title: Vitamin D as supplementary treatment for tuberculosis: a double-blind, randomized, placebo-controlled trial. A single dose of vitamin D enhances immunity to mycobacteria. The effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculous lesion. The effect of multi-vitamin/mineral supplementation on mortality during treatment of pulmonary tuberculosis: a randomised two-by-two factorial trial in Mwanza, Tanzania. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. Calcium plus vitamin D supplementation and the risk of colorectal cancer. Effects of calcitriol on eosinophil activity and antibody responses in patients with schistosomiasis Vitamin D administration to tuberculous children and its value. Hepatitis B vaccines in patients with chronic renal failure before dialysis. A randomized controlled trial of vitamin D3 supplementation in African American women. A randomized controlled trial of vitamin D3 supplementation for the prevention of symptomatic upper respiratory tract infections. Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents Calcitriol (1,25-dihydroxy-vitamin D3) coadministered with influenza vaccine does not enhance humoral immunity in human volunteers. A placebo-controlled trial to evaluate immunomodulatory effects of paricalcitol. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial.
abstract: RATIONALE Vitamin D has been shown to be involved in the host immune response toward Mycobacterium tuberculosis . OBJECTIVES To test whether vitamin D supplementation of patients with tuberculosis ( TB ) improved clinical outcome and reduced mortality . METHODS We conducted a r and omized , double-blind , placebo-controlled trial in TB clinics at a demographic surveillance site in Guinea-Bissau . We included 365 adult patients with TB starting antituberculosis treatment ; 281 completed the 12-month follow-up . The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again 5 and 8 months after the start of treatment . MEASUREMENTS AND MAIN RESULTS The primary outcome was reduction in a clinical severity score ( TBscore ) for all patients with pulmonary TB . The secondary outcome was 12-month mortality . No serious adverse effects were reported ; mild hypercalcemia was rare and present in both arms . Reduction in TBscore and sputum smear conversion rates did not differ among patients treated with vitamin D or placebo .  Overall mortality was 15 % ( 54 of 365 ) at 1 year of follow-up and similar in both arms ( 30 of 187 for vitamin D treated and 24 of 178 for placebo ; relative risk , 1.19 [ 0.58 - 1.95 ] ) . HIV infection was seen in 36 % ( 131 of 359 ) : 21 % ( 76 of 359 ) HIV-1 , 10 % ( 36 of 359 ) HIV-2 , and 5 % ( 19 of 357 ) HIV-1 + 2 . CONCLUSIONS Vitamin D does not improve clinical outcome among patients with TB and the trial showed no overall effect on mortality in patients with TB ; it is possible that the dose used was insufficient . Clinical trial registered with www.controlled-trials.com/is rct n ( IS RCT N35212132 ) RATIONALE Vitamin D was used to treat tuberculosis ( TB ) in the preantibiotic era . Prospect i ve studies to evaluate the effect of vitamin D supplementation on antimycobacterial immunity have not previously been performed . OBJECTIVES To determine the effect of vitamin D supplementation on antimycobacterial immunity and vitamin D status . METHODS A double-blind r and omized controlled trial was conducted in 192 healthy adult TB contacts in London , United Kingdom . Participants were r and omized to receive a single oral dose of 2.5 mg vitamin D or placebo and followed up at 6 weeks . MEASUREMENTS AND MAIN RESULTS The primary outcome measure was assessed with a functional whole blood assay ( BCG-lux assay ) , which measures the ability of whole blood to restrict luminescence , and thus growth , of recombinant reporter mycobacteria in vitro ; the readout is expressed as a luminescence ratio ( luminescence postinfection/baseline luminescence ) . IFN-gamma responses to the Mycobacterium tuberculosis antigens early secretory antigenic target-6 and culture filtrate protein 10 were determined with a second whole blood assay . Vitamin D supplementation significantly enhanced the ability of participants ' whole blood to restrict BCG-lux luminescence in vitro compared with placebo ( mean luminescence ratio at follow-up , 0.57 , vs. 0.71 , respectively ; 95 % confidence interval for difference , 0.01 - 0.25 ; p=0.03 ) but did not affect antigen-stimulated IFN-gamma secretion . CONCLUSIONS A single oral dose of 2.5 mg vitamin D significantly enhanced