Vitamin D is a fat-soluble steroid that is essential for maintaining normal calcium metabolism. In vitamin D deficiency, calcium absorption is insufficient and cannot satisfy the body's needs. Consequently, parathyroid hormone production increases and calcium is mobilized from bones and reabsorbed in the kidneys to maintain normal serum calcium levels--a condition defined as secondary hyperparathyroidism. Most organs, including the gut, brain, heart, pancreas, skin, kidneys, and immune system have receptors for 1,25 (OH)vitamin D. Furthermore, all of these organs have the capacity to synthesize 1,25 (OH)vitamin D from vitamin D. Extensive research suggests that vitamin D deficiency is common and represents a global health problem. Clinical consequences related to low vitamin D levels include not only osteomalacia, osteoporosis, and rickets, but also neuro-muscular dysfunction and fractures. Falls related to neuromuscular dysfunction lead to 40% of all nursing home admissions and are the largest single cause of injury-related deaths in elderly people. About one-third of all persons 65 and older fall at least once a year, resulting in more than 1.5 million emergency room treatments and more than 300,000 hospitalizations. Falls cause more than 11,000 deaths per year, most of them in elderly patients (> or = 75 years) who suffer hip fractures. It is well established that vitamin D deficiency not only has serious consequences for bone health, but also for other organ systems. Previous studies have shown that vitamin D supplementation reduces the number of fractures and directly improves neuromuscular function, thus helping to prevent falls and subsequent fractures. In addition, vitamin D appears to have other important functions as a regulator of cell differentiation and cell growth.