Falls are a major health concern among seniors. Nearly one in three people age 65 and older experiences a fall each year, and many of these incidents result in fractures. Such injuries can lead to pain, reduced independence, lower quality of life, and, in some cases, the need for long term residential care. As populations age, preventing falls and fractures remains an important public health goal worldwide.

Previous reviews have already raised questions about the effectiveness of calcium and vitamin D supplements. Research has generally found no reduction in fracture risk from either supplement alone, while results for taking both together have been mixed. The role of vitamin D in reducing falls has also remained uncertain.

Even so, vitamin D supplements (with or without calcium) continue to be widely recommended by healthcare providers, professional guidelines, and regulatory agencies for bone health. Prescriptions for these supplements have also risen considerably in recent years.

Analysis of 69 Clinical Trials

To better understand the evidence, researchers in Canada analyzed data from 69 randomized controlled trials involving 153,902 adults. The studies compared calcium supplements, vitamin D supplements, or a combination of both against placebo or no treatment to determine whether they reduced the risk of falls and fractures.

Although the quality of the trials varied, the researchers evaluated each study using established methods to assess both potential bias and the certainty of the evidence.

After establishing thresholds for what would qualify 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 showed little to no benefit for preventing specific fractures, including hip fractures, or for reducing falls. These findings were supported largely by moderate to high certainty evidence.

Findings Hold Across Different Groups

The researchers note that some parts of the analysis included relatively few studies and participants. As a result, the findings should be interpreted carefully. They also caution that the results may not apply to people with certain bone disorders or to those receiving medication for osteoporosis.

However, additional analyses produced similar results even after accounting for factors such as age, sex, previous fractures, previous falls, and average calcium intake from food. According to the researchers, this consistency strengthens confidence in the overall conclusions.

Based on the available evidence, the authors conclude that the findings "do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls."

They further suggest that clinicians, guideline panels, and regulatory agencies "should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence."

Focus May Shift to Proven Fall Prevention Strategies

In a linked editorial, researchers say more rigorous and well powered clinical trials are needed to guide recommendations for people who may face a higher risk of fractures or falls.

Until then, they argue that resources and funding may be better directed toward strategies that have already demonstrated meaningful benefits. These include balance training, resistance exercise, and personalized fall prevention programs that combine approaches such as exercise, hazard assessment, and education based on an individual's specific risk factors.