title: Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg) Reduced-fat Gouda-type cheese enriched with vitamin D3 effectively prevents vitamin D deficiency during winter months in postmenopausal women in Greece Development of a Food Group-Based Diet Score and Its Association with Bone Mineral Density in the Elderly: The Rotterdam Study Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: a 2-y randomized trial. Calcium supplementation and bone mineral density in females from childhood to young adulthood: a randomized controlled trial. Vitamin D-enhanced eggs are protective of wintertime serum 25-hydroxyvitamin D in a randomized controlled trial of adults. Higher Dietary Calcium Intakes Are Associated With Reduced Risks of Fractures, Cardiovascular Events, and Mortality: A Prospective Cohort Study of Older Men and Women. Identification of a dietary pattern prospectively associated with bone mass in Australian young adults. Nutrients, endpoints, and the problem of proof. Associations of Bone Mineral Density with Lean Mass, Fat Mass, and Dietary Patterns in Postmenopausal Chinese Women: A 2-Year Prospective Study Dietary Phylloquinone and Menaquinones Intakes and Risk of Type 2 Diabetes Protective association of milk intake on the risk of hip fracture: results from the Framingham Original Cohort. Bone mineral density in postmenopausal Chinese women treated with calcium fortification in soymilk and cow's milk Benefits of milk powder supplementation on bone accretion in Chinese children Calcium-vitamin D-fortified milk is as effective on circulating bone biomarkers as fortified juice and supplement but has less acceptance: a randomised controlled school-based trial. Skeletal benefits from calcium supplementation are limited in children with calcium intakes near 800 mg daily High intake of milk, but not meat, decreases bone turnover in prepubertal boys after 7 days School-milk intervention trial enhances growth and bone mineral accretion in Chinese girls aged 10-12 years in Beijing. Increasing fluid milk favorably affects bone mineral density responses to resistance training in adolescent boys. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial Effects of dairy products on bone and body composition in pubertal girls. Effects of dairy food supplements on bone mineral density in teenage girls Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Milk consumption during teenage years and risk of hip fractures in older adults.
abstract: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Background It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors . However , findings of an ultimately decreased risk of cardiovascular disease ( CVD ) are limited . Instead , recent evidence warns that taking calcium supplements might increase myocardial infa rct ion ( MI ) risk . Objective To prospect ively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality . Methods Data from 23 980 Heidelberg cohort participants of the European Prospect i ve Investigation into Cancer and Nutrition study , aged 35–64 years and free of major CVD events at recruitment , were analysed . Multivariate Cox regression models were used to estimate HRs and 95 % CIs . Results After an average follow-up time of 11 years , 354 MI and 260 stroke cases and 267 CVD deaths were documented . Compared with the lowest quartile , the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk , with a HR of 0.69 ( 95 % CI 0.50 to 0.94 ) and 0.68 ( 95 % CI 0.50 to 0.93 ) , respectively . Associations for stroke risk and CVD mortality were overall null . In comparison with non-users of any supplements , users of calcium supplements had a statistically significantly increased MI risk ( HR=1.86 ; 95 % CI 1.17 to 2.96 ) , which was more pronounced for calcium supplement only users ( HR=2.39 ; 95 % CI 1.12 to 5.12 ) . Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits , while calcium supplements , which might raise MI risk , should be taken with caution Objective The primary aim of the present study was to examine the effectiveness of daily consumption of vitamin D3-enriched , reduced-fat Gouda-type cheese on 25-hydroxyvitamin D ( 25(OH)D ) concentration in postmenopausal women . Health-related quality of life ( HRQL ) indices were examined as secondary outcomes . Design This is a single-blinded ( i.e. , to study participants ) , r and omized , controlled food-based dietary intervention study . Methods A sample of 79 postmenopausal women ( 55–75 years old ) was r and omized either to a control group ( CG : n = 39 ) or an intervention group ( IG : n = 40 ) that consumed , as part of their usual diet , 60 g of either non-enriched or vitamin D3 enriched Gouda-type cheese , respectively , for eight consecutive weeks ( i.e. , from January to March 2015 ) . Sixty grams of enriched cheese provided a daily dose of 5.7 μg of vitamin D3 . Results There was a differential response of mean ( 95 % CI ) serum 25(OH)D levels in the IG and CG , with the former increasing and the latter decreasing significantly over the eight weeks of the trial [ i.e. , by 5.1 ( 3.4 , 6.9 ) nmol/L vs. −4.6 ( −6.4 , −2.8 ) nmol/L , P < 0.001 , respectively ] . The percentages of study participants with 25(OH)D levels < 30 ( deficiency ) and < 50 nmol/L ( insufficiency ) were significantly higher at follow-up in the CG compared to the IG ( 41.0 vs. 0 % , P < 0.001 and 74.4 vs. 47.5 % , P < 0.001 , respectively ) . The emotional well-being scale of the HRQL score increased in the IG compared to a decrease in the CG ( 3.2 vs. −3.8 , P = 0.028 ) . However , none of the other seven scales of the HRQL score significantly differentiated between study groups ( P > 0.1 ) . Conclusions Consumption of 60 g of vitamin D3-enriched , reduced-fat Gouda-type cheese provided a daily dose of 5.7 μg of additional vitamin D3 and was effective in increasing mean serum 25(OH)D concentration and in counteracting vitamin D deficiency during winter months in postmenopausal women in Greece No diet score exists that summarizes the features of a diet that is optimal for bone mineral density ( BMD ) in the elderly . Our aims were ( a ) to develop a BMD-Diet Score reflecting a diet that may be beneficial for BMD based on the existing literature , and ( b ) to examine the association of the  BMD-Diet Score  and the  Healthy Diet  Indicator , a score based on guidelines of the World Health Organization , with BMD in Dutch elderly participating in a prospect i ve cohort study , the Rotterdam Study ( n = 5144 ) .  