If you’re 60 or older, odds are good that a calcium or vitamin D supplement is part of your daily routine.
More than two-thirds of older men and 80% of older women take at least one supplement, according to federal survey data. That includes calcium and vitamin D, which have long been near the top of the list for their promise of keeping aging bones strong and preventing fractures that follow a fall.
Vitamin D, with or without calcium, is widely recommended by doctors, professional guidelines and regulatory agencies for bone health, and prescriptions for it keep climbing.
But a recent comprehensive review published in The BMJ suggests that calcium, vitamin D or a combination of the two provides little to no meaningful protection against fractures or falls for most older adults.
Researchers in Canada analyzed 69 randomized controlled trials covering nearly 154,000 adults, comparing calcium, vitamin D or both against a placebo or no treatment. Most participants were not at high risk of fractures or falls. The team graded each study for potential bias and for the strength of its evidence.
Little to no benefit across the board
The researchers first defined how much benefit would count as meaningful for participants taking calcium, vitamin D or a combination of the two. None of the following three approaches cleared that bar on overall fracture risk:
Calcium alone: The analysis found no meaningful drop in fracture risk, based on evidence from 11 trials and over 9,000 participants.
Vitamin D alone: Researchers found no meaningful drop, based on evidence from 36 trials and over 92,000 participants.
Calcium and vitamin D combined: The review found a small statistically significant reduction that fell short of the clinically meaningful threshold (the amount that makes a difference for patients), based on evidence from 15 trials and over 51,100 participants.
The analysis also showed little to no benefit for preventing specific fractures, including hip fractures, or for reducing falls.
People who took calcium and vitamin D together were slightly less likely to break a bone. But the effect was small, and the researchers said even that may be overstated because most of the benefit came from a single study of people who were already at high risk of fractures.
Findings held across different groups
The results stayed consistent after the researchers accounted for age, sex, previous fractures, previous falls and average calcium intake from food. They cautioned that some parts of the analysis rested on relatively few studies and that the results may not apply to people with certain bone disorders or those taking medication for osteoporosis.
The authors concluded that the evidence does “not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls.”
They added that clinicians, guideline panels and regulatory agencies should re-evaluate their general recommendations in light of the current evidence.
Where prevention might focus instead
Other researchers have called for more rigorous trials for people at higher risk of fractures or falls. Until then, they argued, money and effort may be better spent on strategies already shown to help, such as balance training, resistance exercise and personalized fall-prevention programs that combine exercise, home-safety assessment and education.
For most older adults, the researchers say, calcium and vitamin D supplements don’t deliver the bone protection many have come to expect from them.