The use of calcium, vitamin D, or combined supplementation does not appear helpful in preventing fractures and falls, claims a study.
“Our systematic review found that calcium combined with vitamin D was the only intervention associated with a statistically significant reduction in risk of fractures, while no intervention showed a statistically significant reduction in falls,” the investigators said.
“Clinicians, guideline panels, and regulatory agencies should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence,” they added.
Sixty-nine trials, comprising 152,902 participants, that compared calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (aged ≥18 years) not receiving drug treatment for osteoporosis were included in this systematic review and meta-analysis.
The investigators identified these studies from systematic reviews from 2014, three databases (ie, Embase, Medline, Central), clinical trial registries, abstracts from scientific meetings, and references from included studies. They synthesized the findings using random effects meta-analyses and appraised using the Grading of Recommendations Assessment, Development and Evaluation.
Most of the participants in the eligible trials were community-dwelling (87 percent) and were not at increased risk of fractures or falls (73 percent). [BMJ 2026;393:e088050]
The use of calcium supplements (11 trials, n=9,067; risk ratio [RR], 0.91, 95 percent confidence interval [CI], 0.81‒1.01; moderate certainty), vitamin D supplements (36 trials, n=92 045; RR, 1.00, 95 percent CI, 0.95‒1.06; high certainty), or combined supplementation (15 trials, n=51 126; RR, 0.91, 95 percent CI, 0.84‒0.99; high certainty) provided little or no protection against fractures.
Based on largely moderate to high certainty of evidence, the use of calcium, vitamin D, or combined supplementation similarly showed little to no effect on other fracture and fall outcomes. These findings persisted even after an extensive exploration of heterogeneity across multiple subgroup analyses.
Furthermore, evidence on the benefit of calcium monotherapy or combined supplementation for high-risk patients or those requiring residential care was scarce for several outcomes.
“These findings do not support routine supplementation with calcium, vitamin D, or combined supplementation to prevent fractures or falls,” the investigators said. “However, the results may not be generalizable to individuals with specific bone disorders or to those receiving drug treatment for osteoporosis or using long term corticosteroids.”
Clinical guidelines
Previous systematic reviews suggested the potential benefit of vitamin D, with or without calcium, in reducing the risk of fractures and falls. [JAMA 2004;291:1999-2006; JAMA 2005;293:2257-2264; BMJ 2009;339:b3692; Arch Intern Med 2009;169:551-561; J Am Geriatr Soc 2010;58:1299-1310]
“Conclusions, however, often relied on a small number of trials, specific dosing regimens or subgroup analyses, or treatment effects with clinically uncertain absolute risk reductions,” the investigators said.
“Early meta-analyses might also have been heavily influenced by two trials with concerns about publication integrity, one of which has since been retracted,” they added. [J R Soc N Z 2024;55:267-286]
However, clinical guidelines still recommend vitamin D supplementation, with around 70 percent of 34 existing guidelines published between 2010 and 2020 promoting or suggesting vitamin D supplements for fracture prevention or general health. [Int J Clin Pract 2021;75:e14805]
As a consequence, vitamin D prescriptions rose rapidly in many countries. [J Nutr 2010;140:817-822; NCHS Data Brief 2011;61:1-8; Drugs Aging 2013;30:1029-1038; Osteoporos Int 2015;26:2695-2702]
“Future trials may evaluate interventions other than calcium, vitamin D, or combined supplementation to prevent fractures and falls,” the investigators said. “Potential areas of investigation include dietary strategies, drug review, educational or behavioural approaches, multicomponent interventions, and digital tools for fall prevention.”