Baseline dietary intake , assessed using a food frequency question naire , was categorized into food groups . Food groups that were consistently associated with BMD in the literature were included in the BMD-Diet Score . BMD was measured repeatedly and was assessed using dual energy X-ray absorptiometry . The BMD-Diet Score considered intake of vegetables , fruits , fish , whole grains , legumes/beans and dairy products as “ high-BMD ” components and meat and confectionary as “ low-BMD ” components . After adjustment , the BMD-Diet Score was positively associated with BMD ( β ( 95 % confidence interval ) = 0.009 ( 0.005 , 0.012 ) g/cm2 per st and ard deviation ) . This effect size was approximately three times as large as has been observed for the Healthy Diet Indicator . The food groups included in our BMD-Diet Score could be considered in the development of future dietary guidelines for healthy ageing BACKGROUND Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth period . OBJECTIVE The purpose was to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition  in girls aged 10 - 12 y. DESIGN This placebo-controlled intervention trial r and omly assigned 195 healthy girls at Tanner stage I-II , aged 10 - 12 y , with dietary calcium intakes < 900 mg/d to 1 of 4 groups : calcium ( 1000 mg ) + vitamin D3 ( 200 IU ) , calcium ( 1000 mg ) , cheese ( 1000 mg calcium ) , and placebo . Primary outcomes were bone indexes of the hip , spine , and whole body by dual-energy X-ray absorptiometry and of the radius and tibia by peripheral quantitative computed tomography . RESULTS With the use of intention-to-treat or efficacy analysis , calcium supplementation with cheese result ed in a higher percentage change in cortical thickness of the tibia than did placebo , calcium , or calcium + vitamin D treatment ( P = 0.01 , 0.038 , and 0.004 , respectively ) and in higher whole-body bone mineral density than did placebo treatment ( P = 0.044 ) when compliance was > 50 % . With the use of a hierarchical linear model with r and om effects to control for growth velocity , these differences disappeared . CONCLUSIONS Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium . Diverse patterns of growth velocity may mask the efficacy of supplementation in a short-term trial of children transiting through puberty BACKGROUND Short-term studies established that calcium influences bone accretion during growth . Whether long-term supplementation influences bone accretion in young adults is not known . OBJECTIVE This study evaluated the long-term effects of calcium supplementation on bone accretion among females from childhood to young adulthood . DESIGN A 4-y r and omized clinical trial recruited 354 females in pubertal stage 2 and optionally was extended for an additional 3 y. The mean dietary calcium intake of the participants over 7 y was approximately 830 mg/d ;  calcium-supplemented persons received an additional approximately 670 mg/d . Primary outcome variables were distal and proximal radius bone mineral density ( BMD ) , total-body BMD ( TBBMD ) , and metacarpal cortical indexes . RESULTS Multivariate analyses of the primary outcomes indicated that  calcium-supplementation  effects vary over time . Follow-up univariate analyses indicated that all primary outcomes were significantly larger in the supplemented group than in the placebo group at the year 4 endpoint . However , at the year 7 endpoint , this effect vanished for TBBMD and distal radius BMD . Longitudinal models for TBBMD and proximal radius BMD , according to the time since menarche , showed a highly significant effect of supplementation during the pubertal growth spurt and a diminishing effect thereafter . Post hoc stratifications by compliance-adjusted total calcium intake and by final stature or metacarpal total cross-sectional area showed that calcium effects depend on compliance and body frame . CONCLUSIONS Calcium supplementation significantly influenced bone accretion  in young females during the pubertal growth spurt . By young adulthood , significant effects remained at metacarpals and at the forearm of tall persons , which indicated that the calcium requirement for growth is associated with skeletal size . These results may be important for both primary prevention of osteoporosis and prevention of bone fragility fractures during growth BACKGROUND Despite numerous animal studies that have illustrated the impact of additional vitamin D in the diet of hens on the result ing egg vitamin D content , the effect of the consumption of such eggs on vitamin D status of healthy individuals has not , to our knowledge , been tested . OBJECTIVE We performed a r and omized controlled trial ( RCT ) to investigate the effect of the consumption of vitamin D-enhanced eggs ( produced by feeding hens at the maximum concentration of vitamin D3 or serum 25-hydroxyvitamin D [ 25(OH)D3 ] lawfully allowed in feed ) on winter serum 25(OH)D in healthy adults . DESIGN We conducted an 8-wk winter RCT in adults aged 45 - 70 y ( n = 55 ) who were stratified into 3 groups and were requested to consume ≤2 eggs/wk ( control group , in which status was expected to decline ) , 7 vitamin D3-enhanced eggs/wk , or seven 25(OH)D3-enhanced eggs/wk  . Serum 25(OH)D was the primary outcome . RESULTS Although there was no significant difference ( P > 0.1 ; ANOVA ) in the mean preintervention serum 25(OH)D in the 3 groups , it was ∼7 - 8 nmol/L lower in the control group than in the 2 groups who consumed vitamin D-enhanced eggs . With the use of an ANCOVA , in which baseline 25(OH)D was accounted for , vitamin D3-egg and 25(OH)D3-egg groups were shown to have had significantly higher ( P ≤ 0.005 ) postintervention serum 