Calcium and vitamin D supplements have limited effectiveness in preventing fractures

Supplements with calcium, vitamin D, or their combination offer little or no clinically meaningful benefit in preventing fractures and falls in most older adults, a detailed review of the latest evidence published by the National Academy of Sciences has found. BMJ today.

Almost one-third of people over the age of 65 fall each year, often resulting in fractures, leading to pain, reduced quality of life, and the need for residential care. Therefore, preventing falls and fractures is a global public health priority.

Several previous evidence reviews have found that neither calcium nor vitamin D supplements reduce fractures, and results have been inconsistent when used together. The benefits of vitamin D on falls also remain unclear.

Nevertheless, many clinicians, guidelines, and regulatory agencies recommend vitamin D supplements (with or without calcium) for bone health, and prescriptions have increased significantly in recent years.

To address this uncertainty, Canadian researchers reviewed the results of 69 randomized controlled trials involving 153,902 adults to assess the effectiveness of calcium or vitamin D supplements, or a combination of both, in reducing the number of fractures and falls compared with a placebo or no treatment.

Although the quality of the trials varied, researchers were able to assess risk of bias and certainty of evidence using established tools.

After agreeing on clinically meaningful thresholds, the researchers found little or no effect on fractures from the use of calcium supplements (moderate certainty evidence from 11 trials, 9,067 participants), vitamin D supplements (high certainty evidence from 36 trials, 92,045 participants), or combination supplements (high certainty evidence from 15 trials, 51,126 participants).

Also, based primarily on moderate to high certainty of evidence, calcium, vitamin D, or combined supplements appear to have little effect on certain fractures, such as femoral neck fractures and falls.

The researchers acknowledge that these results should be interpreted with caution because some analyzes included small numbers of trials and participants, and that the results may not apply to individuals with certain bone diseases or those taking medications for osteoporosis.

However, even after further analysis that took into account differences in participants’ age, gender, history of fractures and falls, and average dietary calcium intake, the results were consistent and support the strength of the conclusions.

That’s why they state these findings: ”We do not support daily supplementation of calcium or vitamin D, or a combination of both, to prevent bone fractures and falls.“And they make recommendations to clinicians, guideline committees and regulators.”General recommendations for calcium and vitamin D supplementation need to be reevaluated in light of current evidence. ”

In the linked editorial, researchers say that evidence from rigorous, well-founded trials is needed to inform recommendations for supplementation in high-risk groups.

In the meantime, they suggest that emphasis and funding should be directed toward interventions that have been shown to provide meaningful prevention of falls and fall-related injuries, such as balance and resistance exercises, and interventions that combine elements such as exercise, risk assessment, and education tailored to individual risk.