Researchers in Canada evaluated 69 trials involving 153,902 participants, most of whom were community-dwelling and not at high risk of fractures or falls. The results of their systematic review and meta-analysis were largely based on evidence of moderate to high certainty.
They reported that the results “do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls,” and recommended that “clinicians, guideline panels, and regulatory agencies should re-evaluate their general recommendations”.
“However, the results may not be generalisable to individuals with specific bone disorders or to those receiving drug treatment for osteoporosis or using long term corticosteroids,” they added.
The findings in context
Experts report that around a third of people aged over 65 and around half of those over 80 fall at least once a year. The impact of falls and fractures is significant, with a one-year mortality rate of 31% after a hip fracture.
Despite inconsistent research, guidelines recommend vitamin D supplementation, often with calcium, for musculoskeletal health, and prescriptions have increased substantially since the early 2000s, contributing to economic burden.
The first major trial investigating vitamin D with calcium was published in the 1990s and found a 17% relative reduction in non-vertebral fractures and 23% reduction in hip fractures.
The trial generated interest in the musculoskeletal benefits of calcium and vitamin D, but was conducted on women with an average age of 84 and low baseline vitamin D levels who required residential care. Because many participants may have had unrecognized bone health issues, the findings may not be generalizable to other populations.
Subsequent research had limitations, inconsistencies, and conflicting findings, with more recent studies suggesting no benefit of the supplements for fracture prevention. There is, however, greater uncertainty regarding vitamin D monotherapy and combined supplementation for the prevention of falls.
The current researchers aimed to provide updated evidence by including several large-scale trials published since the previous reviews. The trials they included varied in quality, but they assessed the risk of bias and the certainty of the evidence using established tools.
In addition to finding little or no benefit of vitamin D or calcium for any fracture, the results suggested little to no effect for specific fractures, such as hip fractures.
The current study’s limitations include small subgroup sample sizes and the non-generalisability of the findings to people using osteoporosis drugs. The researchers recommend future trials that evaluate other interventions for fracture prevention, such as dietary strategies and digital tools for fall prevention. They also noted that “exercise and environmental modifications appear promising”.
Source: BMJ doi: https://doi.org/10.1136/bmj-2025-088050; “Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis.” Authors: O. Massé et al.
