What’s the peak performance supplement stack? Glad you asked.

We got Huel to replace mealtime.

Multivitamins because they’re yummy.
Ashwaganda to keep the bloodline alive.

Iron to make my poo black.

Creatine because Andrew Huberman said so.

And Vitamin D plus Calcium - keep my bones nice and strong.

Now, I can’t personally vouch for the effectiveness of every substance currently being peddled to men by podcasters with Turkish veneers. But vitamin D and calcium?

Between osteoporosis advice, Petits Filous ads, and every GP over the age of 45, I thought it was basically settled? Calcium and vitamin D help prevent fractures.

We’re so bullish on vitamin D and calcium because of their critical role in bone homeostasis. I won’t bore you with a repeat of pre-clinical medicine, but in short, low levels of calcium and vitamin D have been associated with:

Increased falls
Increased fracture risk
Reduced muscle function
Loss of bone mineral density

So, logically, keeping them high should reduce all these terrible outcomes, right? …right?

This meta-analysis and systematic review, published in , put this thinking to the test.

If we gave patients calcium, vitamin D, or both, would it reduce their risk of fracture and falls? Let’s find out

They looked out at 69 randomised controlled trials, including 153,902 participants. Sizable indeed…

They excluded patients already on bone protection medication and those who were already very frail. Leaving only regular community-dwelling elderly(average age 71).

After crunching data from 69 randomised controlled trials using random-effects meta-analysis, they came to a fairly awkward conclusion:

For preventing fractures and falls in otherwise typical older adults, Vitamin D and Calcium suddenly look a lot less impressive than we thought.

Calcium Monotherapy: Across 11 trials, calcium had an insignificant effect on the risk of sustaining fractures(RR 0.91, 95% CI 0.81 to 1.01; moderate certainty).

Vitamin D Monotherapy: Across 36 trials and 92,045 patients, vitamin D also offered no benefit or risk reduction for overall fractures (RR 1.00, 95% CI 0.95 to 1.06).

Risk of Falls: Somewhat unsurprisingly, nada. Neither Calcium nor Vitamin D could stop people from hitting the deck.

However, when you put the two together(Calcium + Vit D), there is a glimmer of hope.

Combined supplementation showed a statistically significant relative reduction in the risk of any fracture (15 trials, 51,126 participants; RR 0.91, 95% CI 0.84 to 0.99).

But that glimmer was quickly extinguished.

The absolute risk reduction for overall fractures was just 1.0%.

The authors had predefined 2.0% as the threshold for clinical significance – meaning the result technically “worked,” but not enough to matter to actual humans

To be fair, the paper doesn’t say vitamin D is useless in every situation. Evidence was limited for people with severe deficiencies, people living in residential care, and patients already at very high fracture risk.

But for regular people in the community?
The evidence for routine supplementation suddenly looks a lot shakier than the wellness industry would probably prefer.

Anyway, I’m still taking Huel, nothing tastier than liquid food slop 😋