title: Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Dietary protein and calcium interact to influence calcium retention: a controlled feeding study. Dietary acid load is associated with lower bone mineral density in men with low intake of dietary calcium. Calcium and vitamin D fortified milk reduces bone turnover and improves bone density in postmenopausal women over 1 year Sex Steroid Hormones and Fracture in a Multiethnic Cohort of Women: The Women’s Health Initiative Study (WHI) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Transgalactooligosaccharides stimulate calcium absorption in postmenopausal women. Oligofructose stimulates calcium absorption in adolescents. A combination of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. Dairy Intake Is Protective against Bone Loss in Older Vitamin D Supplement Users: The Framingham Study. Effects of Daily Intake of Calcium and Vitamin D-Enriched Milk in Healthy Postmenopausal Women: A Randomized, Controlled, Double-Blind Nutritional Study. Effect of calcium fortified milk supplementation with or without vitamin K on biochemical markers of bone turnover in premenopausal women. Inhibition of bone turnover by milk intake in postmenopausal women. A diet high in meat protein and potential renal acid load increases fractional calcium absorption and urinary calcium excretion without affecting markers of bone resorption or formation in postmenopausal women. Body composition and strength changes in women with milk and resistance exercise. Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes. Low urine pH and acid excretion do not predict bone fractures or the loss of bone mineral density: a prospective cohort study Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women Protective association of milk intake on the risk of hip fracture: results from the Framingham Original Cohort. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. Long-term effects of calcium-vitamin-D3-fortified milk on bone geometry and strength in older men. Effects of a Multispecies Probiotic Supplement on Bone Health in Osteopenic Postmenopausal Women: A Randomized, Double-blind, Controlled Trial 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. Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized, placebo-controlled, double-blind, clinical trial. Serial measures of circulating biomarkers of dairy fat and total and cause-specific mortality in older adults: the Cardiovascular Health Study.
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 The effect of meat protein on calcium retention at different calcium intakes is unresolved . OBJECTIVE The objective was to test the effect of dietary protein on calcium retention at low and high intakes of calcium . DESIGN In a r and omized controlled feeding study with a 2 x 2 factorial crossover design , healthy postmenopausal women ( n = 27 ) consumed either approximately 675 or approximately 1510 mg Ca/d , with both low and high protein ( providing 10 % and 20 % energy ) for 7 wk each , separated by a 3-wk washout period . After 3 wk , the entire diet was extrinsically labeled with (47)Ca , and isotope retention was monitored by whole-body scintillation counting . Clinical markers of calcium and bone metabolism were measured . RESULTS High compared with low dietary protein significantly increased calcium retention from the low-calcium ( 29.5 % compared with 26.0 % absorbed ) but not the high-calcium diet ( 18 % absorbed ) . For the low-calcium diet , this effect nearly balanced a protein-related 0.5-mmol/d greater urinary calcium excretion . Protein-related calciuretic effects were independent of dietary calcium . Testing at 1 , 2 , 3 , 5 , and 7 wk showed no long-term adaptation in urinary acidity or urinary calcium excretion . High compared with low dietary protein decreased urinary deoxypyridinoline and increased serum insulin-like growth factor I without affecting parathyroid hormone , osteocalcin , bone-specific alkaline phosphatase , or tartrate-resistant acid phosphatase . CONCLUSIONS In healthy postmenopausal women , a moderate increase in dietary protein , from 10 % to 20 % of energy , slightly improved calcium absorption from a low-calcium diet , nearly compensating for a slight increase in urinary calcium excretion . Under practical dietary conditions , increased dietary protein from animal sources was not detrimental to calcium balance or short-term indicators of bone health High dietary acid load ( DAL ) may be detrimental to bone mineral density ( BMD ) . The objectives of the study were to : ( 1 ) evaluate the cross-sectional relation between DAL and BMD ; and ( 2 ) determine whether calcium intake modifies this association . Men ( n = 1218 ) and women ( n = 907 ) aged ≥60 years were included from the National Health and Nutrition Examination Survey 2005 - 2008 .  Nutrient intake from 2 , 24-hour recalls was used to calculate net endogenous acid production ( NEAP ) and potential renal acid load  ( PRAL ) ( mEq/d ) . PRAL was calculated from dietary calcium ( PRALdiet ) and diet + supplemental calcium ( PRALtotal ) . Tests for linear trend in adjusted mean BMD of the hip and lumbar spine were performed across energy-adjusted NEAP and PRAL quartiles . Modification by calcium intake ( dietary or total ) above or below 800 mg/d was assessed by interaction terms . Overall , mean age was 69 ± 0.3 years . Among women , there was no association between NEAP and BMD  . PRALdiet was positively associated with proximal femur BMD ( p trend = 0.04 ) . No associations were observed with PRALtotal at any BMD site ( p range , 0.38 - 0.82 ) . Among men , no significant associations were observed between BMD and NEAP or PRAL . However , an interaction between PRALdiet and calcium intake was observed with proximal femur BMD ( p = 0.08 ) . An inverse association between PRALdiet and proximal femur BMD was detected among men with < 800 mg/d dietary calcium ( p = 0.02 ) ; no associations were found among men with ≥800 mg/d ( p = 0.98 ) . A significant interaction with PRALtotal was not observed . In conclusion , when supplemental calcium is considered , there is no association between DAL and  BMD among adults . Men with low dietary calcium showed an inverse relation with PRAL at the proximal femur ; in women no interaction