Despite decades of advise on bone health, the majority of older persons benefit little from calcium and vitamin D supplementation.

Millions of elderly people take calcium and vitamin D supplements every day in medicine cabinets all over the world in an effort to maintain healthy bones and prevent fractures. According to a comprehensive analysis of 69 scientific trials, these medications don't really protect most people against falls or broken bones.

The supplements, which cost billions of euros annually in the US and Europe, have been advised for decades. However, the supplements don't seem to provide any protection against falls or fractures for healthy older persons who live at home. Exercise regimens that enhance strength and balance, on the other hand, significantly lessen falls.

Decades of conventional wisdom

It's no coincidence that they were paired. Early research suggested that the combination of calcium and vitamin D helped reduce bone fractures that put elderly patients in hospitals, thus doctors started extensively recommending them.

Olivier Massé, a clinical chemist, performed an assessment alongside pharmacy researchers at the University of Montreal (UdeM) to determine whether such guidance still applies. They tracked down almost every trial that had ever been conducted on the matter.

In the end, they had 69 trials tracking almost 150,000 adults, the majority of whom were at home and not at particular risk of a break. It was the largest body of research on these supplements to date.

Pills that don't pay off

The decision was unambiguous. Across all types of fractures, falls, calcium, and vitamins or the combination of the two did not significantly reduce the risk. When taken alone, vitamin D had no discernible impact on falls or fractured bones. Fresh studies are unlikely to reverse that outcome because the researchers were so confident in it.

Calcium alone itself didn't seem any better. A slight indication of more hip fractures among the calcium users did emerge, but the team dismissed it as noise because the signal was tiny and made no biological sense.

Based on a single trial

The fascinating part came with the combo tablet. On paper, calcium and vitamin D together did reduce fractures slightly, and the difference appeared to be genuine rather than random. The one apparent victory in

The researchers then took a straightforward action. When they removed one outdated trial from the computation, the benefit vanished. The study conducted in the 1990s included 84-year-old frail ladies who were all residing in assisted living facilities.

These women started out eating extremely little calcium and had very low vitamin D. Their bones were likely already weak and malnourished. If you give that group vitamins, the number of fractures will drop.

However, if the same group is removed, the benefit to everyone else falls short of what a physician would consider significant. The one exceptional trial was the only bright spot, as no previous review had demonstrated so clearly.

Calculating the true benefit

The benefit was negligible even with that old study left in. Approximately one fracture can be avoided by treating 100 individuals with the combined medication. It takes more than 300 to save one hip fracture.

Such numbers fall far short of what the team had anticipated as a worthwhile outcome. In part to be truthful about what might actually benefit a patient, they drew that line before running the figures.

Therefore, the single outcome that appeared significant was practically meaningless. This change was both significant and insignificant at the same time.

Why the counsel held

The recommendation was maintained for a number of reasons. One was timing. First came the encouraging preliminary results, and while hope was still high, guidelines were published.

The same was indicated by another type of evidence. Supplements appeared to be a clear solution because people with low levels of calcium and vitamin D typically have weaker bones. It just didn't work to fill the gap.

Approximately 70% of clinical guidelines continued to support vitamin D for bone health far into the past ten years, and prescriptions continued to rise nation after nation. Over the course of 30 years, habits gradually relax.

Expenses and adverse effects

There is a cost to all of this. The annual cost of providing these supplements to older persons with osteoporosis in the US and Europe is estimated to be close to $2 billion. Spending has increased over the past few decades.

It's not always simple to live with the medications. It can be challenging to swallow calcium tablets. They frequently cause constipation, bloating, and cramping in the stomach, which causes some older persons to give up.

Rarer hazards also appear. In one big research of older women, the incidence of kidney stones was marginally higher for those taking calcium and vitamin D than for those taking a dummy pill.

Advice could alter.

Regular calcium and vitamin D supplementation does not significantly reduce the risk of fractures or falls for the average older person, as the field now knows with certainty. Although it was previously speculated, it was never proven.

For the majority of healthy folks, that might include stopping a daily medication that wasn't helping much. The authors contend that physicians and the panels that draft the guidelines ought to review general recommendations to add to them.

These results have limitations. Calcium and vitamin D are still necessary for people using osteoporosis medications, and people with specific bone disorders were not the target audience.

Exercise seems to offer more consistent protection outside of those groups. Exercise focused on strength and balance reduces falls in older persons by about 25%, which is more than a supplement could do, according to a big review.