Vitamin D for fall prevention in older adults: what recent meta-analyses show

Vitamin D for fall prevention was one of the great consensus recommendations of geriatric medicine for nearly a decade. Then the USPSTF reversed its position in 2018, the STURDY trial reported a U-shaped harm signal at higher doses, and the question moved from "what dose" to "should we be recommending it at all." Here is the current state of the evidence.

The original recommendation

Bischoff-Ferrari and colleagues published a 2009 meta-analysis pooling 8 trials with 2,426 older adults, reporting a 19% reduction in falls with vitamin D 700-1,000 IU daily and inconsistent effects at lower doses [1]. The American Geriatrics Society and the U.S. Preventive Services Task Force both adopted fall prevention recommendations on the strength of these data, with the USPSTF assigning a B-grade recommendation in 2012.

The reversal

The 2018 USPSTF systematic review concluded that newer evidence did not support vitamin D supplementation for fall prevention in community-dwelling older adults without osteoporosis or vitamin D deficiency, and downgraded the recommendation to D (recommend against) [2]. A separate 2018 large-scale meta-analysis by Bolland et al pooled 81 trials with 53,537 participants and reported no effect on falls or fractures from vitamin D supplementation, with the certainty rated high [3].

STURDY and the U-shaped harm signal

The STURDY trial randomized 688 community-dwelling adults age 70 and over with low baseline 25(OH)D to vitamin D3 at 200, 1,000, 2,000, or 4,000 IU daily for an average 2 years. There was no reduction in the rate of first fall in any group versus the 200 IU reference dose, and the 1,000-4,000 IU groups showed a non-significant trend toward more serious falls [4]. The 2,000 and 4,000 IU groups also had a higher rate of falls with injury, with a hazard ratio of 1.87 (95% CI 1.03-3.41) for the highest-dose group.

The 2024 Cochrane update and the 2025 IPD analysis

The 2024 Cochrane systematic review of 40 trials with 80,800 participants concluded that vitamin D supplementation produced little or no reduction in falls or fractures in community-dwelling older adults (RR 0.97, 95% CI 0.93-1.02) [5]. A 2025 individual-participant-data meta-analysis of 17 trials with 19,200 participants found that benefit was restricted to participants with baseline 25(OH)D below 25 nmol/L; in this subgroup, fall rates were reduced by 17% [6]. The number of participants with that level of deficiency in modern North American and European trials is small, which dilutes the population-level effect.

The high-dose harm

Sanders and colleagues had reported in 2010 that a single annual oral dose of 500,000 IU vitamin D was associated with a 26% increased risk of falls [7]. A 2025 dose-response meta-analysis confirmed the inverted-J relationship, with rates of falls lowest at supplementation regimens producing 25(OH)D between 50 and 75 nmol/L and rising thereafter [8].

Where guidelines stand in 2026

The Endocrine Society's 2024 guideline recommends vitamin D supplementation for adults age 75 and over (600-800 IU/day) on the basis of mortality data, but does not endorse fall prevention as a separate indication [9]. The USPSTF's 2025 reaffirmation maintains the D-grade recommendation against routine fall-prevention supplementation in non-deficient adults.

Bottom line

Vitamin D supplementation does not prevent falls in community-dwelling older adults who are not deficient, and high-dose intermittent regimens may increase risk. The intervention should be reserved for biochemically confirmed deficiency, with daily dosing of 800-1,000 IU and a target 25(OH)D of 50-75 nmol/L.