July 2026
Preventing fracture or falls: routine calcium or vitamin D supplementation of little benefit
By Melanie Hinze
Routine supplementation with calcium, vitamin D or both offers little to no benefit in preventing fractures and falls in adults, according to new research.
The systematic review and meta-analysis by Canadian researchers, published in the BMJ, included 69 randomised controlled trials involving 153,902 adult participants, comparing calcium, vitamin D or combined supplementation with placebo or no treatment.
Despite previous systematic reviews finding no fracture-prevention benefit from calcium or vitamin D monotherapy, prescriptions for these supplements had increased substantially in many countries since the early 2000s, and many guidelines and regulatory agencies continued to recommend vitamin D supplementation, with or without calcium, for musculoskeletal health, the researchers wrote.
Most participants were community dwelling (87%) and not at high risk of fractures or falls (73%). The median follow up was two years, and 84% of trials had a mean participant age of at least 65 years.
For the primary outcome of any fracture, calcium supplementation showed little to no effect (11 trials, 9067 participants; risk ratio [RR], 0.91), as did vitamin D supplementation (36 trials, 92,045 participants; RR, 1.00) and combined supplementation (15 trials, 51,126 participants; RR, 0.91).
Calcium, vitamin D or combined supplementation also appeared to have little to no effect on hip fracture, nonvertebral fracture, vertebral fracture, the risk of falling or the total number of falls, based largely on moderate-to-high certainty evidence. The findings remained robust across multiple subgroup analyses, including by participant age, sex, baseline vitamin D level and dosing regimen.
The study authors noted that evidence was more limited for high-risk patients and those requiring residential care, particularly for calcium monotherapy and combined supplementation.
They concluded that the results did not support routine supplementation with calcium, vitamin D or both to prevent fractures and falls.
Professor Markus Seibel, Professor of Endocrinology at The University of Sydney and Senior Consultant at Concord Hospital, Sydney, told Medicine Today that this meta-analysis confirmed what had been known for more than 20 years.
‘Common clinical practice is to use calcium supplements only in those who are clearly calcium deficient, and to supplement with vitamin D only in those who are clearly vitamin D deficient,’ he said, adding, ‘There is no point giving calcium and/or vitamin D supplements to people who are replete in either or both.’
The authors of an accompanying editorial said that efforts and funding should be redirected to ensuring access to interventions that had been shown to offer meaningful prevention of falls and falls-related injuries, including balance and resistance exercise and multicomponent interventions, such as combining exercise, hazard assessment or education with other interventions tailored to risk assessment.
They also said that evidence from rigorous and well-powered trials was needed to inform recommendations for supplementation in higher risk groups.