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Population aging and osteoporosis are global public health challenges. Osteoporosis markedly increases the risk of fractures, and further morbidity and mortality. Calcium is a major constituent of the bone and vitamin D helps maintain calcium homeostasis. Calcium and vitamin D supplements have long been recognized as the cornerstones for prevention and management of osteoporosis and fractures. Although the associations between calcium and vitamin D supplementation and bone mineral density, fracture prevention, and potential adverse outcomes from available evidence are inconsistent, the Institute of Medicine Committee and the American Geriatrics Society support a key role of calcium and vitamin D in skeletal health. There is insufficient evidence to conclude that calcium with or without vitamin D supplementation increases the risk of cardiovascular events and cancer. Older adults should obtain at least 1000 IU/day of vitamin D with 1000–1200 mg/day of calcium to reduce the risk of fractures. The actual supplementation levels of calcium and vitamin D should be advised individually to specific patient or situation.