A recent draft recommendation from the US Preventive Services Task Force suggests that vitamin D and calcium, while crucial for overall health, do not mitigate the risk of falls or fractures in typically healthy senior citizens. This advice now extends to men, a demographic previously not included in such guidance. Although these nutrients are still necessary for general well-being, alternative measures should be considered to safeguard against fractures or to decrease the likelihood of falling.

In 2018, the task force advised against daily intake of 400 international units or less of vitamin D and 1,000 milligrams or less of calcium for the primary prevention of fractures in postmenopausal women. However, there was insufficient evidence at that time to extend this advice to men. The updated draft recommendation proposes to include men over the age of 60 and to omit specific dosages. This draft is not yet final and will be open for public commentary on the task force's website until January 21st, alongside a draft evidence review.

"During the 2018 recommendation, we lacked a substantial number of male participants in studies concerning fractures and falls related to vitamin D. Since then, we have gathered enough data to draw conclusions, which align with our previous findings: supplementation is not beneficial for prevention purposes," explained task force member Dr. Goutham Rao, who is also the chair of the Department of Family Medicine and Community Health and the chief clinician experience officer for the University Hospitals Health System in Cleveland.

Rao further clarified, "There was also debate about the potential benefits of high doses of vitamin D and calcium, but our most recent findings indicate that no dosage was associated with any significant benefits." Despite this, he emphasized that vitamin D and calcium remain essential nutrients for health, with vitamin D aiding calcium absorption and supporting immune function, brain health, and muscle performance.

"It's important to clarify that no one is suggesting the discontinuation of vitamin D and calcium intake, as the National Academy of Medicine provides specific daily recommendations for these nutrients, which are vital for bone and brain health, among other aspects," Rao stated. "The lack of observed benefits is specific to fractures and falls; these nutrients are still crucial for overall health."

Dr. Sherri-Ann Burnett-Bowie, an associate professor of medicine at Harvard Medical School and a clinical investigator in the Endocrine Division at Mass General Brigham, who was not part of the draft recommendation, noted that the draft might be misconstrued as deeming vitamin D and calcium unimportant. She highlighted the recommended daily allowance, which is between 600 to 800 international units of vitamin D for individuals over the age of one and between 700 to 1,200 milligrams of calcium. Many Americans, she pointed out, do not consume the recommended amounts of calcium, with racial and ethnic disparities affecting dietary calcium adequacy.

"Supplemental calcium, paired with vitamin D to enhance absorption, can help achieve the dietary requirements that may not be met through food alone," Burnett-Bowie said. "There are significant differences in calcium consumption among different racial and ethnic groups, with non-Hispanic Black and non-Hispanic Asian individuals having higher rates of dietary calcium insufficiency. For those aiming to meet calcium or vitamin D needs solely through diet or dietary supplements like Ensure or Boost, many will fall short without additional supplementation."

The draft recommendation specifically advises against the use of vitamin D supplements, with or without calcium, for the primary prevention of fractures in postmenopausal women and men over 60 who reside in community settings, not in nursing homes, long-term care facilities, or hospitals. The task force's systematic review concluded with moderate certainty that vitamin D supplementation showed no net benefit for the primary prevention of fractures and falls in this demographic.

The task force also noted a potential increase in kidney stone incidence with vitamin D and calcium supplementation, although the harm was considered minimal. Calcium is a primary component of most kidney stones. Burnett-Bowie reassured that staying within the recommended daily allowance would result in a low likelihood of harm. "It's unusual for kidney stones to occur if you adhere to the recommended daily allowance," she said.

The Council for Responsible Nutrition, a trade association representing dietary supplement and functional food manufacturers and suppliers, disagrees with the draft recommendation, arguing that it overlooks adults at risk of low vitamin D levels or deficiency. "These individuals stand to gain the most from supplemental vitamin D and calcium," said Dr. Andrea Wong, the group's senior vice president of scientific and regulatory affairs. "Older adults with limited sun exposure, restricted diets, or darker skin tones often face a higher risk of deficiency, making targeted supplementation critical for their health. Dismissing supplementation as unnecessary for the general population undermines its value for those who need it most. It's time for guidance that reflects the full scope of science and prioritizes public health equity."

A study published in 2022 in the New England Journal of Medicine found that vitamin D supplementation did not result in a significantly lower risk of fractures among middle-aged and older adults. Specifically, the study found that consuming 2,000 IU of supplemental vitamin D3 without calcium over more than five years did not reduce total fractures, including hip, wrist, or pelvic fractures, compared to a daily placebo.

"We discovered that supplementation with vitamin D versus placebo in the largest randomized control trial, which included 25,871 adults from 50 states, did not reduce fracture risk, and this was among generally healthy middle-aged and older adults," said study author Dr. Meryl LeBoff, chief of the calcium and bone section in the Endocrinology, Diabetes and Hypertension Division at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. Although this finding aligns with the new USPSTF draft recommendation, it is not generalizable to adults with severe vitamin D deficiency, low bone mass, osteoporosis, on osteoporosis medications, those with malabsorption, or those with high fall risk, or older adults living in residential communities," LeBoff noted.

Osteoporosis is a condition that causes bones to become so fragile that a fall or even mild stress can lead to fractures. In the United States, more than one in four older adults experience a fall each year, potentially resulting in broken bones, hip fractures, or other injuries. To reduce the risk of falls and fractures, older adults can take steps such as getting screened for osteoporosis, especially women over 65, and engaging in regular exercise. Those with osteoporosis may be prescribed treatments to prevent fractures.

"Our recommendation is focused on the prevention of falls and fractures. We want to emphasize that while vitamin D and calcium are not helpful in this regard, there are other actions you can take, including screening for osteoporosis and structured exercise," Rao said. Regular strength-training exercises, such as lifting weights or using resistance bands, and balance-improving exercises like yoga, Pilates, or tai chi can be beneficial.

It's also important to stand up slowly during everyday activities to avoid drops in blood pressure and loss of balance. Some adults may also benefit from having their vision and hearing tested to reduce fall risk or using assistive devices like canes or walkers. In winter, extra caution should be taken when walking on wet or icy surfaces, or considering staying indoors during bad weather. Additionally, it's crucial to inform your doctor about any falls or fractures that have occurred since your last check-up, as these can signal new medical issues.