Calcium and vitamin D supplements, widely prescribed on the NHS to protect against fractures and falls in older people, are ineffective at preventing falls, a major new review has concluded. The findings call into question routine supplementation for the general elderly population and suggest doctors, guideline panels and regulatory agencies “should re-evaluate their general recommendations”.
Published in the British Medical Journal, the review was led by academics in Quebec, Canada. It analysed 69 randomised controlled trials involving a total of 153,902 adults, making it one of the most comprehensive assessments of the subject to date. The researchers examined the effect of calcium supplements, vitamin D supplements, or both taken together, comparing them against a placebo or no treatment. They looked at the risk of any fracture, hip fractures, bone breaks outside the spine, spinal fractures, and the overall frequency of falls.
The study found there was “little to no effect” on the risk of any fracture from taking calcium or vitamin D supplements, alone or in combination. The tablets also had little to no effect on specific fractures or the risk of falls. The team noted that the certainty of evidence was moderate to high, and these conclusions held even after adjusting for factors such as participant age, sex, history of fractures and falls, and average dietary calcium intake.
Almost a third of people aged 65 and over experience at least one fall every year, the researchers said. “As much as 85% of older adults have a fear of falling because of a fall, contributing to reduced daily functioning and increased risk of subsequent falls,” they added. “Furthermore, half of women and one fifth of men will sustain a low trauma fracture during their lifetime, often due to a fall.” Despite these figures, the review found no evidence that taking vitamin tablets reduced these risks.
Methodology and scope of the review
The Canadian team meticulously assessed the risk of bias and the certainty of evidence across all 69 trials. The review included randomised controlled trials that tested calcium supplements, vitamin D supplements, or combined supplements against placebo or no intervention in adults, with a focus on falls and fracture outcomes. While the researchers acknowledged that some trials were small and had few participants, and that the results may not apply to people with specific bone disorders or those receiving drug treatment for osteoporosis, they stressed the strength of the overall evidence.
In Quebec, vitamin D prescriptions alone cost the public health system $43 million in 2025, highlighting the population-level expense of widespread supplementation, even if individual costs appear low — typically between $10 and £50 per year per person.
The researchers concluded: “Our findings do not support routine supplementation with calcium or vitamin D, or combined supplementation to prevent fractures and falls.” They urged clinicians, guideline panels and regulatory agencies to re-evaluate their current recommendations in light of the evidence.
Current UK advice and potential for confusion
The current Government and NHS advice recommends that people take a daily vitamin D supplement during the autumn and winter (October to early March) because of a lack of sunlight in Britain during these months. From about late March or early April to the end of September, the NHS says most people should be able to make all the vitamin D they need from sunlight. Those with darker skin tones — African, African-Caribbean or South Asian backgrounds — may need to consider year-round supplementation, as may certain groups such as babies, young children aged one to four, and people who are housebound or cover most of their skin.
For calcium, adults aged 19 to 64 and over need 700mg per day, which the NHS recommends people should try to obtain from their diet. Good dietary sources include dairy products, green leafy vegetables (excluding spinach due to poor absorption), fortified soya drinks, bread made with fortified flour, and fish eaten with bones such as sardines. Calcium supplements are available, but excessive intake — over 1,500mg per day — can cause stomach pain and diarrhoea.
Vitamin D helps regulate the amount of calcium and phosphate in the body, which keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by osteomalacia in adults. A significant portion of the UK population — estimated up to 60% in some reports — experiences some level of vitamin D deficiency, particularly in winter.
Leading academics and bone health experts have expressed concern that the study’s findings, if applied too broadly, could cause confusion and lead individuals who genuinely need supplements to stop taking them. The review’s focus on “healthy older people” means its conclusions may not apply to those with diagnosed osteoporosis, other metabolic bone diseases, or those on bone-protective medications. For these groups, ensuring adequate calcium intake and vitamin D status remains crucial for the effectiveness of their treatments. The National Osteoporosis Guideline Group provides guidelines for osteoporosis management that often consider calcium and vitamin D in the context of drug therapy, particularly for postmenopausal women receiving osteoporosis treatment unless adequate dietary intake and vitamin D levels are confirmed.
Alternatives to supplementation
When it comes to what people can do to prevent falls and fractures, the research team pointed to weight-bearing exercise combined with tailored advice on preventing falls for each individual. Other research supports this, highlighting that balance and resistance exercises, as well as multicomponent interventions combining exercise, hazard assessment and education, have shown meaningful prevention of falls and fall-related injuries. The National Osteoporosis Society advises that increasing dietary intake of calcium and vitamin D is preferable to supplements for those with low intakes, though it remains unclear whether dietary calcium has health advantages over supplements.
Other nutrients considered important for bone health include magnesium, vitamin K2, and collagen, but the review did not assess these. The core message from the Canadian team is that for the general population of older adults, routine supplementation with calcium or vitamin D alone — or together — does not provide a clinically meaningful benefit in preventing fractures or falls, and that resources are better directed toward exercise-based interventions and personalised fall prevention programmes.