25(OH)D than in the control group . With the use of a within-group analysis , it was shown that , although serum 25(OH)D in the control group significantly decreased over winter ( mean ± SD : -6.4 ± 6.7 nmol/L ; P = 0.001 ) , there was no change in the 2 groups who consumed vitamin D-enhanced eggs ( P > 0.1 for both ) . CONCLUSION Weekly consumption of 7 vitamin D-enhanced eggs has an important impact on winter vitamin D status in adults . This trial was registered at clinical trials.gov as NCT02678364 The aim of this population -based , prospect i ve cohort study was to investigate long-term associations between dietary calcium intake  and fractures , non-fatal cardiovascular disease ( CVD ) , and death from all causes . Participants were from the Melbourne Collaborative Cohort Study , which was established in 1990 to 1994 . A total of 41,514 men and women ( ∼99 % aged 40 to 69 years at baseline ) were followed up for a mean ( SD ) of 12 ( 1.5 ) years . Primary outcome measures were time to death from all causes ( n = 2855 ) , CVD-related deaths ( n = 557 ) , cerebrovascular disease-related deaths ( n = 139 ) , incident non-fatal CVD ( n = 1827 ) , incident stroke events ( n = 537 ) , and incident fractures ( n = 788 ) . A total of 12,097 participants ( aged ≥50 years ) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses .  Mortality was ascertained by record linkage to registries . Fractures and CVD were ascertained from interview ∼13 years after baseline . Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food-frequency question naire . Hazard ratios ( HR ) and odds ratios ( OR ) were calculated for quartiles of dietary calcium intake . Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means ( SD ) of 1348 ( 316 ) mg/d and 473 ( 91 ) mg/d , respectively . Overall , there were 788 ( 10.3 % ) incident fractures , 1827 ( 9.0 % ) incident CVD , and 2855 people ( 8.6 % ) died . Comparing the highest with the lowest quartile of calcium intake , for all-cause mortality , the HR was 0.86 ( 95 % confidence interval [ CI ] 0.76 - 0.98 , p(trend ) = 0.01 ) ; for non-fatal CVD and stroke , the OR was 0.84 ( 95 % CI 0.70 - 0.99 , p(trend ) = 0.04 ) and 0.69 ( 95 % CI 0.51 - 0.93 , p(trend ) = 0.02 ) , respectively ; and the OR for fracture was 0.70 ( 95 % CI 0.54 - 0.92 , p(trend ) = 0.004 ) . In summary , for older men and women , calcium intakes of up to 1348 ( 316 ) mg/d from food were associated with decreased risks for fracture , non-fatal CVD , stroke , and all-cause mortality BACKGROUND Relatively little is known about the relations between dietary patterns and bone health in adolescence , which is a period of substantial bone mass accrual . OBJECTIVES We derived dietary patterns that were hypothesized to be related to bone health on the basis of their protein , calcium , and potassium contents and investigated their prospect i ve associations with bone mineral density ( BMD ) , bone area , and bone mineral content ( BMC ) in a cohort of young adults . DESIGN The study included 1024 young adults born to mothers who were participating in the Western Australian Pregnancy Cohort ( Raine ) Study .  Dietary information was obtained from food-frequency question naires at 14 and 17 y of age . Dietary patterns were characterized according to protein , calcium , and potassium intakes with the use of reduced-rank regression . BMD , bone area , and BMC were estimated with the use of a total body dual-energy X-ray absorptiometry scan at 20 y of age . RESULTS We identified 2 major dietary patterns . The first pattern was positively correlated with intakes of protein , calcium , and potassium and had high factor loadings for low-fat dairy products , whole grains , and vegetables . The second pattern was positively correlated with protein intake but negatively correlated with intakes of calcium and potassium and had high factor loadings for meat , poultry , fish , and eggs . After adjustment for anthropometric , sociodemographic , and lifestyle factors , a higher z score for the first pattern at 14 y of age was positively associated with BMD and BMC at 20 y of age [ differences : 8.6 mg/cm(2 ) ( 95 % CI : 3.0 , 14.1 mg/cm(2 ) ) and 21.9 g ( 95 % CI : 6.5 , 37.3 g ) , respectively , per SD increase in z score ] . The z score for this same pattern at 17 y of age was not associated with bone outcomes at 20 y of age . The second pattern at 14 or 17 y of age was not associated with BMD , BMC , or bone area . CONCLUSIONS A dietary pattern characterized by high intakes of protein , calcium , and potassium in midadolescence was associated with higher BMD and BMC at 20 y of age . Our results indicate that high consumption of low-fat dairy products , whole grains , and vegetables in adolescence are associated with beneficial effects on bone development The early days of nutritional science were a heady time . Working out the metabolic roles and many benefits of specific nutrients was both exciting and clearly important . In more recent times , emphasis has shifted somewhat from metabolism to policy . In a sense , this represents a major victory for nutrition . Less than a century ago , E. V. McCollum had to struggle with the prevailing notion that food was primarily fuel . The idea that not eating something could make one sick was considered laughable . Now , it is taken for granted that the quality of what we eat is at least as important as the quantity , an underst and ing that leads naturally to the determining of nutrient intake requirements . It is not surprising , therefore , that 7 of the last 14 Atwater lectures dealt more or less explicitly with the issue of requirements . This one will be no exception to that pattern . In my McCollum lecture of 5 y ago ( 1 ) , I called attention to what I perceived as a broadening of the way deficiency disease might be conceptualized . The original nutrient deficiency diseases were all of short latency and involved discrete body systems and dysfunctions . Rickets , pellagra , and beriberi are good cases in point . And , while the working science has progressed far beyond these beginnings , these short latency diseases have remained the implicit model for much of our thinking about nutritional deficiency and , to a substantial extent , our determination of nutrient intake requirements . For example , in the first of the dietary reference intake books , that for bone-related nutrients ( 2 ) , the intake requirement for vitamin D was explicitly pegged solely to the prevention of rickets/osteomalacia . As is evident on a moment ’s reflection , short latency was a prerequisite for the discovery of a connection between nutrient intake and disease . Had the outcome of an inadequate intake not been discrete and not been manifested promptly , it is doubtful that we ever would have recognized the connection between cause and effect ( i.e. nutrient intake and health or disease ) . But the science has gone far beyond that point , and it seems that there is no inherent reason why inadequate intake of the same nutrients involved in short-latency diseases could not be producing long latency deficiency disease as well . Moreover , as is now generally recognized , nutrients act through multiple mechanisms , and low intakes might be expected to lead to disorders quite distinct from the disease originally connected with the nutrient . Vitamin D is a good case in point . Total body inputs closer to those that must have prevailed during hominid evolution are associated with reduced risk of disorders as varied as Type I diabetes , hypertension , osteoporosis , various cancers , multiple sclerosis , and periodontal disease , to name only some ( 3–24 ) . ( For several of these disorders there is now what is referred to as ‘ ‘ level I evidence , ’’ i.e. r and omized controlled trials , confirming what had been found both in observational studies and in extensive bench and small animal studies . ) This broadened scheme is illustrated graphically in Figure 1 Objective To assess factors associated with bone mineral density ( BMD ) in postmenopausal women in a longitudinal study , and to examine the relative contribution of lean mass , fat mass , dietary patterns , and years since menopause to BMD . Methods Two hundred and eighty-two postmenopausal women were r and omly selected from Hongqi Community Health Center , in Harbin City , China . All participants were followed up from 2009 to 2011 . Dietary data were collected using a Food Frequency Question naire .  BMD of the left hip , the lumbar spine , and the total body , and the body composition were measured by dual-energy X-ray absorptiometry at baseline and follow-up . Results Lean mass and fat mass were positively associated with BMD of the spine , hip , and the total body at both baseline and follow-up . The association between fat mass and BMD at the spine at baseline ( P = 0.210 ) and at the spine ( P = 0.116 ) and hip ( P = 0.073 ) in the second year was not statistically significant when height was adjusted . Six dietary patterns were identified but only cereal grains-fruits pattern ( P = 0.001 in the spine , P = 0.037 in hip ) and milk-root vegetables pattern ( P = 0.010 in hip ) were associated with BMD of the spine and hip . The linear mixed model of follow-up data showed that lean mass , years since menopause , and age of menophania were the significant determinants of BMD of all sites . Moreover , lean mass was the best determinant of BMD ( VIP = 1.936 ) . Conclusion Lean mass , years since menopause , age of menophania and dietary patterns are the important determinants of BMD of the spine , hip , and the total body . Lean mass is the best determinant of BMD OBJECTIVE To investigate whether dietary phylloquinone and menaquinones intakes are related to risk of type 2 diabetes .  RESEARCH DESIGN AND METHODS We used data from a prospect i ve cohort study in 38,094 Dutch men and women , aged 20–70 years .  Dietary phylloquinone and menaquinones intakes were assessed using a vali date d food frequency question naire . Diabetes case patients were ascertained mainly via self-report and verified against medical records . RESULTS During 10.3 years of follow-up , 918 incident cases of diabetes were documented . In a multivariate model adjusting for diabetes risk factors and dietary factors , phylloquinone intake tended to be associated ( P = 0.08 ) with a reduced risk of type 2 diabetes with a hazard ratio ( HR ) of 0.81 ( 95 % CI 0.66–0.99 ) for the highest versus the lowest quartile . For menaquinones intake , a linear , inverse association ( P = 0.038 ) with risk of type 2 diabetes was observed with an HR of 0.93 ( 0.87–1.00 ) for each 10-μg increment in the multivariate model . CONCLUSIONS This study shows that both phylloquinone and menaquinones intakes may be associated with a reduced risk of type 2 diabetes Dairy foods are rich in bone-beneficial nutrients , yet the role of dairy foods in hip fracture prevention remains controversial . Our objective was to evaluate the association of milk , yogurt , cheese , cream , and milk + yogurt intakes with  incident hip fracture in the Framingham Original Cohort . A total of 830 men and women from the Framingham Original Cohort , a prospect i ve cohort study , completed a food-frequency question naire ( 1988 to 1989 ) and were followed for hip fracture until 2008 . In this population -based study , Cox-proportional hazards regression was used to estimate hazard ratios ( HR ) by categories of energy-adjusted dairy intake ( servings/wk ) , adjusting for st and ard confounders and covariates . The exposure was energy-adjusted intakes of milk , yogurt , cheese , cream , and milk + yogurt ( servings/wk ) . Risk of hip fracture over the follow-up was the primary outcome ; the hypothesis being tested was formulated after data collection . The mean age at baseline was 77 years ( SD 4.9 , range 68 to 96 ) . Ninety-seven hip fractures occurred over the mean follow-up time of 11.6 years ( range 0.04 to 21.9 years ) . The mean ± SD ( servings/wk ) of dairy intakes at baseline were : milk = 6.0 ± 6.4 ; yogurt = 0.4 ± 1.3 ; cheese = 2.6 ± 3.1 ; and cream = 3.4 ± 5.5 . Participants with medium ( > 1 and < 7 servings/wk ) or higher ( ≥7 