My Healthcare News & Research — September 29, 2026 · Calcium and Vitamin D for Fractures and Falls: What the BMJ Review of 69 Trials Actually Found

On September 20, 2026, ScienceDaily ran a story under the headline “Millions take calcium and vitamin D for bone health. A major review finds little benefit.” The review it describes is real and it is large: a systematic review and meta-analysis of 69 randomised controlled trials and 153,902 adults, published in The BMJ on May 20, 2026 by a team of hospital pharmacists and pharmacy professors in Montréal. It asked one question: do calcium pills, vitamin D pills, or the two together prevent fractures and falls in people who are not already being treated for osteoporosis? Its answer, after weighing every trial it could find, was little to no benefit.

That answer matters because these two supplements are among the most widely taken on earth, and because for thirty years they were recommended almost reflexively to anyone past middle age. But the headline hides two things a careful reader needs. First, the review is not new: the paper appeared in May, and the September story simply gave it a second wave of attention. Second, and more important, the review did find a statistically significant reduction in fractures when calcium and vitamin D were taken together — about 9 percent fewer fractures — and then judged that reduction too small to matter, using a yardstick the authors chose themselves and describe, in their own words, as “arbitrary.” Whether you agree with that yardstick is the whole argument, and this article lays it out so you can decide.

What follows is a walk through the paper itself, not the press release: what it measured and in whom, the numbers for each comparison, the threshold that turned a positive result into a “no,” how the finding sits beside the Women’s Health Initiative, VITAL, the 2019 Oxford meta-analysis and the US Preventive Services Task Force, who still plausibly benefits, the harms on the other side of the ledger, and what an ordinary reader should do. The short version: this is not “vitamin D is useless.” It is “a daily pill, taken by a person who is not deficient, does not stop bones breaking.” Those are different sentences.

Table of Contents

  1. The Study at a Glance
  2. What Was Measured, and in Whom
  3. The Results, Number by Number
  4. Significant but “Not Meaningful”: the Threshold
  5. Why Bone Needs Both, and Why Pills Rarely Change the Ending
  6. How It Fits With Thirty Years of Evidence
  7. What the Review Cannot Tell You
  8. Who Still Plausibly Benefits
  9. The Other Side of the Ledger: Harms
  10. What Supporters and Critics Are Saying
  11. What This Means for You
  12. Sources and Primary Documents
  13. Key Research Papers
  14. Connections
  15. Featured Videos

The Study at a Glance

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What Was Measured, and in Whom

The Montréal team accepted any randomised trial in adults that compared calcium, vitamin D, or both against placebo or no treatment, provided the participants were not on drug treatment for osteoporosis, long-term steroids, or the “active” hormonal forms of vitamin D prescribed in kidney disease. Trials in which only one arm also received something else — an exercise programme, hormone therapy — were excluded, because then you cannot tell which ingredient did the work.

The primary outcome was the risk of any fracture. Secondary outcomes were hip, non-vertebral and vertebral fracture, the risk of falling at least once, and the total number of falls. Bone mineral density is not on the list: the review is about the events that hurt, not the number on a DEXA scan. That is a defensible choice, but it means the paper says nothing about whether supplements change bone density, a question other trials answer separately below.

The people in the trials were, on the whole, ordinary older adults. The median trial age was 71. Only 28 percent of trials studied a “high-risk” group, defined as a mean age of 80 or over, residential care, a history of fracture or falls, diagnosed osteoporosis, or a mean baseline vitamin D below 25 nmol/L (10 ng/mL) — frank deficiency. Just 9 trials (13 percent) took place in care homes. Of the 49 trials that reported baseline vitamin D, only two had a mean level in the deficient range, and about a third had a mean below 50 nmol/L (20 ng/mL), the level most laboratories call “insufficient.” The typical participant already had a middling vitamin D level, ate a Western diet and lived at home: exactly the population that buys the pills, and not the population in which the pills were first shown to work.

