Objective To calculate the expected increase in the number of fractures in adults attributable to the predicted increase in the number of elderly Australians. Data sources All fractures in adult residents (> 35 years) of the Barwon Statistical Division (total population, 218000) were identified from radiological reports from February 1994 to February 1996. The Australian Bureau of Statistics supplied predictions of Australia's population (1996 to 2051). Main outcome measure The projected annual number of fractures in Australian adults up to 2051 (based on stable rates of fracture in each age group). Results The number of fractures per year is projected to increase 25% from 1996 to 2006 (from 83000 fractures to 104000). Hip fractures are projected to increase 36% (from 15000 to 21000) because of a substantial rise in the number of elderly aged 85 years and over. Hip fractures are expected to double by 2026 and increase fourfold by 2051. Conclusions In contrast to Europe and North America, where numbers of hip fractures are expected to double by 2026 and then stabilise, in Australia hip fractures will continue to place a growing demand on healthcare resources for many decades. These projections can be used for setting goals and evaluating the costs and benefits of interventions in Australia.

Objective To assess vitamin D intake and casual exposure to sunshine in relation to serum 25‐hydroxyvitamin D (250HD) levels. Design Cross‐sectional study of a population‐based, random sample of women aged 20–92 years, assessed between 1994 and 1997. Setting and participants 861 women from the Barwon Statistical Division (population, 218000), which includes the city of Geelong (latitude 38° south) in Victoria. Main outcome measures Vitamin D intake; serum 250HD level; season of assessment; exposure to sunshine. Results Median intake of vitamin D was 1.2 μg/day (range, 0.0–11.4 μg/day). Vitamin D supplements, taken by 7.9% of participants, increased intake by 8.1% to 1.3 μg/day (range, 0.0–101.2 μg/day) (P< 0.001). A dose–response relationship in serum 250HD levels was observed for sunbathing frequency before and after adjusting for age (P<0.05). During winter (May–October), serum 250HD levels were dependent on vitamin D intake (partial r2=0.01; P<0.05) and were lower than during summer (November–April) (age‐adjusted mean, 59nmol/L [95% CI, 57–62] v 81 nmol/L [95% CI, 78–84]; P<0.05). No association was detected between serum 250HD and vitamin D intake during summer. The prevalences of low concentrations of serum 250HD were, for <28 nmol/L, 7.2% and 11.3% overall and in winter, respectively; and, for < 50 nmol/L, 30.0% and 43.2% overall and in winter, respectively. Conclusions At latitude 38° south, the contribution of vitamin D from dietary sources appears to be insignificant during summer. However, during winter vitamin D status is influenced by dietary intake. Australia has no recommended dietary intake (RDI) for vitamin D, in the belief that adequate vitamin D can be obtained from solar irradiation alone. Our results suggest that an RDI may be needed.

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The substantial 60% reduction in fracture risk associated with statin use is greater than would be expected from increases in BMD alone.

Background and Objectives Traditional Elders are integral to the social structure of Australian Indigenous communities. Due to progressive loss of traditional way of life, however, the role of Elders has been eroding. This study aims to develop a conceptual model of the role of Elders in an Australian Indigenous community, with the goal of attaining strategies to strengthen the role of Elders. Research Design and Methods The study, conducted in a regional Indigenous community in Australia, adopted a community-based participatory approach. Design and focus of the project were informed by a community forum (Yarning Circle). One-on-one semistructured interviews and focus groups with community members were conducted by Indigenous researchers. Group concept mapping (GCM) was applied to elicit major themes in qualitative data, from the point of view of community members, and to derive a conceptual model of the role of Elders. Results Fifty members of the Indigenous community took part in interviews and focus groups. The participants’ median age was 45 years (range 18–76 years); 31 (62%) were female. An additional 24 Indigenous community members took part in the data sorting task of GCM. GCM identified seven major aspects of the role of Elders, including Community relations, Passing down the knowledge, Dealing with racism and oppression, Building a better resourced community, Intergenerational connectedness, Safeguarding our identity, and Caring for our youth. Discussion and Implications Elders fulfill many important roles in contemporary Indigenous communities. Our results can be used to assist the community to codesign a program to increase community wellbeing.

This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia. Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women. Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling. In adults with a baseline calcium intake of 500–900 mg/day, increasing or supplementing this intake by a further 500–1000 mg/day has a beneficial effect on bone mineral density. Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.

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Supplementation with vitamin D helps to alleviate weakness and fatigue seen with deficiency. However, large bolus doses appear to worsen the risk of falls. Whether this occurs as a direct result of muscle weakness is currently unknown. Thus, the aims of this study were to examine the muscle function following administration of high doses of vitamin D. Given the safety issues associated with bolus doses, experiments were conducted on C57BL6 mice. Mice at eight weeks of age with otherwise normal levels of vitamin D were supplemented for four weeks with a high dose (HIGH; n = 12) of vitamin D (20000 IU/kg food) designed to provide a year’s worth of vitamin D. These mice were compared to another group who received that same yearly dose in a single bolus i.p. injection (YEAR; n = 12). Mice provided with standard mouse chow, which contained 1000 IU/kg food, and injected with the vitamin D vehicle were used as controls (CON; n = 16). Force and fatigue properties of hind limb fast- and slow-twitch muscles were measured. CON animals ingested vitamin D consistent with typical human supplementation. HIGH animals consumed significantly more food than the CON animals, such that they ingested more than a year’s worth of vitamin D in four weeks. Despite this, there were few differences in the muscle function compared with CON. YEAR animals demonstrated lower absolute and relative forces in both muscles compared to the HIGH animals, as well as lower force during fatigue and early recovery. Large bolus doses of vitamin D appear to have detrimental effects on the skeletal muscle function, likely being a contributor to increased risk of falls observed with similar doses in humans. Mice ingesting the same amount over four weeks did not demonstrate the same deleterious effects, suggesting this may be a safe way to provide high vitamin D if required.