Calcium and vitamin D supplements do little to prevent fractures or falls

A review of 69 randomized trials and more than 150,000 people found that for healthy older adults, calcium, vitamin D, or both together did little to prevent fractures or falls.

Based on a peer-reviewed study in The BMJ

Summary

A systematic review pooled 69 randomized trials and 153,902 adults, most living independently and not at high risk of fractures.
Vitamin D alone had no effect on fracture risk (risk ratio 1.00), rated high certainty; calcium alone and calcium plus vitamin D (both 0.91) showed little to no clinically meaningful benefit.
The null result held across hip and other fractures and across falls, and survived extensive subgroup analysis.
It does not apply to people with osteoporosis, a diagnosed deficiency, or those in residential care, where evidence was limited.
The authors say balance and resistance exercise prevent falls better than pills, and that guidelines should be revisited.

For decades, older adults have been urged to take calcium and vitamin D to keep their bones strong, and millions do. Now the largest review yet, published in The BMJ, has pooled 69 randomized trials and found little to no effect from calcium, vitamin D, or the two combined on the risk of a fracture or a fall.

The trials followed more than 150,000 adults, most of them living independently and not at high risk of fractures or falls. For that large majority, the supplements did not meaningfully lower the odds of breaking a bone.

Why this review carries weight

Calcium and vitamin D have been tested many times over the years, with results that often looked mixed. This one gathers the trials from systematic reviews from 2014 onward and adds newer ones, and it confirms, with more data than before, that the benefit is not there. What sets it apart is its size and its yardstick. Rather than asking only whether a benefit was detectable at all, the authors measured each result against thresholds considered clinically meaningful, the size of effect that would actually matter to a patient. By that standard, the benefits fell away.

The evidence was strongest for vitamin D taken on its own. On the primary outcome of any fracture, it made no measurable difference, a conclusion the authors rated as high certainty. Calcium on its own, and calcium plus vitamin D, showed little to no effect either. The pattern held for hip fractures, other fracture types, and falls, and it survived an extensive exploration of the data across many subgroups.

Who should not stop

This is not a green light to throw out every supplement. The review looked at generally healthy adults who were not receiving drug treatment for osteoporosis. It does not speak to people who already have osteoporosis, a diagnosed vitamin D deficiency, or a specific bone disorder, and the authors note the findings may not apply to them. Evidence was also limited for frailer people, such as those requiring residential care. If a doctor has put you on calcium or vitamin D for a reason like that, this review is not about you.

What actually helps

So what should someone worried about fractures do? The review points to a clear answer, and it is not on a shelf. The authors argue the focus should shift toward things that do prevent falls and injuries, such as balance and resistance exercise, and programs that combine exercise with home-hazard checks, tailored to individual risk. Their verdict on the pills is blunt: the results “do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls.” They add that guideline groups should re-evaluate their general recommendations in light of the evidence.

For most healthy older adults, the review’s message is that these supplements are not the safeguard they were long sold as.