Does calcium, vitamin D or combined supplementation prevent fractures and falls?

Many clinicians, guidelines and regulatory agencies recommend vitamin D supplementation (with or without calcium) for musculoskeletal health. Prescriptions for calcium and vitamin D have increased substantially since the early 2000s.1 But how effective is calcium and/or vitamin D supplementation in preventing fractures and falls?To investigate this question, Quebec researchers conducted a systematic review and meta-analysis to assess the effect of calcium, vitamin D or combined supplementation on fractures and falls in adults. The authors included randomized controlled trials that compared calcium, vitamin D or combined calcium–vitamin D supplementation with placebo or no treatment in adults (≥ 18 years) not receiving drug treatment for osteoporosis.1The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, nonvertebral fracture, vertebral fracture and falling, as well as the total number of falls. Findings were synthesized using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The researchers set predefined clinical decision thresholds for the outcomes, using absolute reductions, e.g., total fractures (2%), hip fractures (0.7%) and vertebral fractures (2%), rather than relying on statistical significance.1Key results:The review included 69 trials involving 153,902 participants. Participants in most of the trials were living in the community (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9,067 participants; risk ratio [RR] 0.91, 95% confidence interval [95%CI] 0.81–1.01; moderate certainty)vitamin D supplements (36 trials, 92,045 participants; RR 1.00, 95%CI 0.95–1.06; high certainty), or combined calcium–vitamin D supplementation (15 trials, 51,126 participants; RR 0.91, 95%CI 0.84–0.99; high certainty). Calcium, vitamin D or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence.The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high-risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation.1Based on absolute risk reductions and thresholds considered clinically meaningful, the authors conclude that their review found little to no benefit from use of calcium, vitamin D or combined supplementation on the prevention of fractures and falls. Their results do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls.1 The authors contend that clinicians, guideline panels and regulatory agencies should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of this current evidence. The authors caution, however, that their results may not be generalizable to individuals with specific bone disorders or to those receiving drug treatment for osteoporosis or using long-term corticosteroids.1An editorial accompanying the published study points out that effective interventions are needed to reduce falls and their sequelae among older adults. As observational studies have associated low dietary calcium and low serum levels of vitamin D with low bone density and falls, calcium, vitamin D or combined supplementation has been widely promoted for preventive musculoskeletal health in older adults. However, the costs of supplementation at the population level are considerable. For example, vitamin D prescriptions cost the Quebec public health system $43 million in 2025, and this excluded the costs for over-the-counter preparations and vitamin D testing.2The editorial points out that the Quebec study suggests calcium, vitamin D or combined supplementation does not prevent fractures or falls in most older people. On the other hand, interventions such as balance and resistance exercise, and several multicomponent interventions (e.g., combining exercise, hazard assessment or education with other interventions tailored to risk assessment) have been shown to offer meaningful prevention of falls and falls-related injuries. As a result, efforts and funding should be redirected from supplementation to ensuring access to proven interventions.2References:Massé O, Mercurio CM, Dupuis S, et al. Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis. BMJ 2026;393:e088050. (accessed May 26, 2026).Pillay J, Reynolds DL, Thériault G. Calcium, vitamin D, or combined supplementation to prevent fractures and falls. No clinically meaningful benefit for most older people. BMJ 2026;393:s913. (accessed May 26, 2026).

Does calcium, vitamin D or combined supplementation prevent fractures and falls?

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