New insights on calcium and vitamin D supplementation highlight the need for reassessment, according to researchers.
A comprehensive review published by The BMJ reveals that calcium, vitamin D, or their combined supplements show minimal to no significant benefits in preventing fractures and falls among the majority of older adults.
Each year, nearly one-third of individuals aged 65 and older experience falls, frequently resulting in fractures that can lead to pain, decreased quality of life, and the necessity for long-term care. Therefore, preventing falls and fractures is a critical public health concern worldwide.
Numerous earlier reviews have indicated no significant reduction in fractures due to calcium or vitamin D supplements, with mixed results concerning their combined use. Additionally, the impact of vitamin D on fall prevention remains ambiguous.
Despite these findings, numerous healthcare professionals, along with various guidelines and regulatory entities, advocate for vitamin D supplementation (with or without calcium) to support bone health, resulting in a significant uptick in recommended prescriptions in recent years.
In response to this uncertainty, a team of researchers from Canada evaluated data from 69 randomized controlled trials comprising 153,902 adults. The studies investigated the effectiveness of calcium or vitamin D supplements—alone or together—in diminishing the incidence of fractures and falls compared to placebos or no treatment.
While the quality of the trials varied, the researchers assessed biases and established the certainty of the evidence using recognized methodologies.
After determining clinically relevant thresholds, the researchers concluded that calcium supplements (with moderate certainty based on 11 trials involving 9,067 participants), vitamin D supplements (with high certainty from 36 trials involving 92,045 participants), and combined supplementation (with high certainty from 15 trials involving 51,126 participants) provided little to no effect on the occurrence of any fractures.
Moreover, calcium, vitamin D, or combined supplementation also seemed ineffective in preventing specific types of fractures, such as hip fractures, and in reducing falls, supported by moderate to high certainty evidence.
Though the analysis included some studies with limited sample sizes, the researchers advise careful interpretation of findings, acknowledging that results may not be applicable to those with particular bone disorders or individuals undergoing osteoporosis treatment.
Nevertheless, the consistency of the findings remained firm even after accounting for variables like participant age, sex, history of fractures and falls, and average dietary calcium intake, reinforcing the robustness of their conclusions.
The researchers assert that these findings “do not endorse routine supplementation with calcium or vitamin D, or their combination, for preventing fractures and falls.” They recommend that clinicians, guideline committees, and regulatory bodies “should reassess their overall recommendations for calcium and vitamin D supplementation based on current evidence.”
The researchers call for more rigorous and well-structured trials to provide clearer guidance for supplementation among higher-risk groups, as highlighted in a linked editorial.
In the interim, they propose shifting focus and funding towards interventions that have been demonstrated to effectively prevent falls and related injuries. These may include balance and resistance training, along with tailored programs that integrate exercise, hazard assessments, and education based on individual risk factors.
20/05/2026
Notes for editors
Research: Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis doi: 10.1136/bmj-2025-088050
Editorial: Vitamin D, calcium, or combined supplementation to prevent fractures and falls doi: 10.1136/bmj.s913
Link to Academy of Medical Sciences press release labelling system: http://press.psprings.
Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Systematic review and meta-analysis; Opinion
Subjects: People
