This BMJ systematic review and meta-analysis of 69 randomized controlled trials (RCTs) encompassing 153,902 adults delivers high-certainty evidence that calcium, vitamin D, or their combination yields little to no clinically meaningful reduction in fractures or falls among most older adults. Unlike smaller observational studies prone to confounding, these RCTs—assessed via rigorous bias and GRADE tools—establish moderate-to-high certainty null effects on any fracture, hip fracture, and falls. The analysis correctly flags limited applicability to those with diagnosed osteoporosis or on pharmacotherapy, yet it underplays how industry-funded guidelines have sustained supplementation despite parallel null findings in prior large-scale work such as the 2018 USPSTF evidence review and the 2022 Lancet Diabetes & Endocrinology meta-analysis. These patterns reveal over-medicalization: aging bone health framed as a nutrient deficit rather than a multifactorial issue best addressed by resistance training and fall-prevention programs. Redirecting resources here aligns with the linked editorial's call for evidence-based alternatives over reflexive prescribing.