Falls are the leading cause of injury for adults aged 65 and up, with 1 in 4 older adults suffering a fall every year, according to the Centers for Disease Control and Prevention (CDC). There are many factors that increase the risk of falls and resulting fractures, including vision problems, balance issues, and vitamin deficiencies.
To prevent falls and fractures, some older adults take vitamin D and calcium supplements, as the two nutrients are important for bone health. But new research suggests they may not be as helpful as some thought—at least for older adults not at high risk for falls.
Meet the Experts: Cory Calendine, M.D., orthopaedic surgeon at the Bone and Joint Institute of Tennessee; James J. Chao, M.D., F.A.C.S., board-certified surgeon and chief medical officer of VedaNu Wellness; and Jessica Corwin, M.P.H., R.D.N., dietitian and head coach at Respin Health.
The study, published in the , was a systematic review—meaning the researchers examined data from a slew of prior studies to identify overarching trends. Altogether, the researchers reviewed 16 trials comparing fall frequencies between those taking supplements and those taking a placebo (or nothing at all). The over 150,000 participants in these studies were mostly over 65, living independently, and not at high risk of fractures or falls. None were being treated for the bone-degenerative disease osteoporosis.
Ultimately, the researchers found that participants who took calcium, vitamin D, or both saw “little to no benefit” in the incidence of falls or fractures, as compared to those who didn’t take the supplements.
To be clear: Vitamin D and calcium are, indeed, crucial nutrients for bone health. “Calcium is the raw material of bone, we need it,” explains Cory Calendine, M.D., an orthopaedic surgeon practicing with the Bone and Joint Institute of Tennessee. “Vitamin D is essential for your gut to absorb the calcium we need, and it helps keep calcium in the blood regulated.” The question is whether consuming them in supplement form is necessary or helpful for everyone.
Below, experts weigh in on the merits of supplementation and discuss how to promote bone health.
What the findings mean
James J. Chao, M.D., F.A.C.S., board-certified surgeon and chief medical officer of VedaNu Wellness, was unsurprised by the data. “Vitamin D and calcium [supplements] can fix an existing deficiency, but supplementation is not appropriate for every patient over 65 hoping to avoid hip fracture,” he says. “At the end of the day, I think the study illuminates a misunderstanding: nutritional adequacy is related to falling, but it’s not the same thing.”
Supplements are intended to be supplemental; getting nutrients through diet first is always the best option. And of course, a nutrient-rich diet is only one component of a healthy lifestyle. Older adults aiming to prevent falls and fractures—and menopausal and post-menopausal women especially—would do well to exercise regularly, with a particular emphasis on strength training, which promotes bone health. “Bones are living tissue … they respond to nutrition, hormones, muscle mass, movement, balance, sleep, and overall health,” says Jessica Corwin, M.P.H., R.D.N., dietitian and head coach at Respin Health.
Even so, Dr. Calendine stresses that supplementation may still be necessary for people who have brittle bones, are deficient in calcium or vitamin D, or are frail. “Little benefit is not the same as useless,” he says. “Falling takes seconds, but the conditions of falling develop over time through weaker legs, slowing reflexes, sight changes, medications that make you drowsy, tripping hazards, and yes—loose rugs.”
How to actually prevent falls and fractures
1. Prioritize dietary sources of nutrients. Adults should ensure they’re getting enough vitamin D and calcium through their diets. Calcium-rich foods include plain kefir, Greek yogurt, cottage cheese, calcium-set tofu, fortified plant milks, canned salmon with bones, sardines, collard greens, kale, and bok choy, Corwin says. Vitamin D is more challenging to get through food alone, but can be found in fatty fish such as salmon, trout, sardines, and mackerel, as well as in egg yolks, UV-exposed mushrooms, and fortified foods like milk and some plant-based milk alternatives. If you struggle to eat those, your doctor can test your vitamin D levels and advise you on supplementation, if needed.
2. Get enough protein. Protein is an under-discussed nutrient for bone health, especially in older adults and older women. “Bone is built upon a protein matrix. Bone is not just calcium. It is calcium laid down on a collagen framework,” Corwin says. Healthy sources of protein include plain Greek yogurt, lean meats, eggs, cottage cheese, and nuts and seeds.
3. Work your muscles. “Strong muscles place healthy stress on bones, helping signal the body to maintain bone tissue,” Corwin says. “When I think about fracture prevention, resistance training and adequate protein intake are near the top of the list. The more we exert pressure on muscle and bone, the more we are sending the signal to our body that we are using them and must continue to build them up.” Strength training exercises include lifting weights, using resistance bands, and bodyweight moves like squats and push-ups.
The bottom line
“Don’t take this study to mean that calcium and vitamin D aren’t important,” says Dr. Chao. “It simply suggests that most older adults do not need to be routinely supplementing these medications in hopes of preventing fractures or falls.”
Dr. Calendine agrees, stressing that even those who do take vitamin D or calcium should remember there’s more to bone health than supplementation. “Don’t think a supplement is a plan. Train for strength and balance. Structured exercise cuts falls significantly. Avoid the fall, and that avoids the fracture. The pill will not do the heavy lifting—you should.”
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