the ability of participants ' whole blood to restrict BCG-lux luminescence in vitro without affecting antigen-stimulated IFN-gamma responses . Clinical trials should be performed to determine whether vitamin D supplementation prevents reactivation of latent TB infection . Clinical trial registered with www . clinical trials.gov ( NCT 00157066 ) AIM to compare the vitamin D group of pulmonary tuberculosis patients with a placebo group in terms of clinical improvement , nutritional status , sputum conversion , and radiological improvement . METHODS sixty seven tuberculosis patient visiting the Pulmonary Clinic , of Cipto Mangunkusumo Hospital , Jakarta , from January 1st to August 31st , 2001 were included in this study . The subjects were r and omised to receive vitamin D ( 0.25 mg/day ) or placebo in a double blind method , during the 6th initial week of Tb treatment . The rate of sputum conversion , complete blood counts , blood chemistry as well as radiologic examination were evaluated . RESULTS there were more male patients than females ( 39:28 ) , 78.7 % were in the productive age group , 71.6 % had low nutritional status , 62.4 % with low education level , and 67.2 % with low income . One hundred percent of the vitamin D group and only 76.7 % of the placebo group had sputum conversion . This difference is statistically significant ( p=0.002 ) . CONCLUSION the sputum conversion had no correlation with the hemoglobin level , blood clotting time , calcium level , lymphocyte count , age , sex , and nutritional status . There were more subjects with radiological improvement in the vitamin D group Malnutrition is common in pulmonary tuberculosis ( TB ) , and may impair survival . The objective of this study was to assess effects of multi-vitamin/mineral ( MVM ) and zinc ( Zn ) supplementation during TB treatment on mortality . Patients diagnosed with sputum-positive pulmonary TB in Mwanza , Tanzania , were r and omised , using a two-by-two factorial design , to Zn ( 45 mg ) or placebo , and MVM ( vitamins A , B , C , D , E , and selenium and copper ) or placebo .  Survival status was ascertained at the end of the 8-month TB treatment and supplementation period . Of 499 TB patients , 213 ( 43 % ) had HIV . The mean weight gain at 7 months was 6.88 kg ( 95 % CI 6.36 , 7.41 ) . Zn and MVM combined , but neither alone ( interaction , P=0.03 ) , increased weight gain by 2.37 kg ( 95 % CI 0.91 , 3.83 ) , irrespective of HIV status . Survival status at 8 months was determined for 422 patients ( 84.6 % ) , of which fifty-two ( 12.3 % ) had died . Among fifty-two deaths , there were no effects of MVM ( relative risk ( RR ) 0.73 ; 95 % CI 0.43 , 1.23 ) and Zn ( RR 0.76 ; 95 % CI 0.46 , 1.28 ) . However , among HIV co-infected patients , marginally significant effects of both MVM ( RR 0.60 ; 95 % CI 0.34 , 1.05 ) and Zn ( RR 0.63 , 95 % CI 0.37 , 1.08 ) were seen , and MVM and Zn combined reduced mortality ( RR 0.29 ; 95 % CI 0.10 , 0.80 ; interaction ratio 0.52 ) . In conclusion , supplementation with MVM , including Zn , during treatment of pulmonary TB may reduce mortality in those co-infected with HIV . A r and omised trial of the effect of the combined intervention used in this study should be conducted in a different setting to confirm the finding BACKGROUND Tuberculosis ( TB ) often coincides with nutritional deficiencies . The effects of micronutrient supplementation on TB treatment outcomes , clinical complications , and mortality are uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of micronutrients ( vitamins A , B complex , C , and E , as well as selenium ) in Dar es Salaam , Tanzania . We enrolled 471 human immunodeficiency virus (HIV)-infected and 416 HIV-negative adults with pulmonary TB at the time of initiating chemotherapy and monitored them for a median of 43 months . RESULTS Micronutrients decreased the risk ofTB recurrence by 45 % overall ( 95 % confidence interval [ CI ] , 7 % to 67 % ; P = .02 ) and by 63 % in HIV-infected patients ( 95 % CI , 8 % to 85 % ; P = .02 ) . There were no significant effects on mortality overall ; however , we noted a marginally significant 64 % reduction of deaths in HIV-negative subjects ( 95 % CI , -14 % to 88 % ; P = .08 ) . Supplementation increased CD3 + and CD4 + cell counts and decreased the incidence of extrapulmonary TB and genital ulcers in HIV-negative patients . Micronutrients reduced the incidence of peripheral neuropathy by 57 % ( 95 % CI , 41 % to 69 % ; P < .001 ) , irrespective of HIV status . There were no significant