May 20, 2026

expert reaction to meta-analysis looking at evidence for vitamin D supplementation and fracture and fall prevention in older people

A meta-analysis published in The BMJ looks at evidence for vitamin D supplementation to prevent fractures and falls in older people. 

Prof Emma L Duncan, Professor of Clinical Endocrinology, King’s College London, said:

“This systematic review and meta-analysis is consistent with previous similar studies. 

“Here the authors have considered studies that have assessed the effect of calcium and vitamin D supplementation, individually or together, in adults who were otherwise not receiving drug treatment for osteoporosis.  The individual study populations were predominantly community-dwelling adults generally not at high risk of fracture or of falls. 

“The authors showed no significant effect of calcium or vitamin D, individually, on fracture risk or on falls risk.  The effect of combined calcium and vitamin D on fracture risk did reach statistical significance – but, the authors highlight, that the absolute benefit was very small and not considered clinically meaningful; and there was no significant effect of combined calcium and vitamin D for falls risk.   The authors considered the evidence overall for any fracture, and performed appropriate subgroup analyses, including considering specific fracture types (hip, vertebral, etc) and particular patient groups (such as older individuals or individuals in residential care).   The authors also considered the strength of evidence, the heterogeneity of different studies, and the potential for publication bias.   The authors acknowledge the limitations of their study, particularly the limitations of some of their subgroup analyses – including that few studies provided baseline vitamin D levels.  Lastly, the authors appropriately caveat their comments around usefulness of calcium and/or vitamin D use in some individuals in some circumstances – for example, some individuals in residential care.

“Avoiding ineffective treatment – for any condition – is important for everyone, from consumers to prescribers to the health system in general.  This paper will support individuals and their doctors in a more nuanced and personalised approach as to whether calcium and vitamin D will be of individual clinical benefit for that person.  This paper may also encourage discussion, particularly in individuals who are high risk of fracture, regarding the use of well-established and effective therapeutic options that can meaningfully reduce fracture risk – including the risk of hip fracture, the most devasting fracture of all.”

Dr Donal McNally, Reader in Bioengineering, University of Nottingham, said:

“This is a rigorous and well conducted meta-analysis of existing research.  Such a meta-analysis is required in this field because the probability of an individual falling is very low 40-73 (in the paper) per 100 patient years, it is necessary to follow a very large number of patients to get the number of falls and/or fractures required to perform the necessary analysis. It is almost impossible to conduct single studies with the necessary statistical power.

“In many studies, it is possible to ask two questions:  Is there a statistical difference between groups?  If there is, is that difference clinically important?  The challenge here is that even with the large numbers of patients the relatively small numbers of falls/fractures, and differences in the studies aggregated, the answer to the first question is uncertain.  It is possible to combine the two questions by asking the question ‘would the study detect a clinically important difference?’, which is what, in part, the GRADE analysis is doing.  This requires a definition of what a clinically important difference might be.  The authors acknowledge that their choices might not be universally agreed.  For example, they define an important reduction in hip fracture risk as 0.7%.  Whilst this seems very small, the baseline risk was found to be between 1.3 and 1.8%.  They are therefore implying that a ‘meaningful benefit’ could be more than halving the risk of hip fractures.  Given that there are more than 70,000 hip fractures per year in the UK with care costs of approximately £2 billion, some might consider a much smaller reduction a meaningful benefit.”

‘Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis’ by Olivier Massé et al. was published in The BMJ at 23:30 hours UK time Wednesday 20 May 2026. 

DOI: 10.1136/bmj-2025-088050

Declared interests

For all experts, no reply to our request for DOIs was received.