Scientists have assessed the benefits of calcium and vitamin D for protection against fractures

Calcium and vitamin D are necessary for the body, so many elderly people take them additionally in the hope of avoiding falls and fractures. However, an analysis of 69 clinical trials involving more than 153 thousand people did not reveal a significant benefit of such a technique for the majority of elderly people. Why the substances necessary for bones have not become reliable protection against injury and who may still need supplements is in the "Izvestia" material.

What the scientists have verified

Calcium is a part of bone tissue, and vitamin D helps the body absorb it from food. At first glance, the connection seems obvious: if you take both substances additionally, the bones should become stronger, and there should be fewer fractures. But for prevention, it is important to check not only the effect of substances in the body, but also whether people are less likely to get injured.

The authors of the study, published in the journal BMJ, combined the results of 69 randomized clinical trials involving 153,902 adults. They compared the intake of calcium, vitamin D, or both substances together with a placebo or lack of such intake. The researchers were interested in two practical outcomes: fractures and falls.

The test participants were randomly assigned to groups. This approach helps to more accurately assess the effect of supplements: for example, to separate it from the influence of age, habits, or initial state of health. At the same time, the studies included in the review differed in quality, which the authors took into account when assessing the reliability of the conclusions.

Has the risk of fractures decreased

First, the scientists determined which risk reduction could be considered significant for the patient, and then compared the test results with this threshold. They did not find significant protection against fractures either when taking calcium alone, or when taking vitamin D, or when using them together.

The conclusion about calcium is based on 11 trials involving 9,067 people; the researchers rated the reliability of these data as moderate. For vitamin D, they analyzed 36 trials involving 92,045 people, and for the combination of calcium with vitamin D, 15 trials involving 51,126 people. The reliability of the conclusions in the last two cases was assessed as high. A similar pattern was observed in a separate analysis of hip fractures and falls.

This does not mean that calcium and vitamin D are "unnecessary for bones." The study answers a narrower question: does the additional intake of these substances prevent falls and fractures in people included in the trials. The results do not confirm that prescribing supplements to everyone provides tangible protection against these events.

Scientists have pointed to the role of vitamin D in pregnancy

Why can't a fall be prevented with a single supplement

Even the condition of bones is only a part of the reasons that determine the risk of fracture. At first, a person may lose their balance and fall; the likelihood of falling is influenced, in particular, by mobility, visual impairments, medications, and home conditions. Therefore, a remedy related to bone metabolism will not necessarily reduce the number of falls.

The problem is especially important in older age. According to data provided by the BMJ Group, almost one in three people aged 65 and older falls every year. The consequences can be fractures, prolonged pain, and loss of independence.

The authors of the review checked whether the general conclusions changed when taking into account the age and gender of the participants, previous falls and fractures, as well as average dietary calcium intake. The conclusions have generally been preserved. However, there were fewer trials or participants on some individual issues, so their results require careful interpretation.

To whom the conclusions of the study may not be suitable

The authors specifically stipulate that the results cannot be automatically transferred to people with certain bone diseases and to patients receiving drug treatment for osteoporosis. The review also does not resolve the issue of prescribing supplements to a specific person with an established deficiency or other medical indications.

Therefore, a person who has been prescribed calcium or vitamin D by a doctor should not cancel them on their own after reading the study. It is more reasonable to clarify the purpose for which the drug is prescribed: to compensate for a lack of substance, as part of the treatment of the disease, or solely in the hope of preventing a fracture.

It is not necessary to draw the opposite conclusion — as if the amount of calcium in the diet no longer matters. It remains an essential nutrient. Its food sources are, for example, dairy products, some green vegetables and fish, which are eaten together with soft bones. If necessary, supplements and their dose are selected taking into account the diet and health status.

Scientists have linked vitamin D to improved memory and thinking in the elderly

What helps to reduce the risk of falling

Instead of relying only on supplements, the authors suggest paying more attention to measures with proven benefits: balance training, muscle strengthening exercises, and programs tailored to the individual causes of falls.

The practical task is broader than choosing a vitamin complex. If a person has already fallen, they may need to assess their gait and stability, check their eyesight, discuss medications with their doctor, and remove dangerous obstacles at home. The American Working Group on Disease Prevention (USPSTF) recommends exercise programs for people over 65 years of age with an increased risk of falls; it is suggested to decide on additional measures individually.

The BMJ researchers conclude that the available evidence does not support routine administration of calcium and vitamin D solely to prevent falls and fractures. According to the authors of the editorial, additional qualitative tests are needed for groups with a particularly high risk. In the meantime, the main practical conclusion is that injury prevention should be selected for risk reasons in a particular person, and medications prescribed for medical reasons should be discussed with a specialist.