servings/wk ) milk intake tended to have lower hip fracture risk than those with low ( ≤1 serving/wk ) intake ( high versus low intake HR 0.58 , 95 % confidence interval [ CI ] 0.31 - 1.06 , p = 0.078 ; medium versus low intake HR 0.61 , 95 % CI 0.36 - 1.08 , p = 0.071 ; p trend = 0.178 ] . There appeared to be a threshold for milk , with 40 % lower risk of hip fracture among those with medium/high milk intake compared with those with low intake ( p = 0.061 ) . A similar threshold was observed for  milk  + yogurt intake ( p = 0.104 ) . These associations were further attenuated after adjustment for femoral neck bone mineral density . No significant associations were seen for other dairy foods ( p range = 0.117 to 0.746 ) . These results suggest that greater intakes of milk and milk + yogurt may lower risk for hip fracture in older adults through mechanisms that are partially , but not entirely , attributable to effects on bone mineral density Summary Eighteen months of daily consumption of milk containing 250 mg calcium prevented bone mineral density ( BMD ) loss at the hip and the femoral neck in postmenopausal Chinese women aged 45 to 65 . Introduction Estrogen-related bone loss in postmenopausal women can be prevented by the consumption of milk with high doses of calcium and soymilk with high doses of isoflavones . However , high doses of calcium and isoflavones may not be necessary to attain a beneficial effect of milk and soymilk on BMD . We hypothesized that BMD will increase in postmenopausal Chinese women who consume daily 250 mg calcium in milk or soymilk . Milk prevented bone loss at the hip and the femoral neck in postmenopausal Chinese women . Methods A total of 141 eligible Chinese women without osteoporosis , aged 45–65 , and postmenopausal for more than 2 years were r and omized into groups receiving for 18 months ( A ) milk with 250 mg calcium daily , ( B ) soymilk with 250 mg calcium daily , or ( C ) neither milk nor soymilk . Dual-energy X-ray absorptiometry measured the BMD of the spine and hip at 0 , 6 , 12 , and 18 months . Results The BMD in the hip ( 2.52 % ) and the femoral neck ( 2.82 % ) of the women consuming milk was significantly higher ( hip , P = 0.01 ; femoral neck , P < 0.0000001 ) . The women in the control group experienced a reduction in BMD at all sites ; the reduction in BMD was only significant at the hip during 12 months ( P = 0.008 ) and at the femoral neck during 18 months ( P = 0.005 ) . Conclusions Daily consumption of milk containing 250 mg calcium over 18 months prevents BMD loss at the hip and the femoral neck in postmenopausal Chinese women Low dietary calcium intake has been demonstrated to be a risk factor for hip and vertebral fractures in studies conducted among Hong Kong Chinese . Few studies have demonstrated the effect of milk supplementation in bone accretion in Chinese children . The aim was to examine the effects of milk powder supplementation in enhancing bone accretion in Chinese children . Three hundred and forty-four children , aged 9–10 years old , were r and omized to receive milk powder equivalent to 1300 mg and 650 mg calcium , and to a control group , respectively . Bone mineral density ( BMD ) at the proximal femur , lumbar spine and total body were measured at 6 months , 12 months and 18 months . The treatment effects were modeled using linear mixed effect models and compared using linear contrast F-tests , by intention-to-treat . Subjects r and omized to milk powder equivalent to 1300 mg calcium had significantly higher increase in BMD at both the total hip ( 7.4±0.4 % in treatment group versus 6.3±0.4 % in the control ) and the spine ( 8.4±0.5 % in the treatment group versus 7.0±0.5 % in the control group ) . Subjects r and omized to milk powder equivalent to 650 mg calcium had smaller increases in BMD at the total hip and spine , although the increase in BMD at the total body was significantly higher ( 3.1±0.3 % in treatment group versus 2.4±0.2 % in controls ) . It is concluded that supplementing the diet of Chinese children with milk powder was effective in enhancing bone accretion BACKGROUND Hypovitaminosis D , especially during cold seasons , is quite prevalent among primary school children in Tehran . The present study aim ed to compare the efficacy of calcium-vitamin D-fortified-milk , -orange juice and supplement in primary school children . METHODS Children aged 9 - 12 years from both sexes were r and omly assigned to one of six groups to receive plain milk , fortified milk , plain orange juice , fortified orange juice , supplement or placebo . Both fortified-milk and -juice contained 100 IU of vitamin D and 500 mg of calcium per 200 mL package , whereas supplement contained 200 IU of vitamin D and 500 mg of calcium . The duration of intervention was 12 weeks , from November 2008 to March 2009 . RESULTS A total of 410 children completed the study . Regression analysis with adjustment for both sex and initial values of 25(OH)D revealed that consumption of either supplement , fortified orange juice or fortified milk result ed in a 20.8 nm [ confidence interval ( CI ) = 17.4 - 23.9 ] , 9.9 nm ( CI = 7.4 - 12.3 ) or 6.9 nm ( CI = 3.3 - 10.5 ) increase in circulating 25(OH)D compared to the related control groups . However , changes in serum osteocalcin and intact parathyroid hormone in the supplement group did not differ from those of fortified milk or plain milk . The increment of osteocalcin in both plain milk and fortified milk was more than in fortified orange juice , although the difference was statistically insignificant . CONCLUSIONS Despite having double amount of vitamin D and being more effective in raising serum 25(OH)D , supplementation did not confer additional benefit in terms of osteocalcin and intact parathyroid hormone compared to either fortified or plain milk Introduction and HypothesisCalcium supplementation enhances bone mass accrual during administration , with a sustained benefit observed using milk-based calcium but not calcium salts . We tested the hypothesis that calcium from milk minerals but not calcium carbonate