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

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For most of the 2000s, modest daily vitamin D was a default recommendation for preventing falls in older adults. That consensus has eroded. Newer and larger trials have failed to reproduce the early benefit in people who are not deficient, one well-designed dose-finding trial raised a safety signal at higher doses, and the most recent meta-analyses restricted to community-dwelling older adults find no overall effect. The picture that emerges is narrower than the original recommendation: a real but limited benefit confined to genuinely deficient or institutionalised people, and no benefit (and possible harm) from routine or high-dose use in everyone else.

Where the early optimism came from

An influential 2010 systematic review of 10 randomised trials in adults aged 60 and over found that vitamin D therapy reduced falls by about 14% overall (relative risk 0.86, 95% CI 0.79–0.93), with the benefit concentrated in subgroups receiving 800 IU or more per day, adjunctive calcium, and cholecalciferol rather than ergocalciferol [1]. A 2022 meta-analysis of 38 trials and roughly 61,000 participants reached a similar conclusion, reporting that doses of 700 IU or more were associated with a lower fall risk (RR 0.87, 95% CI 0.79–0.96), while doses below 700 IU were not [2]. These analyses, however, pooled very different populations, including many people with low baseline vitamin D, which inflates the apparent average effect.

What the recent meta-analyses actually show

The most directly relevant recent evidence comes from a 2025 meta-analysis that deliberately restricted itself to community-dwelling adults aged 65 and over, pooling 10 randomised trials and 23,211 participants. It found no reduction in fall risk overall (odds ratio 0.99, 95% CI 0.95–1.03), and no significant effect in women, in men, at doses at or below 1,000 IU/day, at doses above 1,000 IU/day, with daily or intermittent dosing, or over follow-up shorter or longer than 12 months [3]. The authors argue that earlier "positive" pooled results were largely an artefact of mixing care-facility and community populations.

That distinction matters, because the 2025 Cochrane review of fall prevention in care facilities reaches a different conclusion for that setting: vitamin D supplementation probably reduces the rate of falls (rate ratio 0.63, 95% CI 0.46–0.86, moderate-certainty evidence) but probably makes little or no difference to the risk of being a faller (RR 0.99, 95% CI 0.90–1.08), and the trials driving that signal enrolled residents with low vitamin D levels [4]. A network meta-analysis published the same year similarly found a benefit only at 800–1,000 IU/day given daily, and only in people who were deficient, with no benefit from intermittent dosing [5].

The dose-finding signal and the high-dose harm

The clearest test of whether more is better was the STURDY trial, which randomised 688 community-dwelling adults aged 70 and over with elevated fall risk and low 25-hydroxyvitamin D to 200, 1,000, 2,000, or 4,000 IU of vitamin D per day. Higher doses did not prevent falls compared with 200 IU/day (hazard ratio 0.94, 95% CI 0.76–1.15 for the best higher dose versus 200 IU). More concerning, several analyses raised safety concerns: serious falls were more common with 1,000 IU/day or higher (HR 1.87, 95% CI 1.03–3.41) as were falls requiring hospitalisation (HR 2.48, 95% CI 1.13–5.46) [6]. This echoes an earlier randomised trial in which a single annual 500,000 IU oral dose increased falls (incidence rate ratio 1.15, 95% CI 1.02–1.30) and fractures (IRR 1.26, 95% CI 1.00–1.59) in older women, with the excess falls clustered in the first three months after each dose [7].

Falls and fractures are not the same question

A large 2018 meta-analysis of 81 trials (53,537 participants) found that vitamin D supplementation had no effect on total fractures (RR 1.00), hip fractures (RR 1.11), or falls (RR 0.97, 95% CI 0.93–1.02), with no difference between higher and lower doses, and the authors concluded there was little justification for supplementing to improve musculoskeletal health in unselected populations [8]. A 2024 meta-analysis confined to healthy older adults likewise found no reduction in fractures or falls, and signalled a possible increase in hip fractures among women (RR 1.34, 95% CI 1.06–1.70) given intermittent high doses without calcium [9]. For comparison, when broad fall-prevention strategies are ranked head to head, exercise-based interventions consistently outperform any single supplement [10].

The practical takeaway

Vitamin D is not a fall-prevention tool for the general older population. The benefit that survives careful analysis is a deficiency-correction effect: it appears in care-facility residents and in people with low measured 25(OH)D, and it disappears in community-dwelling adults who are largely replete. High intermittent or bolus dosing is the regimen most clearly linked to harm and should be avoided. The defensible approach is to test 25(OH)D, restore frank deficiency with modest daily dosing, and rely on exercise and multifactorial assessment—not high-dose vitamin D—to actually reduce falls.

Sources

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