Vitamin D was given daily to monthly in 71 percent of the vitamin D trials and as intermittent or single very large doses in 29 percent. The authors compared daily doses under 1,000 IU, 1,000 to 2,000 IU and over 2,000 IU; D2 with D3; women-only with mixed trials; care-home with community trials; and deficient with replete populations. None of these subgroups behaved differently from the whole — a point that cuts both ways.

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The Results, Number by Number

A risk ratio of 0.91 means the supplemented group had 91 percent of the fractures the placebo group had — a 9 percent relative reduction. The 95% confidence interval is the range within which the true effect probably lies; when it includes 1.00, the result is not statistically significant. Certainty is the GRADE verdict on how much the pooled number can be trusted, from very low to high.

Calcium alone (15 trials, 9,435 participants, mean follow-up 2.8 years)

Vitamin D alone (46 trials; 92,415 participants in the fracture analysis)

This is the cleanest result in the paper. Across nearly a hundred thousand people, vitamin D on its own did not move a single fracture or fall outcome, and the certainty is high for every one of them. A meta-regression — a statistical check of whether the effect depended on how low participants’ vitamin D levels were to begin with, or how high they were pushed — found no relationship either.

Calcium plus vitamin D (17 trials; 51,126 participants in the fracture analysis)

So the combination produced three statistically significant reductions in fractures, including at the hip, the fracture that kills. The review nevertheless concludes that the combination offers “little to no benefit.” The bridge between those two statements is the subject of the next section. One more detail belongs here first: the authors’ sensitivity analyses showed that these absolute reductions were “largely explained by one trial conducted in a very high risk population” — the 1992 French care-home trial described below. Remove it, and the combination’s benefit in ordinary community-dwelling adults shrinks further.

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Significant but “Not Meaningful”: the Threshold

Modern evidence grading no longer stops at “is the p-value under 0.05.” It also asks whether the size of the effect, in absolute terms, is big enough that a patient would care, and for that you need a line: a minimal clinically important difference. The problem, which the authors state plainly, is that “with no established minimal clinically important differences for fractures and falls, we determined thresholds by author consensus.” They set them before running the numbers, which is the honest way: a 2 percentage-point absolute reduction for any, non-vertebral and vertebral fracture; 0.7 points for hip fracture; 3 points for the risk of falling; five falls per 100 person-years.

Against those lines, the combination’s 1.0-point reduction in any fracture, 0.3-point reduction in hip fracture and 1.6-point reduction in non-vertebral fracture all fall short. Hence “little to no benefit.”

Here is the case for the other side, and it is not weak. Hip fracture is rare in a two-year trial of 71-year-olds living at home — on the order of 1 to 2 percent — so a 0.7-point threshold demands that a supplement prevent roughly half of all hip fractures before it counts, a bar few preventive drugs in any field clear over two years. A bioengineer quoted by the UK Science Media Centre made exactly this point: with more than 70,000 hip fractures a year in the UK, “some might consider a much smaller reduction a meaningful benefit.” Two bone epidemiologists wrote to The BMJ in August under the title “Population impact matters,” arguing that a 16 percent relative reduction in hip fracture, spread across an ageing population, is a great many hips.

The authors do not dodge this. Their limitations section says they “did not involve patient partners in establishing minimally important differences,” that they “defined arbitrary absolute effect thresholds,” and that “different teams or clinicians may have alternative definitions.” That candour is to their credit, and it means the headline “finds little benefit” is a judgement laid over the data. The data say: vitamin D alone does nothing measurable; calcium alone does nothing measurable; the pair together prevents about one fracture per hundred people treated for two years, mostly in the frail and deficient. You are entitled to decide whether that is worth a pill.

