A comprehensive review published in The BMJ has found that calcium supplements, vitamin D supplements, or a combination of both provide little to no clinically meaningful benefit in preventing fractures and falls among most older adults. Falls are a major public health concern, affecting nearly one-third of people aged 65 and older each year. They often result in fractures, pain, loss of independence, reduced quality of life, and increased need for long-term care. As populations age worldwide, identifying effective strategies to prevent falls and fractures has become increasingly important.
Although calcium and vitamin D supplements have long been recommended to support bone health, evidence regarding their effectiveness in preventing fractures and falls has remained inconsistent. Previous reviews have generally found no significant reduction in fracture risk from calcium or vitamin D supplementation alone, while findings for combined supplementation have been mixed. Similarly, the role of vitamin D in preventing falls has remained uncertain. Despite these concerns, supplementation continues to be widely recommended by clinicians, professional guidelines, and regulatory agencies, and its use has increased substantially over recent decades.
To provide greater clarity, researchers in Canada conducted an extensive review and meta-analysis of 69 randomized controlled trials involving 153,902 adults. The studies compared calcium supplements, vitamin D supplements, or combined supplementation with placebo or no treatment. The trials varied in quality and design, but researchers systematically assessed the risk of bias and the certainty of the evidence using established evaluation methods. This rigorous approach allowed them to examine the effectiveness of supplementation across a large and diverse population.
After establishing thresholds for what would constitute a clinically meaningful benefit, the researchers found little to no reduction in the risk of experiencing any fracture. Calcium supplementation showed no meaningful benefit based on evidence from 11 trials involving 9,067 participants. Similarly, vitamin D supplementation demonstrated little impact based on high-certainty evidence from 36 trials including 92,045 participants. Combined calcium and vitamin D supplementation also failed to show a clinically important reduction in fractures, based on evidence from 15 trials involving 51,126 participants. The findings were supported by moderate- to high-certainty evidence.
The review further found that supplementation had little to no meaningful effect on specific fractures, including hip fractures, or on the prevention of falls. While the researchers noted that some analyses included relatively small numbers of studies and participants, the overall findings remained consistent across multiple sensitivity analyses. Results did not substantially change when factors such as age, sex, history of falls or fractures, and dietary calcium intake were considered. However, the findings may not apply to individuals with specific bone disorders or those receiving medications for osteoporosis.
Based on the current evidence, the researchers concluded that routine calcium and vitamin D supplementation should not be recommended for the prevention of fractures and falls in the general older adult population. They called on clinicians, guideline developers, and regulatory agencies to re-evaluate existing recommendations in light of these findings. An accompanying editorial emphasized the need for further high-quality research in higher-risk populations. In the meantime, experts suggest that resources should be directed toward interventions with stronger evidence of effectiveness, including balance and resistance training, home hazard assessments, educational programs, and multifactorial interventions tailored to an individual’s risk profile.
More information: Olivier Massé et al, Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis, The BMJ. DOI: 10.1136/bmj-2025-088050
Journal information: The BMJ Provided by BMJ Group
