Recent Findings on Calcium and Vitamin D Supplements in Older Adults

An extensive review published today in The BMJ has revealed that calcium, vitamin D, or their combined supplements offer minimal to no significant benefits in preventing fractures and falls among most older adults.

Approximately one-third of individuals aged 65 and older experience falls each year, often leading to fractures that result in pain, diminished quality of life, and a greater need for assisted living. As such, preventing falls and fractures remains a crucial public health priority worldwide.

Previous reviews of the evidence have consistently shown no notable reduction in fractures attributable to calcium or vitamin D supplements, with the effects of their combined use also yielding inconsistent results. Additionally, the impact of vitamin D on falls remains uncertain.

Despite this lack of conclusive evidence, many healthcare professionals, regulatory bodies, and guidelines continue to recommend vitamin D supplements (alone or alongside calcium) for bone health, leading to a significant increase in prescriptions over recent years.

In light of these uncertainties, researchers in Canada conducted a comprehensive review of 69 randomized controlled trials that involved 153,902 adults. They examined the effects of calcium and/or vitamin D supplementation on the incidence of fractures and falls compared to placebo or no treatment.

Although the trials varied in quality, the researchers employed established tools to evaluate the risk of bias and the certainty of the evidence presented.

After establishing clinically relevant thresholds, the researchers found negligible effects on the occurrence of any fractures from calcium supplements (moderate certainty from 11 trials involving 9,067 participants), vitamin D supplements (high certainty from 36 trials with 92,045 participants), or combined supplementation (high certainty from 15 trials, 51,126 participants).

Furthermore, calcium, vitamin D, or joint supplementation had little to no impact on particular types of fractures, such as hip fractures, or on falls, based primarily on moderate to high certainty of evidence.

While the researchers acknowledge that some analyses included a limited number of trials and participants—advising caution in interpretation—their findings consistently stood strong across various demographic factors, such as age, gender, history of fractures, and dietary calcium intake.

Thus, they concluded that their findings “do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls,” urging clinicians, guideline developers, and regulatory bodies to “re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence.”

The researchers emphasized the necessity for rigorous studies in specific high-risk groups to inform future supplementation guidelines, as noted in a related editorial.

In the interim, they suggested that resources should instead be allocated to interventions with proven effectiveness in preventing falls and related injuries. This could include programs focused on balance and resistance training, as well as multifaceted approaches that integrate exercise, hazard assessments, and personalized risk education.