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Why Bone Needs Both, and Why Pills Rarely Change the Ending

None of this contradicts the biology, which is settled. Calcium stiffens bone, and the blood level is defended so fiercely that when intake falls the parathyroid glands release hormone that dissolves bone to keep it up. Vitamin D is what lets the gut absorb calcium at all; without it, absorption collapses, parathyroid hormone rises, and bone is laid down but never properly mineralised — rickets in a child, osteomalacia in an adult. Correct a genuine deficiency and every one of those numbers reverses. The deficiency pages on this site are in no tension with this review, because the review did not study deficient people.

The trouble is that a fracture in a 72-year-old is rarely caused by too little calcium in the diet. It is caused by decades of remodelling tipping towards resorption, by loss of muscle and balance, by a trip on a rug and the way a body lands. A pill adding 1,000 mg of calcium to a diet already supplying 800 mg changes blood calcium not at all and bone density by about 1 percent — roughly what the Women’s Health Initiative measured at the hip. A 1 percent gain in density is a small change in fracture risk, and a small change over two years is very hard to see even in 50,000 people. That is the arithmetic behind a risk ratio of 0.91.

Vitamin D is a plateau. Once the blood level is above the range where the gut is starved — around 30 to 50 nmol/L — more vitamin D does not produce more absorption or more bone. The Calgary trial that gave healthy adults 400, 4,000 or 10,000 IU a day for three years found that the higher doses produced slightly lower bone density than the lowest, not higher. Most trial participants were already standing on the plateau. That is the mechanism behind a risk ratio of exactly 1.00.

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How It Fits With Thirty Years of Evidence

The 2026 review is the closing chapter of a long argument, not a bolt from the blue. Each landmark below was verified against its original abstract.

1992 — the trial that started it (Chapuy, New England Journal of Medicine)

3,270 French women, mean age 84, in care homes, with low dietary calcium (about 500 mg a day) and very low vitamin D, took 1.2 g of calcium plus 800 IU of vitamin D3 or a double placebo for 18 months. Hip fractures were 43 percent lower and non-vertebral fractures 32 percent lower; femoral bone density rose 2.7 percent on treatment and fell 4.6 percent on placebo. This is the trial that, the 2026 authors say, “largely explained” the combination’s pooled benefit. It worked because the women were deficient, frail and fracturing at 11 percent over three years — and the guidelines that followed extended its result to people who were none of those things.

2006 — the Women’s Health Initiative (Jackson, NEJM)

36,282 healthy postmenopausal women, 1,000 mg calcium plus 400 IU vitamin D3 a day for an average of seven years. Hip bone density 1.06 percent higher on treatment. Hip fracture: hazard ratio 0.88 (0.72 to 1.08), not significant; among women who kept taking the pills, 0.71 (0.52 to 0.97). Kidney stones were more common on treatment: hazard ratio 1.17 (1.02 to 1.34), 449 women versus 381. WHI is why the American task force has recommended against low-dose supplementation in postmenopausal women since 2018.

2015 — Bolland and colleagues, The BMJ

Calcium supplements reduced total fracture in 20 trials (relative risk 0.89, 0.81 to 0.96), but in the four trials at lowest risk of bias (44,505 people) there was no effect at any site, and dietary calcium, milk and dairy were not associated with fracture in cohort studies at all. Only one trial — Chapuy’s — showed a clear reduction.

2016 — the National Osteoporosis Foundation meta-analysis (Weaver, Osteoporosis International)

The strongest recent result on the other side: eight trials, 30,970 participants, calcium plus vitamin D cut total fractures 15 percent (0.85, 0.73 to 0.98) and hip fractures 30 percent (0.70, 0.56 to 0.87). It pooled fewer trials and gave more weight to the care-home studies. Its relative numbers are not far from the 2026 result; the difference is in how the absolute effect was judged.

2018 — Bolland, Grey and Avenell, Lancet Diabetes & Endocrinology

81 trials of vitamin D, 53,537 people: total fracture 1.00 (0.93 to 1.07), hip 1.11 (0.97 to 1.26), falls 0.97 (0.93 to 1.02), no benefit at high doses versus low. The 2026 vitamin-D-alone numbers are, almost to the second decimal place, the same, reached with 54,383 more participants and higher certainty.

