Context: Effects of long-term calcium, with or without vitamin D, on hip bone mineral density (BMD) and bone turnover in sunny climates have not been reported.Objective: The aim was to evaluate the effect of vitamin D added to calcium supplementation on hip dual-energy x-ray absorptiometry BMD and calcium-related analytes.Design, Setting, and Participants: The study was a 5-yr randomized, controlled, double-blind trial of 120 community-dwelling women aged 70-80 yr.Interventions: The interventions were 1200mg/d calcium with placebo vitamin D(Ca group) or with 1000 IU/d vitamin D2 (CaD group), or double placebo ( control).Main Outcome Measures: Hip BMD, plasma 25-hydroxyvitamin D, biomarkers of bone turnover, PTH, and intestinal calcium absorption were measured.Results: Hip BMD was preserved in CaD (- 0.17%) and Ca (0.19%) groups but not controls (- 1.27%) at yr 1 and maintained in the CaD group only at yr 3 and 5. The beneficial effects were mainly in those with baseline 25-hydroxyvitamin D levels below the median ( 68 nmol/liter). At yr 1, compared with controls, the Ca and CaD groups had 6.8 and 11.3% lower plasma alkaline phosphatase, respectively ( P <= 0.02), and 28.7 and 34.5% lower urinary deoxypyridinoline to creatinine ratio, respectively ( P <= 0.05). At 5 yr, this suppression was maintained only in the CaD group. CaD reduced PTH at 3 and 5 yr cf. controls (27.8 and 31.3%, P <= 0.005) in those with baseline PTH levels above the median (3.6 pmol/liter). Therapy did not affect intestinal calcium absorption at high carrier loads.Conclusions: Addition of vitamin D to calcium has long-term beneficial effects on bone density in elderly women living in a sunny climate, probably mediated by a long-term reduction in bone turnover rate.