Calcium and vitamin D supplements have little or no meaningful effect on preventing bone fractures and falls – BMJ Group

Recommendations for calcium and vitamin D supplementation should be reevaluated, researchers suggest

Detailed study finds that supplements with calcium, vitamin D, or their combination offer little or no clinically meaningful benefit in preventing fractures and falls in most older adults. review the latest evidence published by 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.

Therefore, the researchers stated that these findings “do not support routine or combined supplementation of calcium and vitamin D to prevent fractures and falls,” and suggested that clinicians, guideline committees, and regulatory agencies “need to reevaluate general recommendations for calcium and vitamin D supplementation 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.

2026/05/20

Notes for editors
the study: Calcium, vitamin D, or combination supplements to prevent bone fractures and falls: a systematic review and meta-analysis doi: 10.1136/bmj-2025-088050
editorial: Vitamin D, calcium, or combination supplements to prevent bone fractures and falls doi: 10.1136/bmj.s913

Link to the Academy of Medicine’s press release labeling system: http://press.psprings.co.uk/AMSlabels.pdf

Has it been externally peer-reviewed? Yes (research); No (linked editorial)
Types of evidence: Systematic reviews and meta-analyses. opinion
Subject: People