Taking vitamin D, with or without calcium, does not reduce the risk of falls or fractures in older adults, according to a new draft recommendation issued last week by the US Preventive Services Task Force.
More than one in four older adults fall in the US each year, which can lead to broken bones and other injuries. Vitamin D and calcium are sometimes taken together because the body needs vitamin D to absorb calcium, which is essential for bone health.
“Patients have often read or heard from someone that they should take them for various reasons, so they do,” Barbara Baver, Ph.Dsaid a family medicine physician at Ohio State University Wexner Medical Center Health.
The national expert panel’s recommendation does not apply to people with osteoporosis, vitamin D deficiency, or those taking vitamin D for other medical reasons.
Although the report concluded that vitamin D did not reduce the risk of fractures or falls in older adults, it did not say that people should give up vitamin D or calcium or that there are no benefits.
Here’s what the panel found — plus what doctors treating older patients actually suggest to prevent falls and fractures.
A USPSTF panel conducted a systematic review of research on the role of calcium, vitamin D, and falls in the elderly. The panel concluded with “moderate certainty” that vitamin D supplementation showed no benefit for preventing falls and fractures in older adults.
The panelists also found that vitamin D supplementation, with or without calcium, may increase the risk of kidney stones. As a result, the panel does not recommend that men and women age 60 and older take vitamin D supplements, with or without calcium, to prevent fractures and falls.
The panel’s findings build on a 2018 recommendation against postmenopausal women taking 400 units or less of vitamin D and 1,000 milligrams or less of calcium to prevent fractures. (At the time, the panel said there wasn’t enough evidence to make recommendations for men.)
There are several reasons why the risk of falls and fractures increases as you age. “Your bone stock really peaks in your 20s and 30s,” Alex Jahangir, Ph.Dvice chairman and professor in the Department of Orthopedic Surgery at Vanderbilt Health, said Health. “The quality of your bones is also lower as you get older.” As a result, if you fall, you’re more likely to get a fracture.”
Mobility can also be more difficult as you age because of conditions like osteoarthritis or other forms of arthritis, Baver said. “This changes the way we walk, including moving our feet, leaning in different ways to relieve pain,” she said.
Neurological conditions such as neuropathy, which can change sensation in the fingers or feet, can also affect balance and mobility, increasing the risk of falls. Clifford Segil, DOsaid a neurologist who treats older adults at Providence Saint John’s Health Center in Santa Monica, California Health.
“Vision tends to get worse as we get older, so we can make mistakes or not see something in our path that can lead to falls,” Baver said.
Some medications can also cause dizziness and loss of balance, and older adults tend to take more medications to manage their health conditions than younger adults, John Fudima, MDinterim chief of geriatrics and palliative care at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, said Health.
According to Fudima, a lack of vitamin D can also make you more prone to falls.
Doctors stress that the findings don’t suggest there’s no value in taking vitamin D and calcium — just that the combination is unlikely to prevent older adults from having fractures and falls.
“Vitamin D and calcium are important for other functions in the body,” Fudima said. “But in the general, average population aged 60 and over, supplementation is not recommended to prevent fractures and falls.”
In addition to strengthening bones, vitamin D and calcium are necessary for muscle and brain function. Doctors generally recommend that people get them through food rather than supplements, but supplements may be an option for people who don’t get enough nutrients from food. According to Baver, these groups include:
- People with osteoporosis, a disease that develops when bone mineral density and mass decrease
- Those who have problems absorbing some nutrients
- People whose diet is low in calcium
- People who spend no time outdoors or limited time outdoors
- People with hyperparathyroidism, inflammatory bowel disease or celiac disease
“Early studies in patients who had vitamin D deficiency and low calcium intake show a beneficial effect of supplementation,” Sue Shapses, PhD, RDvitamin D researcher and professor of nutritional sciences at Rutgers University’s School of Environmental and Biological Sciences, said Health.
Doctors said there are several ways to reduce the risk of fractures and falls with age.
- Go for routine walks. “I tell people to walk more,” Segil said. Not only does this help build muscle and bone strength, it can also help with balance.
- Do strength training. Weight-bearing exercises can help build bone strength, Segil said. “I would advise people to do weight training over vitamins any day of the week,” he added.
- Try balance exercises. “Balancing exercises like tai-chi, pilates and yoga can also help,” Baver said.
- Look at your medications. People with osteoporosis can take drugs such as bisphosphonates to reduce the risk of fractures, Shapses said.
- Increase your protein intake. As for nutrition, plenty of protein can also help reduce the risk of fractures and falls, Shapses said.
- Stay on top of your eye health. Baver suggests annual eye exams and wearing necessary visual aids such as glasses and contacts.
- Get enough sleep. “Get enough sleep because as people are more tired, the risk of falls and therefore fractures increases,” Baver said.
- Tidy up your home. Clearing the environment to reduce trip hazards is also key, Fudima said.
Unfortunately, reducing the risk of fractures and falls in the elderly is not as simple as taking a supplement. “For most people with adequate levels of vitamin D and calcium, supplements do not help prevent falls or fractures,” Shapses said. “Additions are only helpful if you lack them.”