For years, people were urged to take calcium supplements to avoid losing bone density. This advice was aimed particularly at menopausal and postmenopausal women because they are especially susceptible to bone fragility and fractures. All the same, calcium supplements were often recommended to all older adults. Will taking calcium pills really keep your bones strong? Seniors were also supposed to take vitamin D pills so that they could avoid going out in the sun. Sun exposure is a double-edged sword, after all: it can lead to vitamin D production, which may help keep your bones strong. On the other hand, it also increases your chance of developing skin cancer. Weighing pros and cons is difficult, so many experts prefer to sidestep the question and recommend pills instead.

In December 2017, a meta-analysis published in JAMA demonstrated no benefit from vitamin D or calcium supplementation. People taking the supplements were just as likely to break a bone as people taking placebo pills. Those on vitamin D pills were at higher risk for kidney stones, though. To make sense of this research, we talked with two experts: one, a researcher who specialized in studying bone strength and osteoporosis, and the other a leading nutrition scientist. They explain how we can make sense of the confusion. Are placebo-controlled trials the best way to learn about nutritional supplements and their value? How can you tell if your vitamin D levels are low? Are there supplements you might consider to keep your bones strong?

Since the 2017 study appeared, scientists have published additional research results that bear on whether vitamin D and calcium supplements can keep your bones strong. One was another meta-analysis published in JAMA in April 2018. Like the previous meta-analysis, it showed no reduction in fractures for people taking supplements. Even more recently, investigators in New Zealand systematically reviewed randomized controlled trials of vitamin D supplements for preventing fractures (The Lancet, Oct. 4, 2018). They found no notable benefits. Both of these are meta-analyses, however, and subject to the criticisms our guests offer for such studies.

Robert R. Recker, M.D., M.A.C.P., F.A.C.E. is the O’Brien Professor of Medicine and Chief of the Division of Endocrinology at Creighton University Medical Center. He is also the Director of the Osteoporosis Research Center. He’s a Master of The American College of Physicians and Fellow of the American College of Endocrinology. Walter Willett, M.D., Dr.P.H., is Professor of Epidemiology and Nutrition at Harvard T. H. Chan School of Public Health and Professor of Medicine at Harvard Medical School. Dr. Willett (with Patrick Skerrett) is the author of Eat, Drink and Be Healthy, The Harvard Medical School Guide to Healthy Eating, Updated and Expanded (September 2017). The photograph is of Dr. Willett.

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