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Systematic review finds little fracture prevention benefit from calcium or vitamin D in low-risk adultsBig study finds little benefit from calcium and vitamin D for fracture prevention

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Key Takeaway
Consider that calcium and vitamin D offer little fracture prevention benefit in low-risk community-dwelling adults.

This systematic review and meta-analysis examined the impact of calcium, vitamin D, or combined supplementation on fracture and fall risk in adults not receiving osteoporosis drug treatment. The study included participants from community settings who were generally not at high risk for fractures or falls. Researchers analyzed data from numerous trials to assess the primary outcome of any fracture risk as well as secondary outcomes like hip, vertebral, and non-vertebral fractures and falling frequency.

The analysis indicated little to no effect of calcium supplements on the risk of any fracture. Similarly, vitamin D supplementation alone showed little to no effect on fracture risk or falls. Combined supplementation also demonstrated little to no benefit in preventing fractures or falls in this specific low-risk population. The authors noted that the evidence for high-risk patients or those requiring residential care was limited for many outcomes when using calcium monotherapy or combined supplementation.

The authors observed that based on absolute risk reductions and thresholds considered clinically meaningful, there was little to no benefit from these supplements for fracture and fall prevention in the studied group. The certainty of evidence was moderate for calcium and high for vitamin D and combined supplements. The authors advise against inferring benefits for high-risk patients or those in residential care where the data was insufficient.

Millions of people take daily vitamins to keep their bones strong and avoid falls. But a huge new analysis questions whether these common supplements actually work for everyone. Researchers looked at data from more than 153,000 community-dwelling adults who were not already on treatment for osteoporosis. They found that taking calcium alone or vitamin D alone had little to no effect on preventing any kind of fracture. Even taking both together showed little benefit for most people in the study.

The study involved people living in the community who were not at high risk for breaking bones or falling. The evidence was strongest for vitamin D and the combined supplements, showing high certainty that they did not reduce fracture risk. For calcium alone, the certainty was moderate. The results apply to the general adult population but not necessarily to those in residential care or at very high risk.

Safety signals were not reported in the data provided. The review authors note that evidence for high-risk patients or those needing residential care was limited. This means the findings might not apply to everyone. Based on the numbers, the review concludes there is little to no benefit from these supplements for preventing fractures and falls in the groups studied.

What this means for you:
Calcium and vitamin D supplements showed little to no benefit for preventing fractures or falls in this large adult group.

Study Details

Study typeMeta analysis
Sample sizen = 902
EvidenceLevel 1
Follow-up216.0 mo
PublishedMay 2026
View Original 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.
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