<p>Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by a high recurrence rate, which poses a significant challenge for long-term management. A hypothesized link between vitamin D deficiency and otoconial dysfunction suggests that supplementation could be a viable preventive strategy. However, evidence from early studies has been inconsistent. This systematic review aims to synthesize the current evidence from randomized controlled trials (RCTs) on the efficacy of vitamin D supplementation in preventing BPPV recurrence. A systematic literature search for RCTs was conducted across PubMed, Scopus, CENTRAL, and Web of Science up to September 2025. We included trials comparing vitamin D supplementation against placebo or no intervention in adult patients with BPPV. The primary outcome was the BPPV recurrence rate. Secondary outcomes included time to first recurrence and adverse events. BPPV recurrence was pooled using STATA v. 19, and the risk ratio (RR). Five RCTs involving 1,118 patients were included. Vitamin D supplementation significantly reduced the risk of BPPV recurrence compared to control groups (RR: 0.33; 95% CI: 0.16–0.70; <i>p</i> &lt; 0.001). Although substantial heterogeneity was observed (I² = 78%), the protective effect remained robust across sensitivity analyses. Also, vitamin D supplementation significantly prolonged the time to the first recurrence. Vitamin D supplementation was safe and well-tolerated, with minor adverse events primarily associated with adjuvant calcium use rather than vitamin D monotherapy. Vitamin D supplementation appears to be an effective prophylactic treatment for preventing BPPV recurrence in patients with vitamin D deficiency or insufficiency. While the protective effect is robust, the high heterogeneity among trials highlights the need for further research to determine the optimal dosage and standardized treatment regimen.</p>