Calcium, vitamin D do not lower risk for fractures or falls

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Key takeaways:

Calcium and vitamin D are not linked to a clinically meaningful reduction of fracture risk.
Researchers said future studies should focus on interventions other than supplements to lower fracture risk.

Calcium and vitamin D supplementation do not reduce the risk for falls or fractures among older adults, according to findings published in The BMJ.

In a systematic review and meta-analysis of 69 trials that included a combined 153,902 participants, researchers found no associations between calcium and vitamin D monotherapy and risk for fractures and falls. Calcium and vitamin D used in combination was tied to a slightly reduced risk for fractures. However, the researchers wrote that the association did not meet the study’s criteria for clinically meaningful benefit.

Vitamin K

Calcium and vitamin D supplementation do not reduce the risk for falls or fractures among older adults. Image: Adobe Stock.

“Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits with calcium, vitamin D or combined supplements on fracture and fall prevention,” Olivier Massé, PharmD, MSc, pharmacist at Sacred Heart Hospital of Montreal, and colleagues wrote. “These findings do not support routine supplementation with calcium, vitamin D or combined supplementation to prevent fractures or falls.”

Researchers searched for randomized controlled trials comparing supplementation of calcium, vitamin D or both in combination with placebo or no treatment. The primary outcome was risk for any fractures. Risk for falls and specific types of fractures were assessed as secondary outcomes. The researchers defined clinically meaningful as a reduction of at least 0.7% in hip fractures, at least 2% for any fracture, nonvertebral fractures and vertebral fractures, at least 3% in falls and at least five falls per 100 person-years.

No clinically meaningful benefit

Of the trials, 46 assessed vitamin D monotherapy. Over a mean follow-up of 2 years, there was no difference in fracture risk between adults receiving vitamin D and those receiving placebo or no treatment. Vitamin D did not affect the risk for any specific type of fracture or falls.

There were 15 trials that investigated calcium monotherapy. During a mean follow-up of 2.8 years, there was no difference in fracture risk between the calcium and control groups. Calcium supplementation was not associated with risk of any type of fracture or falls.

Sixteen trials examined the effect of calcium and vitamin D combination therapy on fracture risk. During a mean follow-up of 2.3 years, adults who received combination therapy had lower risk for any type of fracture than those receiving placebo or no treatment (RR = 0.91; 95% CI, 0.84-0.99). Combination calcium and vitamin D was tied to reduced risk for hip fractures (RR = 0.84; 95% CI, 0.74-0.96), nonvertebral fractures (RR = 0.87; 95% CI, 0.78-0.96) and falls (RR = 0.92; 95% CI, 0.84-1) than placebo or no treatment. However, the researchers said none of the associations met the study’s clinically meaningful criteria.

“Apart from exercise and drug treatments for osteoporosis, few interventions with moderate or high certainty evidence have been consistently shown to reduce the risk of fractures,” the researchers wrote. “Future trials may evaluate interventions other than calcium, vitamin D or combined supplementation to prevent fractures and falls. Potential areas of investigation include dietary strategies, drug review, educational or behavioral approaches, multicomponent interventions, and digital tools for fall prevention.”

Shifting focus to interventions

In a related editorial, Guylène Thériault, MD, MEd, clinical lecturer at University of Montreal, and colleagues wrote about how calcium and vitamin D supplementation was posited as an “effortless and inexpensive” method for preventing fractures among older adults. Thériault said findings from the meta-analysis show that supplementation does not prevent fractures or falls, and future studies should move away from supplementation and toward investigating other potential interventions.

“There is good evidence showing that exercise focusing on balance and strength (not just walking), or interventions combining this exercise, home hazard assessment, or education with other interventions tailored to risk assessment offer meaningful reduction in risk,” Thériault told Healio. “Efforts should focus on better funding and implementation of these interventions, which may require an interdisciplinary team-based approach.”

Thériault acknowledged that data on the effect of supplementation in some high-risk populations are limited, including adults with vitamin D deficiency, those with previous fractures and older adults living in nursing homes.

“If there are further trials, they should focus on these higher-risk populations,” Thériault said.

For more information:

Guylène Thériault MD, MEd, can be reached at endocrinology@healio.com.

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Sources/Disclosures

Source:

Massé O, et al. BMJ. 2026;doi:10.1136/bmj-2025-088050.

Reference:

Disclosures:
Massé reports receiving payments from CPD Network, Ensemble IQ and Pharmascope. Thériault reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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