effects on weight gain , body composition , anemia , or HIV load . CONCLUSIONS Micronutrient supplementation could improve the outcome in patients undergoing TB chemotherapy in Tanzania BACKGROUND Higher intake of calcium and vitamin D has been associated with a reduced risk of colorectal cancer in epidemiologic studies and polyp recurrence in polyp-prevention trials . However , r and omized-trial evidence that calcium with vitamin D supplementation is beneficial in the primary prevention of colorectal cancer is lacking . METHODS We conducted a r and omized , double-blind , placebo-controlled trial involving 36,282 postmenopausal women from 40 Women 's Health Initiative centers : 18,176 women received 500 mg of elemental calcium as calcium carbonate with 200 IU of vitamin D3 [ corrected ] twice daily ( 1000 mg of elemental calcium and 400 IU of vitamin D3 ) and 18,106 received a matching placebo for an average of 7.0 years . The incidence of pathologically confirmed colorectal cancer was the design ated secondary outcome . Baseline levels of serum 25-hydroxyvitamin D were assessed in a nested case-control study . RESULTS The incidence of invasive colorectal cancer did not differ significantly between women assigned to calcium plus vitamin D supplementation and those assigned to placebo ( 168 and 154 cases ; hazard ratio , 1.08 ; 95 percent confidence interval , 0.86 to 1.34 ; P=0.51 ) , and the tumor characteristics were similar in the two groups . The frequency of colorectal-cancer screening and abdominal symptoms was similar in the two groups . There were no significant treatment interactions with baseline characteristics . CONCLUSIONS Daily supplementation of calcium with vitamin D for seven years had no effect on the incidence of colorectal cancer  among postmenopausal women . The long latency associated with the development of colorectal cancer , along with the seven-year duration of the trial , may have contributed to this null finding . Ongoing follow-up will assess the longer-term effect of this intervention . ( Clinical Trials.gov number , NCT00000611 . ) Abstract Objective : Parasitic infestations are known to elicit T-helper lymphocyte type 2 ( Th-2 ) reactions , characterized by a pronounced eosinophila and high IgE levels . In humans both elevated specific IgE levels and eosinophil counts are associated with resistance to reinfection with schistosomiasis . This study aim ed to establish whether the Th-2 reaction could be enhanced with calcitriol ( vitamin D3 ) . Calcitriol has been shown to cause a shift from Th-1 to Th-2 type reactions when applied locally to the skin . Methods : Fifty-nine patients with Schistostomahaematobium infection were r and omized to one of four treatment modalities , i.e. ( a ) praziquantel ( PZQ ) 60 mg · kg−1orally on day 1 , ( b ) PZQ 60 mg · kg−1 on day 1 plus calcitriol 1 μg per day orally for 5 consecutive days , ( c ) calcitriol 1 μg per day for 5 consecutive days or ( d ) placebo . Blood for differential counts , eosinophil cationic protein ( ECP ) , specific IgE and IgG to whole-worm antigen , as well as urine sample s for egg counts , were collected on days 0 and 21 . Results : Baseline values did not differ significantly between the groups . Calcitriol alone result ed in significant increases in circulating lymphocytes ( median increase of 5.5 % ) and the percentage of eosinophil vacuolization ( mean increase 28 % ) . It , however , significantly decreased ECP levels ( mean decrease 46 % ) . PZQ in combination with calcitriol significantly enhanced production of specific IgE ( mean increase 213 % ) and IgG ( mean increase of 170 % ) and tended to increase eosinophil vacuolization ( mean increase 22 % ) . All these changes also differed significantly from those in the placebo group . The specific IgE and IgG levels were also significantly higher than the already increased levels seen with PZQ treatment only . ECP levels were , however , not significantly affected by combination therapy , whereas PZQ alone significantly enhanced ECP production ( mean increase 93 % ) . Conclusions : The increases in specific IgE responses and percentage of eosinophil vacuolization favour a Th-2 type of reaction . The ECP values viewed in isolation may , paradoxically , indicate a Th-1 response ; this could , however , have been an artefact due to the method of ECP detection ex vivo . Finally , it would seem that calcitriol does cause some immune augmentation when combined with PZQ therapy in patients with schistosomiasis . However , long-term follow-up