will be sustained after supplementation was discontinued . Methods Ninety-nine pre-pubertal boys and girls aged 5–11 years were followed for 12 months after being r and omized to receive 800 mg/day of calcium from milk minerals ( MM ) or calcium carbonate ( CC ) , or a placebo ( Pla ) in a 10-month double blind study . Total body and regional BMC , and femoral shaft bone dimensions were measured using dual energy x-ray absorptiometry . Group differences were determined using ANCOVA . Results In the intention to treat analysis of the entire sample , no group differences were observed in increments in BMC or bone dimensions during or after supplementation . In those children who remained pre-pubertal , greater gains in pelvis BMC in the milk mineral group than controls were sustained ( 37.9 versus 29.3 % respectively , p<0.02 ) . Conclusion In healthy children consuming about 800 mg calcium daily , calcium supplementation with milk minerals or calcium carbonate does not appear to be produce biologically meaningful benefits to skeletal health . A benefit of calcium supplementation in pre-pubertal was evident , but inconclusive , with the biological significance of the effect of calcium supplementation at the pelvis , and the longevity of this effect to be determined Objective : To compare the short-term effect of a high milk and a high meat intake , identical in protein amount , on bone turnover during prepuberty . Setting : A University Department . Design and Subjects : From 28 , r and omly recruited , 8-year-old boys , first 14 were assigned to the  milk group and next 14 to the  meat group .  In each group , 12 boys finished the dietary intervention . Intervention : Milk ( 1.5 l/day ) and meat ( 250 g/d ) , both containing ∼53 g of protein , were given together with the habitual diet for 7 days . At baseline and day−7 , serum osteocalcin ( s-OC ) , bone-specific alkaline phosphatase ( s-BAP ) and C-terminal telopeptides of type I collagen ( s-CTX ) were measured ( immunoassay ) and dietary intake was estimated ( a 3-day weighted food record ) . Results : Baseline s-OC , s-BAP and s-CTX were not significantly different between the groups . After 7 days , the average protein intake increased in both groups by 47.5 g ; the milk group had higher ( P<0.0001 ) calcium intake ; s-OC and s-CTX decreased ( P⩽0.04 ) in the milk group ( −30.9 % ; −18.7 % , respectively ) compared with the meat group ( + 6.4 % ; −1.0 % , respectively ) and s-BAP decreased ( P=0.06 ) both in the milk ( −3.9 % ) and the meat group ( −7.5 % ) . Conclusions : At the equal protein intake , milk , but not meat , decreased bone turnover in prepubertal boys after 7 days . This effect was probably due to some milk-derived compounds , rather than to the total protein intake . Future studies should eluci date the mechanism(s ) of milk-related decline of bone turnover and its relevance for peak bone mass during growth . Sponsorship : University PhD scholarships A 2-year milk intervention trial was carried out with 757 girls , aged 10 years , from nine primary schools in Beijing ( April 1999 - March 2001 ) . Schools were r and omised into three groups : group 1 , 238 girls consumed a carton of 330 ml milk fortified with Ca on school days over the study period ; group 2 , 260 girls received the same quantity of milk additionally fortified with 5 or 8 microg cholecalciferol ;  group 3 , 259 control girls .  Anthropometric and bone mineralisation measurements , as well as dietary , health and physical-activity data , were collected at baseline and after 12 and 24 months of the trial . Over the 2-year period the consumption of this milk , with or without added cholecalciferol , led to significant increases in the changes in height ( > or = 0.6 % ) , sitting height ( > or = 0.8 % ) , body weight ( > or 2.9 % ) , and ( size-adjusted ) total-body bone mineral content ( > or = 1.2 % ) and bone mineral density ( > or = 3.2 % ) . Those subjects receiving additional cholecalciferol compared with those receiving the milk without added 25-hydoxycholecalciferol had significantly greater increases in the change in ( size-adjusted ) total-body bone mineral content ( 2.4 v. 1.2 % ) and bone mineral density ( 5.5 v. 3.2 % ) . The milk fortified with cholecalciferol significantly improved vitamin D status at the end of the trial compared with the milk alone or control groups . It is concluded that an increase in milk consumption , e.g. by means of school milk programmes , would improve bone growth during adolescence , particularly when Ca intake and vitamin D status are low This study examined the effects of increasing milk on bone and body composition responses to resistance training in adolescents . Twenty-eight boys ( 13 to 17 years of age ) were r and omly assigned to consume , in addition to their habitual diet , 3 servings/day of 1 % fluid milk ( n=14 ) or juice not fortified with calcium ( n=14 ) while engaged in a 12-week resistance-training program . For all subjects combined , there were significant ( P < or=.05 ) changes in height ( + 0.5 % ) , sigmaseven skin folds ( -7.7 % ) , body mass ( + 2.6 % ) , lean body mass ( + 5.1 % ) , fat mass ( -9.3 % ) , whole-body bone mineral content ( + 3.6 % ) , bone mineral density ( + 1.8 % ) , and maximal strength in the squat ( + 43 % ) and bench press ( + 23 % ) . Compared with juice , the milk group had a significantly greater increase in bone mineral density ( 0.014 vs 0.028 g/cm(2 ) ) . Increasing intake of milk in physically active adolescent boys may enhance bone health The Chinese diet is low in calcium ( less than 500 mg/day on average ) , and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture . In this study , we r and omly assigned 200 postmenopausal Chinese women ( age range , 55 - 59 years ) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group . The following are the mean percentage changes ( and SEs ) in height and bone mineral density ( BMD ) over 24 months : for height , -0.1 + /- 0.2 cm in the milk supplementation group and -0.2 + /- 0.1 cm in the control group ; for BMD at the total hip , -0.06 + /- 0.22 % in the milk supplementation group and -0.88 + /- 0.26 % in the control group ; for BMD at the spine ( L1-L4 ) , -0.56 + /- 0.29 % in the milk supplementation group and -1.5 + /- 0.29 % in the control group ; for total body BMD , -0.32 + /- 0.16 % in the milk supplementation group and -1.2 + /- 0.19 % in the control group ( p < 0.05 by analysis of covariance [ ANCOVA ] for repeated measures for height and BMD at all sites ) . The milk supplementation group had less loss in terms of both height and BMD than the control group ( p < 0.05 by ANCOVA for repeated measures ) . Serum parathyroid hormone ( PTH ) concentration was lower and serum 25-hyroxyvitamin D [ 25(OH)D ] level was higher in the milk supplementation group than the control group at 12 months ( p < 0.05 by paired t-test ) . We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss Abstract Objectives : To investigate the effect of milk supplementation on total body bone mineral acquisition in adolescent girls . Design : 18 month , open r and omised intervention trial . Subjects : 82 white girls aged 12.2 ( SD 0.3 ) years , recruited from four secondary schools in Sheffield . Intervention : 568 ml ( one pint ) of whole or reduced fat milk per day for 18 months . Main outcome measures : Total body bone mineral content and bone mineral density measured by dual energy x ray absorptiometry . Outcome measures to evaluate mechanism included biochemical markers of bone turnover ( osteocalcin , bone alkaline phosphatase , deoxypyridinoline , N-telopeptide of type I collagen ) , and hormones important to skeletal growth ( parathyroid hormone , oestradiol , insulin-like growth factor I ) . Results : 80 subjects completed the trial .  Daily milk intake at baseline averaged 150 ml in both groups . The intervention group consumed , on average , an additional 300 ml a day throughout the trial . Compared with the control group , the intervention group had greater increases of bone mineral density ( 9.6 % v 8.5 % , P=0.017 ; repeated measures analysis of variance ) and bone mineral content ( 27.0 % v 24.1 % , P=0.009 ) . No significant differences in increments in height , weight , lean body mass , and fat mass were observed between the groups . Bone turnover was not affected by milk supplementation . Serum concentrations of insulin-like growth factor I increased in the milk group compared with the control group ( 35 % v 25 % , P=0.02 ) . Conclusion : Increased milk consumption significantly enhances bone mineral acquisition in adolescent girls and could favourably modify attainment of peak bone mass . Key messages Osteoporosis is a major public health problem ; 40 % of women will sustain an osteoporotic fracture Maximising peak bone mass at skeletal maturity may be one of the most important protective measures against fracture in later life Adolescence is a critical time for bone mineral acquisition An increase in milk consumption among adolescent girls result ed in significant gains in bone mineral over an 18 month period This simple intervention indicates that increased milk consumption may be associated with higher peak bone OBJECTIVE To study the effect of calcium supplementation with dairy products on the bone and body composition of pubertal girls . DESIGN R and omized control study with 12-month follow-up . SETTING General community . SUBJECTS Forty-eight white girls whose mean age was 11 years and sexual development at Tanner stage 2 . INTERVENTION One group 's diet was supplemented with dairy products to the recommended dietary allowance of 1200 mg calcium daily . The other group ate their usual diet . MAIN OUTCOME MEASURES Bone mineral content and density were measured at the radius , femoral neck , lumbar spine , and total body bone mineral by single-photon and dual-energy x-ray absorptiometry at the start of the study and after 3 , 6 , 9 , and 12 months . Body composition ( lean body mass and body fat ) was measured by dual-energy x-ray absorptiometry at the same intervals . Serum calcium , phosphate , 25-hydroxyvitamin D , 1,25-dihydroxyvitamin D , alkaline phosphatase , magnesium , and albumin concentrations were determined at the start and end of the study . The urinary calcium/creatinine ratio and hydroxyproline concentration were also determined . RESULTS The dairy group had higher intakes of calcium , phosphate , vitamin D , and protein than control subjects . The dairy group had significantly greater increases during the 1-year study in bone mineral density at the lumbar spine bones ( 22.8 % + /- 6.9 % vs 12.9 % + /- 8.3 % ) and in total body bone mineral ( 14.2 % + /- 7.0 % vs 7.6 % + /- 6.0 % ) than control subjects . Dietary calcium , phosphate , vitamin D , and protein intakes were associated with the lumbar bone density and total body bone calcium . There were no differences in serum or urinary biochemical values between the two groups at the start or end of the study . CONCLUSIONS Young girls whose dietary calcium intake was provided primarily by dairy products at or above the recommended dietary allowances had an increased rate of bone mineralization . Increased intake of dairy foods did not increase overall total or saturated fat intake and was not associated with excessive weight gain or increased body fat Summary Background Bone mineral density ( BMD ) is largely genetically determined and this influence is most powerful in the period of rapid skeletal development in childhood and late adolescence but environmental factors such as exercise and dietary calcium intake may influence up to 20 % . Aims of the study The aims of the study were to examine healthy late adolescent females for the effects and benefits of a high calcium intake from dairy product foods on bone mineral density , body composition , lipids and biochemistry . The secondary aim is determine whether a high intake of dairy product foods in the diet is acceptable for this age group long term . Methods Ninety-one teenage girls who participated in a two-year r and omised controlled study on the effect of dairy food supplementation on dietary patterns , body