Taking vitamin D and calcium every day? Doctors reveal why supplements may not protect bones the way many believe - The Times of India

For years, vitamin D and calcium tablets have enjoyed an almost magical reputation. A certain age arrives, knees begin to ache, or a health check-up mentions "weak bones," and the small white tablets often become part of the daily routine. Many people take them without a prescription, assuming they are an insurance policy against fractures and ageing bones.But one of the largest reviews on the subject is now challenging that belief.A new systematic review and meta-analysis published in The BMJ analysed 69 clinical trials involving more than 153,000 adults. The conclusion was surprising: vitamin D supplements, calcium supplements, or even taking both together offered little to no meaningful benefit in preventing fractures or falls in most adults.The findings do not suggest that these nutrients are unimportant. Instead, they reveal something more nuanced and perhaps more powerful: healthy bones cannot be built through pills alone.Researchers behind the BMJ study looked at evidence from dozens of randomised controlled trials conducted over several decades. The participants were mostly community-dwelling adults who were not considered at high risk of fractures.The results showed that:Calcium supplements had little effect on reducing fractures.Vitamin D supplements showed virtually no reduction in fracture risk.Taking both together offered only very small benefits that were not considered clinically meaningful.The study also found little evidence that these supplements significantly reduced falls, which are among the leading causes of fractures in older adults.The findings echo earlier recommendations from the US Preventive Services Task Force (USPSTF), which concluded that routine supplementation with vitamin D and calcium in healthy, community-dwelling adults does not prevent fractures.Bones are living tissues. They are constantly being broken down and rebuilt. This process depends on far more than just two nutrients."Blindly taking vitamin D and calcium supplements may not prevent fractures or make bones stronger," said Dr Anup Khatri, Senior Consultant-Orthopedics at Gleneagles Hospital, Parel, Mumbai."So, good bone health will be based on factors like regular exercise, a balanced diet, sunlight exposure, and overall lifestyle. Supplements should be taken when there is a deficiency or on a doctor's advice."Think of bone health like constructing a house. Calcium and vitamin D may be bricks and cement, but without workers, maintenance and a solid foundation, the structure cannot stand strong. Exercise, muscle strength, hormones, sleep, protein intake and healthy body weight all influence how bones age.The body's skeleton also responds to movement. Weight-bearing activities such as walking, climbing stairs and strength training stimulate bones to become stronger over time. A pill simply cannot replicate that biological response.Part of the reason lies in fear. Fractures, especially hip fractures in older adults, can change lives permanently. People naturally look for easy preventive measures. Supplements appear harmless, inexpensive and convenient.There is also the widespread assumption that if a nutrient is good, then more of it must be better.Dr Khatri cautioned against this approach, "Healthy adults should take supplements only after the doctor's advice. Don't try to take any supplement just because others are taking. Or don't just Google and take any supplements without the doctor's knowledge."This advice is particularly relevant in India, where vitamin D deficiency is common despite abundant sunshine.The study does not mean these supplements are useless. There are people who genuinely benefit from them, including:Individuals with proven vitamin D deficiency.Older adults with osteoporosis.People with malabsorption disorders.Those on medications that affect bone health.Individuals with limited sunlight exposure.Patients recovering from certain fractures.​For these groups, supplementation may still be necessary and beneficial."Go for regular health check-ups and do a vitamin D test as advised by the doctor instead of mindlessly taking any supplements," said Dr Khatri. "The doctor will decide the line of treatment if there is vitamin D or calcium deficiency."The key message is not to abandon supplements altogether, but to use them thoughtfully and only when there is a medical reason.The study may have delivered disappointing news for supplement enthusiasts, but it also pointed toward a more encouraging truth: many aspects of bone health remain within daily control."For keeping the bones strong, it is necessary to do weight-bearing exercise like walking or strength training on a regular basis," said Dr Khatri."Make sure to have a balanced diet involving foods loaded with calcium and protein. Get enough sunlight in the morning, quit smoking and alcohol, maintain an optimum weight and prevent falls to reduce the chances of a fracture."In practical terms, this means:​Walking regularly.Eating calcium-rich foods such as milk, curd and leafy vegetables.Including adequate protein through paneer, pulses and soy products.Spending some time outdoors in morning sunlight.Avoiding smoking and limiting alcohol.Maintaining muscle strength and balance as age advances.​Perhaps the biggest misconception, according to Dr Khatri, is believing that pills are a shortcut."A large number of people believe opting for vitamin D and calcium pills is the only way to keep the bones strong and healthy. But this is not true at all."Strong bones, it turns out, are less about what is swallowed and more about how one lives.This article includes expert inputs shared with TOI Health by:Dr Anup Khatri, Senior Consultant-Orthopedics at Gleneagles Hospital, Parel, Mumbai.Inputs were used to explain why experts are rethinking the routine use of vitamin D and calcium supplements and why bone health depends on much more than simply taking daily pills.