is needed to prove that these findings would translate into resistance against reinfection Our study was done to assess the value of administration of vitamin D to tuberculous children . The study included twenty four newly diagnosed tuberculous children ; eleven males and thirteen females . Their age ranged from one and half to thirteen years . Thirteen patients were extra thoracic type of T.B. , while only seven were intrathoracic and the rest were mixed . They were r and omly divided into two Groups according to the treatment administered : Group A patients were given Rifampicin , Isoniazid and Streptomycin . Group B received in addition vitamin D. After eight weeks therapy , the patients of each group were evaluated regarding clinical , laboratory , and radiological improvement . Vitamin D level is raised after treatment in both Groups A and B , but this rise is not significant . It also showed insignificant difference between the two groups .  Vitamin D level showed very high significant decrease in tuberculous children than matched healthy controls ( non tuberculous children ) . Calcium was significantly elevated after treatment in Group A whereas no significant change was detected in Group B. Phosphorous was highly significantly elevated after treatment in Group A , whereas in Group B it is just significantly elevated . Alkaline phosphatase level in both groups A and B were slightly decreased after treatment . However , this decrease was not significant . Clinical improvement was more evident in Group B patients ( those taking vitamin D ) as compared to Group A patients . The same was noted with X-ray and Sonographic findings . We concluded that vitamin D therapy may be of great value in addition to antituberculous drugs in the treatment of tuberculous children , and its use is highly recommended Hepatitis B remains a significant risk to patients receiving chronic hemodialysis , but no certain method of prevention has been identified . We tested two vaccines , plasma-derived vaccine ( 40-micrograms dose ) and recombinant-derived vaccine ( 40-micrograms and 20-micrograms doses ) , in 61 patients with chronic renal failure who were not yet dependent on dialysis . Patients were followed up clinical ly and with laboratory tests of kidney function and hepatitis B virus serology for one year . Significantly more recipients of plasma-derived vaccine responded to vaccination ; they also achieved a higher titer of antibody to hepatitis B virus than did recipients of recombinant-derived vaccine when evaluated at 6 , 7 , 9 , and 12 mo after vaccination . No serious side effects were observed with any vaccine preparation , nor were excessive adverse effects observed in any group . Compared with the dialysis patients previously studied , patients with renal failure who were not yet dependent on dialysis responded more favorably to the hepatitis B virus vaccine BACKGROUND We conducted a r and omized , placebo-controlled , double-blind trial to test the hypothesis that vitamin D(3 ) supplementation would prevent bone loss in calcium-replete , African American postmenopausal women . METHODS Two hundred eight healthy black postmenopausal women , 50 to 75 years of age , were assigned to receive either placebo or 20 microg/d ( 800 IU ) of vitamin D(3 ) . Calcium supplements were provided to ensure a total calcium intake of 1200 to 1500 mg/d . After 2 years , the vitamin D(3 ) dose was increased to 50 microg/d ( 2000 IU ) in the active group , and the study continued for an additional year . Bone mineral density ( BMD ) was measured every 6 months . Markers of bone turnover , vitamin D metabolites , and parathyroid hormone ( PTH ) levels were measured in serum . RESULTS There were no significant differences in BMD between the active and control groups throughout the study . There was also no relationship between serum 25-hydroxyvitamin D levels attained and rates of bone loss . There was an increase in BMD of the total body , hip , and radius at 1 year in both groups . Over the 3 years , BMD declined at these sites by 0.26 % to 0.55 % per year . The BMD of the lumbar spine increased slightly in the placebo and active groups . There were no persistent changes in serum PTH levels or the markers of bone turnover , although there was a transient decline in PTH in both groups at 3 months . No significant adverse events were attributed to vitamin D supplementation . CONCLUSIONS There was no observed effect of vitamin D(3 ) supplementation on bone loss or bone turnover markers in calcium-replete , postmenopausal African American women . Further studies are needed to determine if these findings are applicable to women of other ethnic groups Vitamin D has been shown to be an important immune system regulator . Vitamin D insufficiency during winter may cause increased susceptibility to upper respiratory tract infections ( URIs ) . To determine whether vitamin D supplementation during the winter season prevents or decreases URI symptoms , 162 adults were r and omized to receive 50 microg vitamin D3 ( 2000 IU ) daily or matching placebo for 12 weeks . A bi-weekly question naire was used to record the incidence and severity of URI symptoms . There was no difference in the incidence of URIs between the vitamin D and placebo groups ( 48 URIs vs. 50 URIs , respectively , P=0.57 ) . There was no difference in the duration or severity of URI symptoms between the vitamin D and placebo groups [ 5.4+/-4.8 days vs. 5.3+/-3.1 days , respectively , P=0.86 ( 95 % CI for the difference in duration -1.8 to 2.1 ) ] . The mean 25-hydroxyvitamin D level at baseline was similar in both groups ( 64.3+/-25.4 nmol/l in the vitamin D group ; 63.0+/-25.8 nmol/l in the placebo group ; n.s . ) . After 12 weeks , 25-hydroxyvitamin D levels increased significantly to 88.5+/-23.2 nmol/l in the vitamin D group , whereas there was no change in vitamin D levels in the placebo group . There was no benefit of vitamin D3 supplementation in decreasing the incidence or severity of symptomatic URIs during winter . Further studies are needed to determine the role of vitamin D in infection OBJECTIVE . Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States . In light of the importance of vitamin D for skeletal and nonskeletal health , including innate immunity , developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research . The objective of this study was to evaluate the effect of administration of oral cholecalciferol , 100000 IU every 2 months , and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations , serum and urine calcium , and HIV disease progression during a 12-month period . METHODS . HIV-infected children and adolescents who were aged 6 to 16 years were r and omly assigned to receive vitamin D ( 100000 IU bimonthly ) and calcium ( 1 g/day ; n = 29 ) or double placebo ( n = 27 ) . Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay , albumin-corrected calcium concentrations , and spot urinary calcium-creatinine ratios were determined monthly . RESULTS . No abnormalities in serum calcium concentration were observed . One participant who received placebo  developed hypercalciuria . No group differences were seen in the change in CD4 count or CD4 % or viral load during 12 months . The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group , as was the monthly serum 25-hydroxyvitamin D area under the curve . After completing 12 months of study , 2 ( 6.7 % ) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration < 20 ng/mL compared with 14 ( 50 % ) in the placebo group . Twelve ( 44.4 % ) in the group that received vitamin D and calcium  had a trough serum 25-hydroxyvitamin D concentration of ≥30 ng/mL compared with 3 ( 11.1 % ) in the placebo group . CONCLUSIONS . Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100000 IU every 2 months , together with 1 g/day calcium , is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations Calcitriol , also known as 1,25-dihydroxy-vitamin D3 , is a steroid hormone that has been shown to have effects on cytokine production and lymphocyte proliferation . Coadministration of calcitriol with trivalent influenza vaccine in mice enhanced both mucosal and systemic antibody responses . We studied the effects of calcitriol coadministered with a commercially available influenza vaccine in 175 human volunteers in this double-blind , placebo controlled clinical trial . Subjects that received calcitriol experienced more pain at the injection site compared with placebo recipients . No significant differences in hemagglutination inhibition titers against H1N1 , H3N2 , or influenza B antigens were detected at 1 or 3 months postvaccination . We conclude that coadministration of 1.0 microg of calcitriol at a site adjacent to influenza vaccination does not enhance humoral immunity in human volunteers Calcitriol has shown a benefit in various small uncontrolled studies of ex vivo immune function . We hypothesized that paricalcitol , a new vitamin D derivative , will have a positive effect on the immune system with minimal adverse effects on calcium homeostasis . Thirty-one hemodialysis patients not administered vitamin D because of low intact parathyroid hormone ( PTH ) levels were r and omized to placebo or 4 microg of paricalcitol intravenously with the hemodialysis session three times weekly for 12 weeks . Effects on in vivo and ex vivo assessment s of immune function were evaluated . All patients achieved the target dose of paricalcitol .  