Calcium and vitamin D supplements do not prevent fractures or falls, study finds

Calcium and vitamin D supplements may do little to prevent fractures or falls in older people, prompting scrutiny of advice to take them for bone health.

A major review found no clinically meaningful benefit from the tablets in reducing fractures or falls.

The findings challenge longstanding NHS advice that older adults should routinely take vitamin D to support bone health.

The health service also recommends that those who do not get enough calcium in their diet should take a daily supplement.

Every year, NHS England spends more than £111m on vitamin D prescriptions alone, up from £13m in 2001.

The researchers said: “Apart from exercise and drug treatments for osteoporosis, few interventions have been consistently shown to reduce the risk of fractures.

“Clinicians, guideline panels, and regulatory agencies should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence.”

Almost a third of adults aged 65 and over have at least one fall a year, while half of all women will break a bone at some point in their lifetime.

Experts agree that calcium and vitamin D remain important for bone health when they are obtained naturally.

Calcium is found in dairy products such as milk, cheese and yoghurt, as well as leafy green vegetables such as kale and broccoli, and oily fish.

Vitamin D is gained mainly through direct exposure to sunlight, with smaller amounts coming from oily fish and egg yolks.

However, there has long been scepticism over whether vitamin D and calcium supplements, typically taken as daily tablets, offer meaningful protection.

In an effort to assess their effect on bone health, Canadian researchers from CIUSSS du Nord-de-l’Île-de-Montréal analysed 69 clinical trials involving more than 153,900 adults.

They compared the effects of calcium supplements, vitamin D, or both combined, against a placebo or no treatment.

Calcium supplements showed little to no effect on fracture risk.

Vitamin D alone also showed no meaningful benefit, with evidence from 36 trials involving more than 92,000 patients showing no meaningful effect. Combining both supplements made no difference.

Crucially, the supplements failed to protect even those already diagnosed with osteoporosis, a condition that weakens bones and makes them more likely to break and affects some 3 million people in the UK.

The team said the NHS should fundamentally reassess recommendations for both supplements.

Experts said the money spent on the pills may be better directed towards exercise programmes and lifestyle interventions, which have been shown to make a real difference.

The team also said calcium supplements can be poorly tolerated by many older adults, frequently causing bloating, constipation and abdominal pain, and should only be taken when absolutely necessary.

However, some experts warned that scrapping supplement advice could do more harm than good.

Public health nutritionist Dr Emma Derbyshire, from the Health and Food Supplements Information Service, said supplements may still be crucial for patients who are deficient in vitamin D and calcium.

Around one in six adults and a fifth of children are believed to be severely deficient in vitamin D.

Studies show calcium deficiency is also high in young women, with a fifth of girls aged 11 to 18 consuming less than the recommended amount.

Derbyshire said: “With vitamin D intakes from food well below recommended levels and a substantial proportion of young people already showing deficiency, alongside notable calcium intakes below safe thresholds, there is a clear and ongoing public health concern.

“These issues are also highly relevant in older adults, where inadequate intake can further accelerate age-related declines in bone health.”

“Those with dietary shortfalls such as vitamin D and Calcium, should carry on bridging gaps with supplementation.”

Dr Richard Abel, a musculoskeletal expert at Imperial College London, said: “The message is not ‘stop calcium and vitamin D’.

“The message is that routine supplements should not be mistaken for proper fracture prevention. Osteoporosis is a serious, preventable and treatable disease.

“The best way to help patients is to identify the people who are genuinely at high risk and those who may benefit from calcium and vitamin D because they are deficient or have low intake, and those who need proven osteoporosis medicines because their fracture risk is high.”