2019 — Yao and colleagues, JAMA Network Open

Vitamin D alone (11 trials, 34,243 people): any fracture 1.06 (0.98 to 1.14), hip 1.14 (0.98 to 1.32). Vitamin D with calcium (6 trials, 49,282 people): any fracture 0.94 (0.89 to 0.99), hip 0.84 (0.72 to 0.97). Compare that hip number with the 2026 review’s 0.84 (0.74 to 0.96): identical. Yao called the combination “a more promising strategy”; Massé calls the same effect “little to no benefit.” Same data, different yardstick.

2022 — VITAL’s bone study (LeBoff, NEJM)

25,871 American men over 50 and women over 55, not selected for deficiency or low bone mass, 2,000 IU of vitamin D3 a day or placebo for a median of 5.3 years, 1,991 fractures adjudicated from records. Total fractures: hazard ratio 0.98 (0.89 to 1.08). Hip 1.01 (0.70 to 1.47). Nothing. VITAL is the largest contributor to the 2026 vitamin-D-alone estimate and the main reason its certainty is high.

The US Preventive Services Task Force, 2018 and 2024

In April 2018 the Task Force recommended against 400 IU or less of vitamin D with 1,000 mg or less of calcium in community-dwelling postmenopausal women (a D grade), found the evidence insufficient for higher doses and for men and younger women, and found adequate evidence that the combination increases kidney stones. It excluded nursing-home residents and people with osteoporosis, known deficiency or a previous fracture. On December 17, 2024 it posted a draft update that goes further: against vitamin D with or without calcium to prevent fractures in postmenopausal women and men aged 60 and over, and against vitamin D to prevent falls in the same group. The comment period closed in January 2025 and the topic is still listed as in progress. The BMJ review and the American draft were written independently and land in the same place.

The picture is consistent: vitamin D alone has never prevented a fracture in a large trial of non-deficient adults; calcium plus vitamin D produces a small relative reduction driven by frail, deficient, institutionalised women; and the field’s disagreement is not about the numbers but about whether a one-in-a-hundred absolute benefit deserves a blanket recommendation.

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What the Review Cannot Tell You

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Who Still Plausibly Benefits

Reading the review against the trials it pooled, four groups stand apart from the “routine supplementation” the authors argue against.

  1. People with a documented deficiency. A blood 25-hydroxyvitamin D below about 25 to 30 nmol/L (10 to 12 ng/mL) is a treatable disease state, osteomalacia, and correcting it is treatment, not prevention. The review did not study this group and does not claim to. A vitamin D test tells you which group you are in; the site’s deficiency page covers who is at risk.
  2. Frail older people in residential care, especially women over 80 with a poor diet. This is the Chapuy population, the one group in which combined supplementation has ever produced a large, unambiguous fall in hip fractures. The 2026 authors concede their conclusions may understate the benefit here. A combined supplement remains reasonable practice for them.
  3. Anyone on osteoporosis medication. Bisphosphonates, denosumab, teriparatide and romosozumab were all tested with calcium and vitamin D on board, and some can drop blood calcium dangerously if vitamin D is low. If you take a bone drug, the supplement that came with it is part of the treatment, not a separate decision.
  4. People on long-term corticosteroids or with specific bone disorders — named by the authors as outside the reach of their conclusion.

Notice who is not on the list: the healthy 60-year-old with a normal diet, a normal blood level and no fracture, taking a daily calcium-and-D tablet “for her bones.” That is the person the review, WHI, VITAL and the American task force all describe, and for her the evidence of benefit is somewhere between very small and none.

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The Other Side of the Ledger: Harms

A supplement that does little for most people can still be worth taking if it costs nothing and harms no one. The review argues that neither is quite true of calcium tablets; the case against vitamin D at ordinary doses is weaker.

