Calcium and vitamin D are important for bone health, but taking them as routine supplements may not do much to prevent falls or fractures for most older adults, according to a new review.
The study, published in The BMJ, reviewed 69 randomized controlled trials involving 153,902 adults. Researchers found that calcium supplements, vitamin D supplements or the two taken together offered little to no clinically meaningful benefit for preventing fractures or falls in most older people.
The findings do not mean calcium and vitamin D are useless. Both nutrients play important roles in the body, and some people may need supplements because of deficiency, osteoporosis, certain medical conditions or medications that affect absorption. But the review suggests routine supplementation should not be treated as a broad fall- or fracture-prevention strategy for most older adults.
Falls are a major health concern with age. Nearly one-third of people 65 and older fall each year, and those falls can lead to fractures, pain, loss of independence and the need for residential care. Because of that, preventing falls and fractures is a major public health priority.
Calcium and vitamin D supplements have long been recommended for bone health, and prescriptions have increased in recent years. But previous evidence reviews have found mixed or disappointing results, especially when looking at whether supplements actually reduce fractures or falls.
To examine the evidence more closely, researchers in Canada reviewed trials comparing calcium, vitamin D or combined supplements with placebo or no treatment. The trials varied in quality, but the researchers assessed the risk of bias and certainty of evidence using established methods.
After setting thresholds for what would count as a meaningful benefit, they found little to no effect on the risk of experiencing any fracture. That was true for calcium supplements, vitamin D supplements and combined supplementation.
The same pattern held for more specific outcomes, including hip fractures and falls. Much of the evidence was rated as moderate to high certainty.
The researchers noted some cautions. Some analyses included a smaller number of trials or participants. The findings also may not apply to people with specific bone disorders, people receiving drug treatment for osteoporosis or those with medical reasons to take supplements.
Still, the results were consistent after the researchers accounted for factors such as age, sex, history of falls or fractures and average calcium intake from food.
The authors wrote that the findings “do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls.” They also said clinicians, guideline panels and regulatory agencies “should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence.”
A linked editorial argued that more rigorous research is still needed for higher-risk groups. In the meantime, the editorial suggested more attention and funding should go toward strategies already shown to help prevent falls and fall-related injuries.
Those strategies include balance and resistance exercise, checking homes for fall hazards and tailoring prevention plans to a person’s individual risk.
Calcium and vitamin D still matter. But for many older adults, preventing fractures and falls may require a broader approach, including strength, balance, safe home environments, medication review and individualized medical care.
The authors reported that they received no funding for this review and no industry financial support for the submitted work. Several authors reported receiving payments in the past 36 months from non-industry organizations for educational activities related to osteoporosis, fracture prevention, calcium or vitamin D. The authors said, to their knowledge, those organizations do not have interests that would be affected by the review’s findings.