Doctors May Need To Rethink Calcium and Vitamin D Recommendations After Major Review

New evidence suggests calcium and vitamin D supplements may do far less to prevent fractures and falls than widely believed.

Calcium and vitamin D supplements, whether taken separately or together, provide little to no meaningful benefit in preventing fractures or falls in most older adults, according to a major review published in The BMJ.

Nearly one in three adults age 65 and older experiences a fall each year. Many of these falls lead to fractures, which can cause pain, lower quality of life, and increase the need for assisted living or residential care. As a result, reducing falls and fractures remains a major public health goal worldwide.

Earlier reviews have also found little evidence that calcium or vitamin D supplements reduce fracture risk, and findings on combined supplementation have been inconsistent. The role of vitamin D in preventing falls has also remained uncertain.

Even so, many doctors, health guidelines, and regulatory agencies continue to recommend vitamin D supplements, with or without calcium, to support bone health. Prescriptions for these supplements have also risen significantly in recent years.

Large Review Examines Fracture and Fall Prevention Evidence

To better understand the issue, researchers in Canada analyzed data from 69 randomized controlled trials involving 153,902 adults. The studies examined whether calcium supplements, vitamin D supplements, or a combination of both could reduce fractures and falls compared with placebo or no treatment.

Although the quality of the trials varied, researchers evaluated the risk of bias and the reliability of the evidence using established scientific methods.

After setting thresholds for what would count as a clinically meaningful benefit, the team found little to no reduction in overall fracture risk from calcium supplements (moderate certainty evidence from 11 trials; 9,067 participants), vitamin D supplements (high certainty evidence from 36 trials; 92,045 participants), or combined supplementation (high certainty evidence from 15 trials; 51,126 participants).

The analysis also found little to no benefit for preventing specific fractures, including hip fractures, or reducing falls. These conclusions were supported by mostly moderate to high certainty evidence.

Findings Consistent Across Different Groups

The researchers noted that some analyses included relatively few studies and participants, meaning the findings should be interpreted carefully. They also said the results may not apply to people with certain bone disorders or those receiving medication for osteoporosis.

Still, additional analyses showed consistent results across different groups, including variations in age, sex, history of fractures or falls, and average calcium intake through diet. This strengthened confidence in the overall findings.

The researchers 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 for calcium and vitamin D supplementation in light of current evidence.”

Experts Call for Better Fall Prevention Strategies

Researchers writing in a related editorial said more large, high-quality trials are needed to determine whether supplementation could help people at higher risk.

For now, they recommend shifting attention and funding toward strategies proven to reduce falls and fall-related injuries. These include balance training, resistance exercise, and combined approaches that may involve exercise, home hazard assessment, or education tailored to an individual’s level of risk.

Reference: “Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis” by Olivier Massé, Claudia Mei Mercurio, Sébastien Dupuis, Maya Al Sahwi, Alexandra Arruda, Gabriel Dallaire, Katherine Desforges, Nicolas Dugré and David Williamson, 20 May 2026, BMJ.
DOI: 10.1136/bmj-2025-088050

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