Nutrition researchers have been arguing for decades as to whether vitamin D and calcium supplemental actually work to prevent or reduce the incidence of bone fractures in older adults. With a rapidly aging world population, broken bones and fractures are becoming a major public health concern, with huge social and economic consequences. Now a new study published in the Journal of the American Medical Association has come to the conclusion that vitamin D and calcium supplements do not, in fact, seem to prevent bone breaks or hip fractures.
The study analyzed 33 randomized clinical trials involving more than 50,000 adults over the age of 50 who lived on their own (that is, not in a nursing home or other type of residential care facility). Fractures are a significant concern for this population — previous studies have found that about 40% of women in this group will wind up with at least one “major osteoporotic fracture” at some point in their lives, and that among adults who break a hip, 20% died within a year of their injury.
The researcher team, led by Dr. Jia-Guo Zhao of Tianjin Hospital in northeastern China, combed through numerous trials, systematic reviews and other reports published in the last decade to zero in on 51,145 people included in the studies to assess the role of calcium and/or vitamin D supplement in preventing bone fractures.
Among 14 trials that compared calcium supplements with either a placebo or no treatment, there was no statistically significant relationship between use of the mineral (in pill form) and the risk of suffering a hip fracture.
Nor was there any clear link between calcium supplements and fractures involving the spine or other bones.
Even when the researchers accounted for each study participant’s gender, past history of bone fractures, amount of calcium they consumed in their diets and the dose of the calcium pills they took (if they did), there was still no sign that supplements were effective.
An additional 17 trials looked into the role of vitamin D, which helps the body absorb calcium. Once again, they found no statistically significant link between vitamin D use and reduced fractures of the hip, spine and elsewhere.
Looking closer at specific subgroups, they found that for people who started out with at least 20 nanograms of vitamin D per milliliter of blood, adding more vitamin D through supplements was associated with a greater risk of hip fractures.
The same was true for people who took high doses of vitamin D supplements just once a year.
Finally, they examined results of 13 trials involving people who took a combined calcium-vitamin D supplement. Again, there was no statistically significant link between supplement use and reduced risk for any kind of fracture or combination of fractures. This was true regardless of gender, past fractures, supplement dose, dietary calcium or baseline blood levels of vitamin D.
The researchers noted that thousands of people in this final group were participants in the Women’s Health Initiative, a long-term study sponsored by the National Heart, Lung and Blood Institute in the U.S. Earlier reports based on data gathered by the Women’s Health Initiative found that calcium and vitamin D supplements were associated with a lower risk of fractures, but only for women who took hormone therapy after menopause. To get a clearer picture of the direct link (if any) between supplements and fracture risk, Zhao and his colleagues opted not to include data from women on hormone therapy.
It’s still possible that calcium and vitamin D supplements are useful for people who live in nursing homes or other residential facilities, the study authors wrote.
Such people are more likely to have osteoporosis, due to a combination of poor diet, less sun exposure (which the body needs to synthesize vitamin D) and other factors.
But for older adults who live on their own, they wrote, the results are clear: “These findings do not support the routine use of these supplements.”