Calcium, vitamin D, or combined supplements offer little to no clinically meaningful benefit on fracture and fall prevention in most older people, according to a review of the latest evidence. The findings suggest that supplementation recommendations should be re-evaluated.

Lack of benefit for either supplement has been shown in previous studies, the authors noted. “Yet despite this, many clinicians, guidelines, and regulatory agencies recommend vitamin D supplements (with or without calcium) for bone health, and prescriptions have increased substantially in recent years.”

For the current study, researchers reviewed 69 randomized controlled trials involving 153,902 adults that assessed the effect of calcium or vitamin D supplements — or a combination of both — on reducing fractures and falls compared with placebo or no treatment.

The review found little to no effect on fractures from calcium supplements (moderate certainty evidence; 11 trials, 9,067 participants), vitamin D supplements (high certainty evidence; 36 trials, 92,045 participants), or combined supplementation (high certainty evidence; 15 trials, 51,126 participants).

Calcium, vitamin D, or combined supplementation also appeared to have little to no effect on specific fractures, such as hip fractures, or on falls, based largely on moderate to high certainty evidence. Findings were consistent after further analyses accounting for participant age, sex, history of fractures and falls, and average dietary calcium intake.

The findings "do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls," the researchers conclude, and they suggest clinicians, guideline panels, and regulatory agencies "should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence."

A linked editorial suggests redirecting focus toward interventions shown to offer meaningful prevention, such as balance and resistance exercise and interventions that combine exercise, hazard assessment, or education tailored to individual risk.

To download the study, published in the BMJ, click here 

To read the linked editorial, click here