J Bone Miner Res

Cocoa extract and multivitamins fail to reduce fracture risk in older adults

March 14, 2025

Study details: The COSMOS trial was a randomized, double-blind, placebo-controlled study involving 21,442 older adults (≥60 years for men and ≥65 years for women). Participants were assigned to one of four groups: cocoa extract + multivitamin/mineral (MVM), cocoa extract + MVM placebo, cocoa extract placebo + MVM, or double placebo. The daily cocoa extract supplement contained 500 mg/d flavanols and 80 mg/d (–)-epicatechin; the daily MVM supplement was Centrum Silver. The intervention lasted a median of 3.6 years, with participants self-reporting fractures annually.

Results: During the study period, 2083 incident clinical fractures were reported. Cocoa extract supplementation didn’t significantly reduce the risk of total clinical fractures (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 0.95-1.12) or nonvertebral fractures (aHR, 1.05; 95% CI, 0.96-1.14). Similarly, MVM supplementation didn’t significantly lower the risk of total clinical fractures (aHR, 1.09; 95% CI 1.00-1.19), hip fractures (aHR, 1.06; 95% CI, 0.80-1.42), or nonvertebral fractures (aHR, 1.10; 95% CI, 1.00-1.20).

Clinical impact: Cocoa extract and MVM supplements don’t appear to provide a protective effect against fractures in older adults. Clinicians should consider these results when advising patients on the use of these supplements for bone health.

Source:

Crandall CJ, et al. (2025, February 18). J Bone Miner Res. Effects of Cocoa Extract Supplementation and Multivitamin/Multimineral Supplements on Self-Reported Fractures in the Cocoa Supplement and Multivitamins Outcomes Study (COSMOS) Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/39964350/