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What Supporters and Critics Are Saying

The linked editorial. The BMJ paired the paper with an editorial by three authors associated with Canadian preventive-care guideline work. Its thrust matches the paper’s closing line: that “clinicians, guideline panels, and regulatory agencies should re-evaluate their general recommendations,” and that effort and money should move to interventions with proven effects on falls — balance and resistance exercise, home-hazard assessment, and multi-component programmes tailored to individual risk.

Supporters point to the consistency of the vitamin-D-alone null across 36 trials and 92,000 people, the pre-registration, the GRADE discipline, and the fact that the same numbers keep appearing whoever pools them. A professor of clinical endocrinology at King’s College London told the Science Media Centre the study was consistent with previous research, that the subgroup analyses were appropriate, and that combined supplementation showed “a statistically significant but clinically negligible” reduction in fracture risk. A geriatrician quoted by McMaster University’s evidence service called it “an opportunity for deprescribing in some populations.”

Critics concentrate on three things. The thresholds: a 0.7-point hip-fracture line demands an implausibly large effect against a 1 to 2 percent background rate, and three significant results are being set aside by a rule the authors admit is arbitrary. Population impact: a 16 percent relative reduction in hip fracture, applied to millions of older adults, is a large absolute number — the argument of the August letter from two Australian bone epidemiologists. Generalisability: a review whose participants were 87 percent community-dwelling, 73 percent low-risk and almost never deficient cannot speak for the people in whom supplementation was designed to work, and the authors’ own caveats about care homes, osteoporosis drugs and deficiency should have been in the headline.

What neither side disputes is the vitamin-D-alone result. No commentator we could find argues that a daily vitamin D tablet, given to a non-deficient older adult, prevents fractures. The argument is about the pair, and about the frail.

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What This Means for You

Sort yourself into one of three boxes.

If you are a generally healthy adult who takes calcium and vitamin D “for your bones” without a measured deficiency, a fracture or a bone drug, the honest reading of this review, WHI, VITAL and the American task force is that the pills are very unlikely to stop you breaking anything. You are not in danger from stopping them; you were never getting much from taking them. What the evidence does support in this group is unglamorous: resistance and balance exercise; enough protein; not smoking; fixing the rug, the lighting and the bathroom; reviewing medicines that cause dizziness; and, past 65 for women or with risk factors for men, a bone density scan so that osteoporosis, if present, is treated with something that works. The fracture prevention page on this site walks through all of it.

If you do not know your vitamin D level and have a reason it might be low — you rarely see the sun, cover your skin, have dark skin far from the equator, are over 75 or housebound, have coeliac or Crohn’s disease or bariatric surgery behind you — a single blood test settles it. If you are deficient, correcting it is treatment, and this review has nothing to say against it. Use an ordinary daily dose, not a quarterly or annual bolus, and once replete, stop climbing: the Calgary trial found 4,000 and 10,000 IU a day produced slightly less bone than 400 IU.

If you are on an osteoporosis drug, live in care, have had a fragility fracture, take long-term steroids or have a diagnosed bone disorder, nothing in this paper applies to you, by its authors’ own statement. Keep taking what your prescriber paired with the treatment and raise the question with them rather than acting on a headline.

Two closing points for everyone. Calcium from food — dairy if you tolerate it, sardines with their bones, calcium-set tofu, leafy greens, almonds — carries none of the stone or heart signals attached to tablets, and 800 to 1,000 mg a day is achievable without a pill. And vitamin D from midday sun and oily fish comes with the body’s own thermostat. The review does not say the nutrients are unimportant. It says that adding more of them, from a bottle, to a body that already has enough does not do what the bottle promises — and that the decades in which we told everyone otherwise deserve to be re-examined.

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Sources and Primary Documents

Every number attributed to the review was taken from the open-access full text of the paper, not from the press release. Expert comments are attributed to the outlet that published them.

