Taking vitamin D with calcium doesn’t have any effect on fracture risk

#1

https://www.bmj.com/content/393/bmj-2025-088050

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.

#2

Given that the median age of the study participants was 71.2, it’s worth noting that men actually reach their peak TBBMC and TBBMD at ages 25.7 and 26.2, respectively. Supplementing with calcium and vitamin D during this window might actually be more effective. The higher your peak bone mass when you’re young, the lower your chances of developing osteoporosis later in life. Building that ‘bone bank’ is crucial, which is why anti-aging should start as early as possible. I’m just really glad I managed to efficiently build up my bone reserves before hitting that age.

#3

Linked editorial: Calcium, vitamin D, or combined supplementation to prevent fractures and falls

No clinically meaningful benefit for most older people
Other interventions, such as balance and resistance exercise, and several multicomponent interventions (eg, combining exercise, hazard assessment, or education with other interventions tailored to risk assessment11) have been shown to offer meaningful prevention of falls and falls related injuries.1113 For most older people, Massé and colleagues’ findings show that calcium, vitamin D, or combined supplementation does not prevent fractures or falls. Efforts and funding should be redirected from supplementation to ensuring access to proven interventions.