Can Oral Nutritional Supplementation Improve Fracture Healing in Adults? A Systematic Review of Controlled Clinical Studies

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Background: Oral nutritional supplements are widely proposed as a means of improving fracture repair; however, it remains unclear whether any specific product accelerates healing in adults. We evaluated controlled clinical studies that reported direct fracture-site outcomes.Methods: PubMed was searched from inception to July 25, 2026, for controlled clinical studies of adults with acute fractures who received oral nutritional or nutraceutical supplements. Eligible studies included a concurrent comparator and at least one focal healing outcome, such as radiographic union, time to union, callus formation, fracture-site bone mineral density, or mechanical properties. Database searching was supplemented by citation chasing. A single reviewer performed screening, extraction, and risk-of-bias assessment using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) or the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Owing to marked clinical and methodological heterogeneity, findings were synthesized narratively in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results: The search identified 365 records, of which 35 were assessed in full text. Twenty-two controlled studies involving 1,819 participants were eligible. The interventions included vitamins C and D, minerals, protein-based products, bovine colostrum, botanical extracts, trehalose, and multinutrient formulations. Vitamins C and D did not consistently improve focal fracture healing outcomes. Zinc-containing products, bovine colostrum, trehalose, selected botanical preparations, and multinutrient combinations produced favorable signals, but these findings generally came from small studies with heterogeneous outcomes and substantial risk-of-bias concerns. Adverse event reporting was limited, and certainty was low or very low for every intervention–outcome grouping.Conclusions: No specific oral supplement can currently be recommended for routine use solely to accelerate fracture healing. Adequate energy and protein intake and correction of documented deficiencies remain appropriate components of fracture care. Promising findings for individual products require confirmation in adequately powered, independently replicated trials using standardized, clinically meaningful union outcomes.

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