Calcium2026-05

Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis.

Massé Olivier, Mercurio Claudia Mei, Dupuis Sébastien, Al Sahwi Maya et al. — BMJ (Clinical research ed.)

Summary

A large review of many studies found that taking calcium, vitamin D, or both as supplements generally does not prevent fractures or falls in most adults. These supplements showed little to no significant benefit for individuals not at high risk of these events. This suggests that for many, supplements may not be necessary for bone health and fall prevention.

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Key points

Calcium supplements alone showed little to no effect on preventing fractures.
Vitamin D supplements alone also had minimal impact on preventing fractures or falls.
Combining calcium and vitamin D supplements offered little significant benefit.
These findings primarily apply to healthy adults not at high risk of fractures or falls.

What the study looked at

This comprehensive review aimed to determine if taking calcium, vitamin D, or a combination of both as supplements effectively prevents broken bones (fractures) and falls in adults. The focus was on understanding the overall impact of these supplements. Researchers conducted a systematic review and meta-analysis, a rigorous approach that involves carefully collecting and analyzing data from many previously published randomized controlled trials. This particular review included 69 trials with over 150,000 adult participants. Most of these individuals were healthy and living in their communities, not considered to be at high risk for fractures or falls, nor were they receiving drug treatment for osteoporosis. The analysis concluded that calcium supplements alone, vitamin D supplements alone, or a combination of both showed little to no significant benefit in preventing any type of fracture or reducing the risk of falls in this general adult population. These findings were consistent across various outcomes and robust even after extensive subgroup analyses.

Dietary takeaway

While supplements might seem like an easy solution, this study suggests that for many adults, focusing on a balanced diet rich in calcium-containing foods like dairy products, leafy greens, and fortified foods may be sufficient for maintaining bone health. It's important to remember that individual needs vary, and this single study does not provide definitive guidance for everyone. Always consult a healthcare provider before making significant changes to your diet or starting any new supplements.

Abstract

OBJECTIVE: To assess the effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Trials included in systematic reviews from 2014, three databases (Medline, Embase, CENTRAL) to 19 February 2025, clinical trial registries, abstracts from scientific meetings, and references from included studies. ELIGIBILITY CRITERIA: Randomised controlled trials comparing calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. DATA EXTRACTION AND SYNTHESIS: The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane's risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important. RESULTS: This review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (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, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 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. CONCLUSION: Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023483915.

View on PubMed →DOI: 10.1136/bmj-2025-088050