Comprehensive review published in BMJ Our findings suggest that taking calcium supplements, vitamin D supplements, or both has little or no clinically meaningful benefit in preventing fractures and falls for most older adults.
Falls are a major health concern for older adults. Nearly one in three people over the age of 65 experience a fall each year, many of which result in a broken bone. These injuries can cause pain, decreased independence, decreased quality of life, and possibly the need for long-term residential care. As populations continue to age, preventing falls and fractures remains an important public health goal globally.
Previous reviews have already raised questions about the effectiveness of calcium and vitamin D supplements. Studies have generally found that either supplement alone does not reduce fracture risk, but results are mixed when taking both together. The role of vitamin D in reducing falls also remains unclear.
Still, vitamin D supplements (with or without calcium) continue to be widely recommended by health care providers, professional guidelines, and regulatory agencies for bone health. Prescriptions for these supplements have also increased significantly in recent years.
Analysis of 69 clinical trials
To better understand the evidence, Canadian researchers analyzed data from 69 randomized controlled trials involving 153,902 adults. This study compared calcium supplements, vitamin D supplements, or a combination of both to a placebo or no treatment to determine whether they reduced the risk of falls and fractures.
Although the quality of the trials varied, the researchers used established methods to evaluate each study to assess both potential bias and certainty of the evidence.
After establishing a threshold for what would be considered a clinically meaningful benefit, the research team found that calcium supplements (moderate certainty evidence from 11 trials, 9,067 participants), vitamin D supplements (high certainty evidence from 36 trials) found little or no reduction in overall fracture risk with sex evidence, 92,045 participants) or combination supplements (high certainty evidence from 15 trials, 51,126 participants).
The analysis also showed little effect on preventing certain fractures, including femoral neck fractures, or reducing falls. These findings were primarily supported by moderate to high certainty evidence.
Findings are common across different groups
The researchers note that some of their analyzes included relatively small numbers of studies and participants. Therefore, the findings should be interpreted with caution. They also cautioned that the results may not apply to people with certain bone diseases or those receiving treatment for osteoporosis.
However, additional analyzes found similar results even after accounting for factors such as age, gender, previous fractures, previous falls, and average calcium intake from food. The researchers say this consistency strengthens confidence in their overall conclusions.
Based on the available evidence, the authors concluded that the findings “do not support routine supplementation of calcium or vitamin D, or their combination, to prevent bone fractures and falls.”
They further suggest that clinicians, guideline committees, and regulatory agencies “should reevaluate general recommendations for calcium and vitamin D supplementation in light of current evidence.”
Focus may shift to proven fall prevention strategies
In a linked editorial, researchers say more rigorous, evidence-based clinical trials are needed to guide recommendations for people at high risk of fractures and falls.
Until then, they argue, it would be better to direct resources and funding to strategies that have already proven to be meaningfully effective. These include individualized fall prevention programs that combine approaches such as balance training, resistance exercises, exercise based on an individual’s specific risk factors, risk assessment, and education.