Twenty patients were anergic at the start of the study ; 4 of 11 patients in the paricalcitol group and 0 of 9 patients in the placebo group converted to reactive ( P = 0.09 ) . The in vivo response to st and ard hepatitis B booster vaccine and in vitro proliferation and release of interleukin-2 ( IL-2 ) , IL-6 , tumor necrosis factor-alpha , and interferon-gamma from stimulated lymphocytes were not different between the groups . In contrast to clinical immune effects , paricalcitol increased serum calcium levels and decreased PTH and bone alkaline phosphatase levels ( all P < 0.05 ) . However , hypercalcemia was infrequent . In vitro experiments showed that paricalcitol led to greater dose-dependent thymidine uptake than calcitriol in lymphocytes isolated from either dialysis patients or control subjects . Paricalcitol has a tendency toward improving delayed hypersensitivity reactions , but did not have other proimmune effects . However , as expected , paricalcitol had significant effects on calcium homeostasis compared with placebo . Thus , patients with low PTH levels are unlikely to experience the proimmune effects of vitamin D therapy without more profound and potentially adverse oversuppression of PTH BACKGROUND Elderly people who have a fracture are at high risk of another . Vitamin D and calcium supplements are often recommended for fracture prevention . We aim ed to assess whether vitamin D3 and calcium , either alone or in combination , were effective in prevention of secondary fractures . METHODS In a factorial- design trial , 5292 people aged 70 years or older ( 4481 [ 85 % ] of whom were women ) who were mobile before developing a low-trauma fracture were r and omly assigned 800 IU daily oral vitamin D3 , 1000 mg calcium , oral vitamin D3 ( 800 IU per day ) combined with calcium ( 1000 mg per day ) , or placebo .  Participants who were recruited in 21 UK hospitals were followed up for between 24 months and 62 months . Analysis was by intention-to-treat and the primary outcome was new low-energy fractures . FINDINGS 698 ( 13 % ) of 5292 participants had a new low-trauma fracture , 183 ( 26 % ) of which were of the hip . The incidence of new , low-trauma fractures did not differ significantly between participants allocated calcium and those who were not ( 331 [ 12.6 % ] of 2617 vs 367 [ 13.7 % ] of 2675 ; hazard ratio ( HR ) 0.94 [ 95 % CI 0.81 - 1.09 ] ) ; between participants allocated vitamin D3 and those who were not ( 353 [ 13.3 % ] of 2649 vs 345 [ 13.1 % ] of 2643 ; 1.02 [ 0.88 - 1.19 ] ) ; or between those allocated combination treatment and those assigned placebo ( 165 [ 12.6 % ] of 1306 vs 179 [ 13.4 % ] of 1332 ; HR for interaction term 1.01 [ 0.75 - 1.36 ] ) . The groups did not differ in the incidence of all-new fractures , fractures confirmed by radiography , hip fractures , death , number of falls , or quality of life . By 24 months , 2886 ( 54.5 % ) of 5292 were still taking tablets , 451 ( 8.5 % ) had died , 58 ( 1.1 % ) had withdrawn , and 1897 ( 35.8 % ) had stopped taking tablets but were still providing data for at least the main outcomes . Compliance with tablets containing calcium was significantly lower ( difference : 9.4 % [ 95 % CI 6.6 - 12.2 ] ) , partly because of gastrointestinal symptoms . However , potentially serious adverse events were rare and did not differ between groups . INTERPRETATION The findings do not support routine oral supplementation with calcium and vitamin D3 , either alone or in combination , for the prevention of further fractures in previously mobile elderly people
target: Serious adverse events attributable to vitamin D supplementation were rare across all studies .
  On the basis of studies review ed to date , the strongest evidence supports further research into adjunctive vitamin D therapy for tuberculosis , influenza , and viral upper respiratory tract illnesses .
background: OBJECTIVE To review the existing human controlled intervention studies of vitamin D as adjunctive therapy in setting s of infection and provide recommendations for design and implementation of future studies in this field on the basis of the evidence review ed .