D(3 ) CONTEXT Studies examining whether vitamin D supplementation increases muscle mass or muscle-specific vitamin D receptor ( VDR ) concentration are lacking . OBJECTIVE Our objective was to determine whether vitamin D₃ 4000 IU/d alters muscle fiber cross-sectional area ( FCSA ) and intramyonuclear VDR concentration over 4 months . DESIGN AND SETTING This was a r and omized , double-blind , placebo-controlled study in a single center . PARTICIPANTS Participants were 21 mobility-limited women ( aged ≥ 65 years ) with serum 25-hydroxyvitamin D ( 25OHD ) levels of 22.5 to 60 nmol/L. MAIN OUTCOME MEASURES Baseline and 4-month FCSA and intramyonuclear VDR were measured from vastus lateralis muscle cross-sections probed for muscle fiber type ( I/IIa/IIx ) and VDR using immunofluorescence . RESULTS At baseline , mean ( ±SD ) age was 78 ± 5 years ; body mass index was 27 ± 5 kg/m² , 25OHD was 46.3 ± 9.5 nmol/L , and  a short physical performance battery score was 7.95 ± 1.57 out of 12 . At 4 months , 25OHD level was 52.5 ± 17.1 ( placebo ) vs 80.0 ± 11.5 nmol/L ( vitamin D [ VD ] ; P < .01 ) , and change in 25OHD level was strongly associated with percent change in intramyonuclear VDR concentration-independent of group ( r = 0.87 , P < .001 ) . By treatment group , percent change in intramyonuclear VDR concentration was 7.8 % ± 18.2 % ( placebo ) vs 29.7 % ± 11.7 % ( VD ; P = .03 ) with a more pronounced group difference in type II vs I fibers . Percent change in total ( type I/II ) FCSA was -7.4 % ± 18.9 % ( placebo ) vs 10.6 % ± 20.0 % ( VD ; P = .048 ) . CONCLUSION Vitamin D₃ supplementation  increased intramyonuclear VDR concentration by 30 % and increased muscle fiber size by 10 % in older , mobility-limited , vitamin D-insufficient women . Further work is needed to determine whether the observed effect of vitamin D on fiber size is mediated by the VDR and to identify which signaling pathways are involved
target: In conclusion , we observed no improvement in muscle strength after the administration of vitamin D with or without calcium supplements .
  We did find a small but significant deterioration of mobility .
background: BACKGROUND It has been suggested that vitamin D status or supplementation is important for maintaining or improving muscle strength and mobility in older adults .
  The study results , however , do not provide consistent results .
  We therefore aim ed to summarise the available evidence systematic ally , including only studies conducted in community-dwelling older persons .