Calcium and vitamin D are essential for the body, so many older adults take supplements in the hope of avoiding falls and fractures. However, an analysis of 69 clinical trials involving over 153,000 people found no significant benefit to such supplementation for the majority of older adults. An Izvestia report explores why these bone-essential nutrients failed to provide reliable protection against injuries and identifies who might still need the supplements.
What the scientists examined
Calcium is a component of bone tissue, while vitamin D helps the body absorb it from food. At first glance, the link seems obvious: taking both substances as supplements should strengthen bones and reduce the incidence of fractures. However, for prevention purposes, it is important to verify not only how these substances act within the body but also whether people actually suffer fewer injuries.
The authors of the study, published in the BMJ, pooled the results of 69 randomized clinical trials involving 153,902 adults. These trials compared the intake of calcium, vitamin D, or both combined against a placebo or no supplementation. The researchers focused on two practical outcomes: fractures and falls.
Trial participants were assigned to groups randomly. This approach allows for a more accurate assessment of the supplements’ effects—for instance, by isolating them from the influence of age, lifestyle habits, or baseline health status. However, the studies included in the review varied in quality, a factor the authors took into account when evaluating the reliability of their conclusions.
Did fracture risk decrease?
First, the scientists determined what level of risk reduction would be considered clinically significant for a patient, and then compared the trial results against this threshold. They found no significant protection against fractures—whether calcium was taken alone, vitamin D was taken alone, or the two were used in combination.
The conclusion regarding calcium is based on 11 trials involving 9,067 people; Researchers rated the reliability of this data as moderate. For vitamin D, they analyzed 36 trials involving 92,045 people, while for the combination of calcium and vitamin D, they analyzed 15 trials involving 51,126 people. The reliability of the findings in these latter two cases was rated as high. A similar pattern was observed when hip fractures and falls were analyzed separately.
This does not mean that calcium and vitamin D are “unnecessary for bones.” The study addresses a more specific question: whether supplementation with these substances prevents falls and fractures in the people included in the trials. The results do not confirm that prescribing supplements to everyone provides significant protection against these events.
Why a single supplement cannot prevent falls
Bone health is only one of the factors determining fracture risk. A person may first lose their balance and fall; the likelihood of falling is influenced by factors such as mobility, vision impairment, medications, and home environment. Therefore, an agent affecting bone metabolism will not necessarily reduce the number of falls.
This issue is particularly important for older adults. According to data cited by the BMJ Group, nearly one in three people aged 65 and older falls each year. Consequences can include fractures, chronic pain, and a loss of independence.
The review authors examined whether the overall conclusions changed when accounting for participants’ age and sex, history of falls and fractures, and average dietary calcium intake. The conclusions remained largely unchanged. However, for certain specific questions, there were fewer trials or participants, so those results require cautious interpretation.
To whom the study findings may not apply
The authors explicitly state that the results cannot be automatically applied to people with specific bone diseases or to patients undergoing pharmacological treatment for osteoporosis. The review also does not address the issue of prescribing supplements to a specific individual with a diagnosed deficiency or other medical indications.
Therefore, anyone prescribed calcium or vitamin D by a doctor should not discontinue taking them on their own after reading the study. It is wiser to clarify the purpose of the prescription: whether it is to correct a deficiency, treat a medical condition, or solely to prevent fractures.
One should not draw the opposite conclusion—that dietary calcium intake no longer matters. It remains an essential nutrient. Dietary sources include, for example, dairy products, certain green vegetables, and fish consumed with soft bones. If supplements are needed, the specific product and dosage are determined based on the individual’s diet and health status.
What helps reduce the risk of falling
Instead of relying solely on supplements, the authors suggest focusing on measures with proven benefits—such as balance training, muscle-strengthening exercises, and programs tailored to the specific reasons why an individual falls.
The practical challenge goes beyond simply choosing a vitamin regimen.
For individuals who have already experienced a fall, it may be necessary to assess gait and stability, check vision, review current medications with a doctor, and eliminate household hazards. The U.S. Preventive Services Task Force (USPSTF) recommends exercise programs for adults over 65 who are at increased risk of falling; decisions regarding additional measures should be made on an individual basis.
Researchers publishing in the BMJ conclude that available evidence does not support the routine prescription of calcium and vitamin D solely to prevent falls and fractures. The authors of the accompanying editorial note that further high-quality trials are needed for particularly high-risk groups. In the meantime, the key practical takeaway is that injury prevention strategies should be tailored to an individual’s specific risk factors, and any medically prescribed medications should be discussed with a specialist.
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