Might not really help prevent broken bones
By BMJ Group
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Nearly one in three adults age 65 and older experiences a
fall each year. Many of these falls lead to fractures, which can cause pain,
lower quality of life, and increase the need for assisted living or residential
care. As a result, reducing falls and fractures remains a major public health
goal worldwide.
Earlier reviews have also found little evidence that calcium
or vitamin D supplements reduce fracture risk, and findings on combined
supplementation have been inconsistent. The role of vitamin D in preventing
falls has also remained uncertain.
Even so, many doctors, health guidelines, and regulatory
agencies continue to recommend vitamin D supplements, with or without calcium,
to support bone health. Prescriptions for these supplements have also risen
significantly in recent years.
Large Review Examines Fracture and Fall Prevention Evidence
To better understand the issue, researchers in Canada
analyzed data from 69 randomized controlled trials involving 153,902 adults.
The studies examined whether calcium supplements, vitamin D supplements, or a
combination of both could reduce fractures and falls compared with placebo or
no treatment.
Although the quality of the trials varied, researchers
evaluated the risk of bias and the reliability of the evidence using
established scientific methods.
After setting thresholds for what would count as a
clinically meaningful benefit, the team found little to no reduction in overall
fracture risk from calcium supplements (moderate certainty evidence from 11
trials; 9,067 participants), vitamin D supplements (high certainty evidence
from 36 trials; 92,045 participants), or combined supplementation (high
certainty evidence from 15 trials; 51,126 participants).
The analysis also found little to no benefit for preventing
specific fractures, including hip fractures, or reducing falls. These
conclusions were supported by mostly moderate to high certainty evidence.
Findings Consistent Across Different Groups
The researchers noted that some analyses included relatively
few studies and participants, meaning the findings should be interpreted
carefully. They also said the results may not apply to people with certain bone
disorders or those receiving medication for osteoporosis.
Still, additional analyses showed consistent results across
different groups, including variations in age, sex, history of fractures or
falls, and average calcium intake through diet. This strengthened confidence in
the overall findings.
The researchers concluded that the evidence “does not
support routine supplementation with calcium or vitamin D, or combined
supplementation to prevent fractures and falls.” They added that clinicians,
guideline panels, and regulatory agencies “should re-evaluate their general
recommendations for calcium and vitamin D supplementation in light of current
evidence.”
Experts Call for Better Fall Prevention Strategies
Researchers writing in a related editorial said more large,
high-quality trials are needed to determine whether supplementation could help
people at higher risk.
For now, they recommend shifting attention and funding
toward strategies proven to reduce falls and fall-related injuries. These
include balance training, resistance exercise, and combined approaches that may
involve exercise, home hazard assessment, or education tailored to an
individual’s level of risk.
Reference: “Calcium, vitamin D, or combined supplementation
to prevent fractures and falls: systematic review and meta-analysis” by Olivier
Massé, Claudia Mei Mercurio, Sébastien Dupuis, Maya Al Sahwi, Alexandra Arruda,
Gabriel Dallaire, Katherine Desforges, Nicolas Dugré and David Williamson, 20
May 2026, BMJ.
DOI: 10.1136/bmj-2025-088050