composition and bone density in post-pubertal teenage girls were approached one year after the cessation of the study to determine the effects of the cessation of dairy supplements on bone mineral density , dietary habits , biochemical markers , body composition and blood lipids . Bone mineral density and bone mineral content were assessed at the hip , spine and total body . Anthropometric data were collected , and exercise , Tanner , dietary assessment , preference and compliance question naires were administered . Lipid profiles , hydroxyproline excretion and urinary calcium and sodium excretion measurements were performed . Results There were no significant differences between the 2 groups for height , weight , lean and fat mass . The supplemented group had significantly higher calcium , phosphorus and protein intake during the supplementation period ( p<0.001 ) . No differences were seen between the groups 12 months after supplementation finished . There were no significant differences in exercise level , preference or acceptability of dairy products or in the lipids and bone markers between baseline the end of supplementation and 1 year follow-up . There was a significant increase in trochanter ( 4.6 % ) , lumbar spine ( 1.5 % ) and femoral neck ( 4.8 % ) BMD ( p<0.05 ) in the high calcium group at the end of supplementation . There was an increase in bone mineral content at the trochanter ( p<0.05 ) and lumbar spine ; however the latter was not statistically significant , in the high calcium group at the end of supplementation . There was no difference in vertebral height or width at any stage of the study , indicating no influence on bone size . Conclusions In this 3 year study ( 2 years of supplementation , 1 year follow-up ) , teenage girls , aged 15–18 years , were able to significantly increase their BMD at the trochanter , femoral neck and lumbar spine when supplemented with dairy product foods to a mean calcium intake of 1160 mg/d . There was also an effect seen on the BMC particularly at the trochanter and to a lesser extent at the lumbar spine . The dietary calcium intake achieved did not adversely affect body weight , fat and lean mass or blood lipid profiles . Twelve months after the supplementation finished the girls had returned to their baseline diet , indicating self- selection of a high dairy product diet may be hard to achieve The etiologic role of dietary calcium and vitamin D intake in primary prevention of  osteoporotic fractures is uncertain , despite considerable research efforts . With the aim to examine these associations with an improved precision , we used data from a large population -based prospect i ve cohort study in central Sweden . We estimated nutrient intake from a self-administered food-frequency question naire filled in by 60,689 women , aged 40 - 74 years at baseline during 1987 - 1990 . During follow-up , we observed 3986 women with a fracture at any site and 1535 with a hip fracture .  Rate ratio of fractures ( RR ) and 95 % CI were estimated using Cox proportional hazards models . We found no dose-response association between dietary calcium intake and fracture risk . The age-adjusted RR of hip fracture was 1.01 ( 95 % CI 0.96 - 1.06 ) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 ( 95 % CI 0.96 - 1.03 ) . Furthermore , women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes : RR 1.07 ( 95 % CI 0.92 - 1.24 ) and RR 1.00 ( 95 % CI 0.79 - 1.27 ) , respectively . Vitamin D intake was not associated with fracture risk . Furthermore , women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures ( 95 % CI 0.88 - 1.17 ) . Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women IMPORTANCE Milk consumption during adolescence is recommended to promote peak bone mass and thereby reduce fracture risk in later life . However , its role in hip fracture prevention is not established and high consumption may adversely influence risk by increasing height . OBJECTIVES To determine whether milk consumption during teenage years influences risk of hip fracture in older adults and to investigate the role of attained height in this association . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study over 22 years of follow-up in more than 96,000 white postmenopausal women from the Nurses ' Health Study and men aged 50 years and older from the Health Professionals Follow-up Study in the United States . EXPOSURES Frequency of consumption of milk and other foods during ages 13 to 18 years and attained height were reported at baseline . Current diet , weight , smoking , physical activity , medication use , and other risk factors for hip fractures were reported on biennial question naires . MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to calculate relative risks ( RRs ) of first incidence of hip fracture from low-trauma events per glass ( 8 fl oz or 240 mL ) of milk consumed per day during teenage years . RESULTS During follow-up , 1226 hip fractures were identified in women and 490 in men . After controlling for known risk factors and current milk consumption , each additional glass of milk per day during teenage years was associated with a significant 9 % higher risk of hip fracture in men ( RR = 1.09 ; 95 % CI , 1.01 - 1.17 ) . The association was attenuated when height was added to the model ( RR = 1.06 ; 95 % CI , 0.98 - 1.14 ) . Teenage milk consumption was not associated with hip fractures in women ( RR = 1.00 per glass per day ; 95 % CI , 0.95 - 1.05 ) . CONCLUSIONS AND RELEVANCE Greater milk consumption during teenage years was not associated with a lower risk of hip fracture in older adults . The positive association observed in men was partially mediated through attained height
target: In conclusion , the role of dairy products for BMC or BMD has been sufficiently established in Chinese and Caucasian girls and women .
  In Caucasian women , drinking milk also reduces fracture risk .
background: The relevance of dairy produce for the diminishment of osteoporotic risk is still a matter of scientific debate due to the outcome of a few single observational studies .