Panel warns against vitamin D, calcium use to prevent falls in older adults

A panel of independent health experts recommended this month against older adults using vitamin D and calcium supplements to prevent falls and fractures, citing inadequate evidence to support their effectiveness.

The guidance from the U.S. Preventive Services Task Force underscores the risks of supplementation without prior testing and diagnosis for a vitamin D deficiency or for osteoporosis.

While vitamin D and calcium are important for bone health and muscle function, the task force, a blue-ribbon panel of experts in disease prevention and evidence-based medicine, said the supplements do little to reduce falls or fractures, and they may increase the risk of kidney stones.

The task force said the recommendation applies to people living at home, including women who have gone through menopause and men 60 years and older. It does not apply to people in assisted living or nursing homes because people living in those facilities may be more prone to health complications, including risk of falls.

Patients whose medical providers have suggested supplements as part of their clinical regimen are recommended to continue with that guidance.

The task force assigned a grade of D to the recommendation, indicating that it advises against use of the supplements because of moderate or high certainty that they provide no net benefit or that the harms outweigh the benefits — discouraging its use.

Falls are the leading cause of injury-related death among people 65 and older, a problem that increased steadily from 2012 to 2021. In 2020, health care spending related to falls in older adults that did not result in death was $80 billion, according to the Centers for Disease Control and Prevention.

“The cream of the crop of research studies were done and examined in this review, and essentially no difference was found between those who took the supplements versus those who didn’t,” said Ruiz, a professor of clinical psychology at the University of Arizona.

Andrea Wong, senior vice president at the Council for Responsible Nutrition, a trade association representing companies that manufacture and supply dietary supplements, said the recommendations are limiting.

She said getting enough vitamin D through a healthy diet is possible but challenging.

“Americans are falling too short of nutrients,” Wong said. “People are not eating well to get the amount of vitamin D that they need from food alone.”

Nutrient-dense foods containing vitamin D include fish such as trout, salmon and tuna. Milk, yogurt and cheese can provide the vitamin, too. Calcium is also found in these foods.

A 2020 randomized controlled trial published in the New England Journal of Medicine, of nearly 26,000 participants 50 and older, found no benefits of supplemental vitamin D for bone health.

Meryl Susan LeBoff, the study’s lead author and chief of the calcium and bone section at Brigham and Women’s Hospital in Boston, said the task force’s recommendations align with her research and similar studies on supplements.

Excessive amounts of vitamin D can accumulate in the body, putting a strain on the kidneys and potentially causing damage. Water-soluble vitamins, such as vitamin C, are filtered through the kidneys more effectively, lowering the risk of toxicity.

Other research has found that supplements can be dangerous. A 2016 study highlighted a rise in older Americans using unproven vitamins and supplements, which many physicians say can have potentially life-threatening drug interactions.

“From the time we’re very young, we hear so much about how vitamin D is good for your bones and vitamin A is good for your eyes, but exceeding the amounts you need to survive doesn’t have any benefit,” said F. Perry Wilson, a nephrologist at the Yale School of Medicine.