Calcium plus vitamin D supplementation and risk of fractures: An updated meta-analysis from the National Osteoporosis Foundation
Open accessAbstract
UNLABELLED: The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). INTRODUCTION: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults. METHODS: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed. RESULTS: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative. CONCLUSIONS: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.
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Aerobic activity paired with adequate calcium intake and vitamin D lowers fracture risk and slows age-related bone loss.
“Regular resistance and weight-bearing exercise builds muscle and supports bone formation, while aerobic activity paired with adequate calcium intake and vitamin D lowers fracture risk and slows age-related bone loss [140].”
From Interorgan Communications in Skeletal Pathophysiology: From Molecular Pathways to Multidisciplinary Therapies (2026) · cites this paper as [140]
The Discussion reports that combined calcium and vitamin D supplementation is associated with reduced total and hip fracture risk. It does not establish that pairing those nutrients with aerobic activity lowers fracture risk or slows age-related bone loss; it also does not support the sentence’s resistance- and weight-bearing-exercise claims. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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“…Stimulate mechanotransduction, improve BMD [186] • Aerobic exercise + vitamin D and calcium Reduce fracture risk, slow age-related bone loss [50,140] • Aerobic training + ω -3 fatty acids Lower inflammation, slow postmenopausal bone loss [141] • Exercise + bisphosphonate therapy Greater BMD…”
- Authors
- Weaver, C. M., Alexander, D. D., Boushey, C. J., Dawson-Hughes, B., Lappe, J. M., LeBoff, M. S., Liu, S., Looker, A. C., Wallace, T. C., & Wang, D. D.
- Affiliations
- Purdue University West Lafayette (US)
- University of Hawaii Cancer Center (US)
- Creighton University (US)
- Brigham and Women's Hospital (US)
- Tufts University (US)
- Centers for Disease Control and Prevention (US)
- George Mason University (US)
- Corresponding author
- Wallace, T. C.
- Venue
- Osteoporosis International
- Published
- 2015-10-28
- Volume
- 27
- Issue
- 1
- Pages
- 367-376
- ISSN
- 0937-941X (ISSN-L)
- 1433-2965
- PMC
- PMC4715837
- OpenAlex
- W2218738226
- Cited by
- 615
- References
- 54
- Citations by year
- 2026: 39 · 2025: 55 · 2024: 66 · 2023: 63 · 2022: 60 · 2021: 72 · 2020: 76 · 2019: 68 · 2018: 41 · 2017: 47 · 2016: 25 · 2015: 1 · 2014: 1
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-07-11)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Osteoporosis International (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Creighton Digital Repository (CDR) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- Council for Responsible Nutrition
- Consumer Healthcare Products Association
- Natural Products Association
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Vitamin D Research Studies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- calcium supplementation, vitamin D supplementation, fracture prevention, hip fracture, osteoporosis, fracture risk reduction, older adults, Women's Health Initiative
- MeSH terms
- Calcium, Drug Therapy, Combination, Humans, Vitamin D, Osteoporosis, Postmenopausal, Randomized Controlled Trials as Topic, Risk Assessment, Dietary Supplements, Bone Density Conservation Agents, Osteoporotic Fractures
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