Vitamin D, Bone Health, Falls and Fractures: What Trials Found
What large trials and reviews found for vitamin D and fractures, falls and bone density in different groups, with the amounts and outcomes and what US and UK sources advise.
Content last updated . This page has not been medically reviewed.
Evidence labels: established nutritional role / deficiency treatment, evidence in adequately nourished people, mixed, insufficient evidence, evidence of harm.
Fractures: what the trials found
| Source | Who and what | Result | Label |
|---|---|---|---|
| VITAL ancillary study (US, 2022) | 25,871 adults, men 50 and older and women 55 and older, not selected for deficiency or osteoporosis; vitamin D3 2,000 IU a day vs placebo, median 5.3 years | Total fractures hazard ratio 0.98 (0.89 to 1.08), no significant effect [3] | No benefit found in adequately nourished people |
| BMJ review (2026) | 69 trials, 153,902 adults, mostly community-dwelling and not at high risk | Vitamin D alone, 36 trials: any fracture risk ratio 1.00 (0.95 to 1.06), high certainty. Evidence for high-risk or residential-care groups was limited [4] | No benefit found; limited data in high-risk groups |
| Meta-analysis of 7 trials (2024) | 71,899 people aged 60 and older without bone disease, vitamin D vs placebo | Total fractures risk ratio 1.03 (not significant); in women, hip fractures were more common (164 vs 121 events), and the authors advised against high intermittent doses without calcium in this group [5] | Mixed; possible harm signal with intermittent dosing |
| Annual 500,000 IU trial (2010) | 2,256 women 70 and older at high fracture risk; one large dose each autumn or winter for 3 to 5 years | More falls (rate ratio 1.15) and more fractures (1.26) than placebo [6] | Evidence of harm at this dosing pattern |
The USPSTF (US, 2018) recommends against 400 IU or less of vitamin D with 1,000 mg or less of calcium to prevent fractures in community-dwelling postmenopausal women, and says evidence on higher amounts is inadequate. Its review excluded people with known osteoporosis or vitamin D deficiency, and its page notes an update is in progress. [7]
Bone density
A 2014 meta-analysis of 23 trials (4,082 people, mean duration 23.5 months, mostly women, average age 59) found a small benefit at the femoral neck (0.8%) and no effect at other sites. Bone density is a biomarker, not a fracture. [8]Falls
| Source | Who and what | Result | Label |
|---|---|---|---|
| USPSTF (US, 2018) | Community-dwelling adults 65 and older | Recommends against vitamin D to prevent falls; recommends exercise for those at increased risk [7] | Guideline |
| Meta-analysis of 10 trials (2025) | 23,211 community-dwelling adults 65 and older | Fall risk odds ratio 0.99 (0.95 to 1.03), no reduction [9] | No benefit found |
| Network meta-analysis of 35 trials (2024) | 58,937 older adults | 800 to 1,000 IU a day: risk ratio 0.85 (0.74 to 0.95) vs placebo or no treatment; higher doses above 1,000 IU a day raised fall risk compared with 800 to 1,000 IU [10] | Mixed; reviews disagree |
| BMJ review (2026) | Calcium, vitamin D or both | Little to no effect on fractures and falls, based largely on moderate to high certainty [4] | No benefit found |
The reviews pooled different trials, doses and groups, which is why they disagree. The network analysis found its fall reduction mainly in people with blood 25(OH)D of 50 nmol/L or below. [10] That suggests people with low levels may differ from those without, but it does not prove it.
What supports bone health
The NHS says regular exercise is essential for bone health, with weight-bearing and resistance exercise particularly important, and that calcium and vitamin D matter because vitamin D helps the body absorb calcium. [11] See Osteoporosis and bone health, Calcium and Vitamin K2 and bone evidence.Frequently asked questions
Does vitamin D prevent fractures?
In generally healthy adults, large trials and a 2026 BMJ review found no reduction. [3][4]
Does vitamin D prevent falls?
The USPSTF recommends against it in community-dwelling adults 65 and older. Some reviews found a benefit at 800 to 1,000 IU a day, others none. [7][10][9]
Is vitamin D good for osteoporosis?
Treating osteoporosis is clinician-led. MedlinePlus says a provider may recommend higher doses if you have risk factors. [12]
Can a big yearly vitamin D dose be harmful?
In one trial of women 70 and older, 500,000 IU once a year raised the risk of falls and fractures. [6]
What helps bones besides supplements?
The NHS lists regular weight-bearing and resistance exercise, a balanced diet with calcium and vitamin D, not smoking and limiting alcohol. [11]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Who should ask a clinician
- Osteoporosis or a past fracture. MedlinePlus says a provider may recommend higher doses of vitamin D if you have risk factors for osteoporosis. [12]
- Suspected deficiency. Do not diagnose it from symptoms or self-treat; a clinician can check vitamin D and calcium levels. [2] See Vitamin D deficiency and testing.
- Large occasional doses. The trials above link very large intermittent doses with more falls or fractures. [6][5]
- Too much. Excess vitamin D can raise calcium. See Vitamin D toxicity and Vitamin D and calcium.
- Medicines. Steroids and some other medicines can affect vitamin D levels. [13] See Medication interactions.
- Older adults. See Older adults.
References
- NHS (UK). Vitamin D. Page last reviewed 3 August 2020. Read 2026-10-22.
- NHS (UK). Rickets and osteomalacia. Read 2026-10-23.
- LeBoff et al. 2022. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults (VITAL). N Engl J Med. PMID 35939577. Read 2026-10-23.
- Massé et al. 2026. Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis. BMJ. PMID 42161415. Read 2026-10-23.
- de Souza et al. 2024. Vitamin D Supplementation and the Incidence of Fractures in the Elderly Healthy Population: A Meta-analysis of Randomized Controlled Trials. J Gen Intern Med. PMID 38997531. Read 2026-10-23.
- Sanders et al. 2010. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. PMID 20460620. Read 2026-10-23.
- US Preventive Services Task Force. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults. Final statement 17 April 2018 (page notes an update is in progress). Read 2026-10-23.
- Reid et al. 2014. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. PMID 24119980. Read 2026-10-23.
- Torres-Lopez et al. 2025. Efficacy of Vitamin D Supplementation on the Risk of Falls Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Clin Med. PMID 40943885. Read 2026-10-23.
- Tan et al. 2024. Effect of vitamin D, calcium, or combined supplementation on fall prevention: a systematic review and updated network meta-analysis. BMC Geriatr. PMID 38698349. Read 2026-10-23.
- NHS (UK). Osteoporosis: prevention. Page last reviewed 13 October 2022. Read 2026-10-23.
- MedlinePlus Medical Encyclopedia (US National Library of Medicine). Vitamin D. Review date 21 January 2025. Read 2026-10-22.
- MedlinePlus (US National Library of Medicine). Vitamin D Test. Read 2026-10-22.