Calcium and vitamin D supplements unlikely to prevent falls: Study

A new in-depth review shows calcium and vitamin D supplements are unlikely to help older people avoid fractures and falls, adding weight to existing evidence.
 
Published by the British Medical Journal, the study reviewed 69 randomised controlled trials that assessed the effect of calcium or vitamin D supplements, or a combination of both, on reducing the number of fractures and falls compared with placebo or no treatment.
 
Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%).
 
According to the study’s authors, the results show very little benefit to falls and fracture risk.
 
‘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,’ they wrote.
 
‘Calcium and vitamin D monotherapy did not significantly reduce any outcome, either statistically or clinically.’
 
Overall, they wrote, their findings ‘do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls’.
 
The authors added that guideline panels, and regulatory agencies ‘should re-evaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence’.
 
The aim of the study was to bring clarity on the topic, as the researchers noted that despite results showing a lack of effectiveness, many clinicians, guidelines, and regulatory agencies recommend vitamin D supplementation (with or without calcium) for musculoskeletal health.
 
Associate Professor Joel Rhee, who is Head of General Practice at the University of New South Wales, said the review’s findings are broadly consistent with the current RACGP Red Book recommendations on osteoporosis prevention.
 
‘The key message for GPs is that calcium and vitamin D supplements should not be recommended routinely for community-based older people as a general falls or fracture prevention strategy,’ he told newsGP.
 
‘The likely absolute benefit is low, and this review adds to the evidence that routine supplementation does not provide clinically meaningful protection for most older adults.’
 
However, Associate Professor Rhee noted some ‘important caveats’.
 
‘The review does not settle the question for all high-risk groups. This includes those with a higher risk of deficiency or fracture, including those in residential aged care,’ he explained.
 
‘It is also important that the review’s findings may not apply to people with specific bone disorders or those receiving active osteoporosis treatment, such as antiresorptive therapy.’
 
While the review adds weight to existing evidence, Associate Professor Rhee says this does not mean GPs should stop thinking about calcium and vitamin D altogether.
 
‘Don’t routinely recommend calcium and vitamin D to the general population, but consider supplementation when dietary calcium intake is low or vitamin D deficiency is present, especially in people with established osteoporosis and those from some high-risk groups,’ he said.
 
‘For GPs, the broader message is to focus on evidence-based fracture and falls prevention.
 
‘This includes assessing osteoporosis risk, identifying minimal trauma fractures, addressing modifiable falls risks, encouraging weight-bearing and resistance exercise where appropriate, and using osteoporosis medications when indicated.’
 
The authors of an accompanying editorial also flagged the importance of other interventions, such as balance and resistance exercise, and multicomponent interventions, such as combining exercise, hazard assessment, or education with other interventions tailored to risk assessment.
 
These, they wrote, have been shown to offer meaningful prevention of falls and falls-related injuries.
 
‘Efforts and funding should be redirected from supplementation to ensuring access to proven interventions.’
 
Preventing falls and fractures in older people was described in the BMJ as a global health priority, with almost a third of older adults over 65 years of age experience at least one fall annually.
 
In 2023–24, Australians aged 65 years and over were almost 12 times as likely to be hospitalised due to a fall than adults aged 25–44 years, with rates of hospitalisation sitting at 3299 and 277 per 100,000 people, respectively.
 
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