DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS ⚠️ Outdated Clinical Content / Potential for Misinterpretation
A BMJ systematic review of 69 trials in nearly 154,000 older adults found calcium, vitamin D, or both produced little to no reduction in fracture or fall risk, challenging default supplementation practice.
Clinical Considerations
- Pooled data showed little to no reduction in overall fracture risk from calcium, vitamin D, or combined supplementation versus placebo.
- Hip fracture risk and fall risk were similarly unaffected across the reviewed trials.
- Findings apply to average-risk older adults, not patients with documented deficiency, malabsorption, or CKD-related calcium dysregulation.
- Multicomponent interventions — strength training, balance work, home safety — showed more consistent risk reduction than supplementation alone.
Practice Applications
- Recognize routine calcium/vitamin D supplementation alone offers limited fracture protection in average-risk patients.
- Consider deprescribing supplementation when no deficiency, malabsorption, or specific indication exists.
- Avoid discontinuing supplementation in patients with confirmed deficiency or osteoporosis without individualized review.
- Monitor patients transitioned off supplementation for fall risk factors requiring separate intervention.