  1. Massé O, Mercurio CM, Dupuis S, Al Sahwi M, Arruda A, Dallaire G, Desforges K, Dugré N, Williamson D (2026). Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis. BMJ 393:e088050. — doi:10.1136/bmj-2025-088050 · open-access full text at Europe PMC (PMC13188451) · PubMed PMID: 42161415
  2. Pillay J, Reynolds DL, Thériault G (2026). Calcium, vitamin D, or combined supplementation to prevent fractures and falls. BMJ (linked editorial). — doi:10.1136/bmj.s913
  3. BMJ Group press release, May 20, 2026. Recommendations for calcium and vitamin D supplementation should be re-evaluated, suggest researchers. bmjgroup.com
  4. ScienceDaily, September 20, 2026. Millions take calcium and vitamin D for bone health. A major review finds little benefit. sciencedaily.com
  5. Science Media Centre (UK), May 20, 2026. Expert reaction to meta-analysis looking at evidence for vitamin D supplementation and fracture and fall prevention in older people. sciencemediacentre.org
  6. Nguyen TV, Tran TS (2026). Population impact matters when evaluating calcium and vitamin D supplementation. BMJ (letter). — doi:10.1136/bmj-2026-100495
  7. Avenell A, Grey A, Macleod AD, Bolland MJ (2026). Healthcare expenditure on vitamin D supplementation. BMJ (letter). — doi:10.1136/bmj-2026-100477
  8. US Preventive Services Task Force (2018). Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Recommendation Statement. JAMA. — doi:10.1001/jama.2018.3185
  9. US Preventive Services Task Force, December 17, 2024. Draft Recommendation Statement: Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Falls and Fractures in Community-Dwelling Adults (public-comment announcement). uspreventiveservicestaskforce.org
  10. McMaster Optimal Aging Portal. Evidence summary and clinician commentary on Massé et al. 2026. mcmasteroptimalaging.org

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Key Research Papers

The background literature discussed above. Each entry was checked against Crossref or PubMed before it was written down, and the abstract of each was read for the claim it supports.

  1. Chapuy MC, Arlot ME, Duboeuf F, et al. (1992). Vitamin D3 and Calcium to Prevent Hip Fractures in Elderly Women. New England Journal of Medicine. — doi:10.1056/NEJM199212033272305
  2. Jackson RD, LaCroix AZ, Gass M, et al.; Women’s Health Initiative Investigators (2006). Calcium plus Vitamin D Supplementation and the Risk of Fractures. New England Journal of Medicine. — doi:10.1056/NEJMoa055218
  3. Wallace RB, Wactawski-Wende J, O’Sullivan MJ, et al. (2011). Urinary tract stone occurrence in the Women’s Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. American Journal of Clinical Nutrition. — doi:10.3945/ajcn.110.003350
  4. Sanders KM, Stuart AL, Williamson EJ, et al. (2010). Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial. JAMA. — doi:10.1001/jama.2010.594
  5. Bolland MJ, Leung W, Tai V, et al. (2015). Calcium intake and risk of fracture: systematic review. BMJ. — doi:10.1136/bmj.h4580
  6. Weaver CM, Alexander DD, Boushey CJ, et al. (2016). Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporosis International. — doi:10.1007/s00198-015-3386-5
  7. Bolland MJ, Grey A, Avenell A (2018). Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes & Endocrinology. — doi:10.1016/S2213-8587(18)30265-1
  8. Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK (2019). Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA. — doi:10.1001/jama.2019.11889
  9. Yao P, Bennett D, Mafham M, et al. (2019). Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Network Open. — doi:10.1001/jamanetworkopen.2019.17789
  10. LeBoff MS, Chou SH, Ratliff KA, et al. (2022). Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. New England Journal of Medicine. — doi:10.1056/NEJMoa2202106

PubMed Topic Searches

  1. PubMed: Calcium and vitamin D supplementation for fracture prevention, meta-analyses
  2. PubMed: Vitamin D supplementation and falls in older adults
  3. PubMed: Calcium supplements, kidney stones and cardiovascular risk

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Connections

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