Calcium and vitamin D supplements, taken alone or together, provide little to no meaningful protection against fractures or falls for most older adults, according to a sweeping review published this week in The BMJ.
The systematic review and meta-analysis pooled data from 69 randomized controlled trials involving 153,902 participants, making it one of the largest examinations yet of supplements taken daily by millions of older adults on the advice of doctors and public health guidelines. Calcium alone was tested in 11 trials covering 9,067 people; vitamin D alone in 36 trials covering 92,045 people; and the combination in 15 trials covering 51,126 people. Across all three approaches, the researchers found little to no effect on fracture risk. Combined calcium-and-vitamin-D supplementation was linked to a modest reduction in fractures, but the researchers said the effect was too small to count as clinically meaningful.
A Widely Used, Widely Unproven Habit
The finding is notable because calcium and vitamin D supplementation has become routine for older adults concerned about osteoporosis and falls, and prescriptions have risen steadily in recent years. Nearly one in three adults over 65 falls at least once annually, and fractures from those falls are a leading cause of disability and lost independence in old age.
"[Current evidence] does not support routine supplementation with calcium or vitamin D, or combined supplementation, to prevent fractures and falls."
Olivier Massé and co-authors, writing in The BMJ
The review's authors, led by pharmacist Olivier Massé of Montreal's Hôpital du Sacré-Coeur and the Université de Montréal, wrote that clinicians "should re-evaluate their general recommendations" in light of the pooled data, according to a summary released by BMJ Group. The authors caution that some subgroup analyses relied on a relatively small number of trials, and that the findings may not extend to people with diagnosed bone disorders or those already taking osteoporosis medications, groups largely excluded from the trials reviewed. They call for further rigorous trials specifically in those higher-risk populations before drawing firm conclusions there.
Rather than reflexive supplementation, the researchers point to balance training and resistance exercise as strategies with more consistent evidence behind them for preventing falls. Guideline bodies that currently recommend calcium and vitamin D for general fracture prevention are likely to face pressure to revisit those recommendations as the review circulates through clinical practice.