was observed . This study highlights the importance of calcium intake in counteracting the adverse effect of DAL on bone health . Further research should determine the relation between DAL and change in BMD with very low calcium intake Purpose In Malaysia , hip fracture incidence is higher in Chinese women than other ethnic groups . This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-inulin versus regular milk over 1 year on aspects of bone health in Chinese postmenopausal women in Malaysia . Methods One-hundred and twenty-one women ( mean age 59 ( ± 4 ) years ) were r and omized into two groups : control ( n = 60 ; regular milk , 428 mg calcium per day ) or intervention ( n = 61 ; fortified milk at 1200 mg calcium , 96 mg magnesium , 2.4 mg zinc , 15 μg vitamin D and 4 g FOS-inulin per day ) . At baseline , weeks 12 , 24 , 36 and 52 , parathyroid hormone ( PTH ) , C-Telopeptide of Type I Collagen ( CTx-1 ) , Procollagen I Intact N-Terminal propeptide ( PINP ) and vitamin D levels were assessed . Bone density ( BMD ) was measured at baseline and week 52 using a GE Lunar iDXA . Results Body mass index , lumbar spine and femoral neck BMD did not differ between groups at baseline . Over 52 weeks , mean plasma 25 ( OH ) D3 levels increased to 74.8 nmol/L ( intervention group ) or remained at 63.1 nmol/L ( control group ) ( p < 0.001 between groups ) . PTH levels increased in the control group ( p = 0.001 ) . The intervention result ed in a significant suppression of CTx-1 and PINP at p = 0.018 and p = 0.004 . Femoral neck BMD remained stable in the intervention group but decreased significantly in the controls , with a borderline treatment effect ( p = 0.07 ) . Conclusion Compared with regular milk , the fortified milk suppressed bone turnover markers and tended to increase femoral neck BMD Context We hypothesize that endogenous sex steroids are associated with fracture risk independent of race/ethnicity . Design and Setting We performed a nested case-control study within the prospect i ve Women 's Health Initiative Observational Study . Incident nonspine fractures were identified in 381 black , 192 Hispanic , 112 Asian , and 46 Native American women over an average of 8.6 years . A r and om sample of 400 white women who experienced an incident fracture was chosen . One control was selected per case and matched on age , race/ethnicity , and blood draw date .  Bioavailable estradiol ( BioE2 ) , bioavailable testosterone ( BioT ) , and sex hormone-binding globulin ( SHBG ) were measured using baseline fasting serum . Conditional logistic regression models calculated the odds ratio ( OR ) and 95 % confidence interval ( CI ) of fracture across tertiles of hormone . Results In multivariable and race/ethnicity-adjusted models , higher BioE2 ( > 8.25 pg/mL ) and higher BioT ( > 13.3 ng/dL ) were associated with decreased risk of fracture ( OR , 0.65 ; 95 % CI , 0.50 to 0.85 ; P trend = 0.001 and OR , 0.76 ; 95 % CI , 0.60 to 0.96 ; P trend = 0.02 , respectively ) . The interaction term between race/ethnicity and either BioE2 or BioT was not significant . There was no association between SHBG and fracture risk . In models stratifying by race/ethnicity , higher BioE2 was associated with a lower risk of fracture in both white women ( OR , 0.56 ; 95 % CI , 0.36 to 0.87 ) and black women ( OR , 0.61 ; 95 % CI , 0.39 to 0.96 ) . Higher BioT was associated with a significantly lower fracture risk in only black women ( OR , 0.65 ; 95 % CI , 0.43 to 1.00 ) , P trend = 0.03 . Conclusions Serum BioE2 and BioT are associated with fracture risk in older women irrespective of race/ethnicity and independent of established risk factors for fracture BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent The aim of this study was to investigate whether a product rich in transgalactooligosaccharides ( TOS , Elix'or ) stimulates true Ca absorption in postmenopausal women . The study was a double-blind , r and omized crossover study , consisting of two 9-d treatment periods separated by a 19-d washout period . During the treatment periods , 12 subjects  drank 200 mL yogurt drink twice ( at breakfast and lunch ) containing either TOS ( 20 g/d ) or the reference substance , sucrose . On d 8 of each treatment period , (44)Ca and (48)Ca were administered orally and intravenously , respectively . Before and during the 36 h after isotope administration , urine was collected and the ratios of isotopes present were measured by inductively coupled plasma mass spectrometry ( ICP-MS ) . From the isotope enrichments , true calcium absorption was calculated . TOS increased true calcium absorption 16 % , from ( mean + /- SD ) 20.6 + /- 7.0 % during the reference treatment to 23.9 + /- 6.9 % during the TOS treatment ( P : = 0.04 , one-sided ) . In conclusion , in this study in postmenopausal women , greater Ca absorption was observed after consumption of a product rich in TOS ( Elix'or ) compared with the reference treatment . This increase in Ca absorption was likely due solely to TOS . The increased Ca absorption was not accompanied by increased urinary Ca excretion , meaning that TOS also may indirectly increase the uptake of Ca by bones and /or inhibit bone resorption BACKGROUND In rats , nondigestible oligosaccharides stimulate calcium absorption . Recently , this effect was also found in human subjects . OBJECTIVE The objective of the study was to investigate whether consumption of 15 g oligofructose/d stimulates calcium absorption in male adolescents . DESIGN Twelve healthy , male adolescents aged 14 - 16 y received , for 9 d , 15 g oligofructose or sucrose ( control treatment ) daily over 3 main meals . The treatments were given according to a r and omized , double-blind , crossover design , separated by a 19-d washout period . On the 8th day of each treatment period , 44Ca was given orally with a st and ard breakfast containing approximately 200 mg Ca . Within half an hour after administration of 44Ca , 48Ca was administered intravenously . Fractional calcium absorption was computed from the enrichment of 44Ca:43Ca and 48Ca:43Ca in 36-h urine sample s , which was measured by inductively coupled plasma mass spectrometry . RESULTS An increase in true fractional calcium absorption ( % ) was found after consumption of oligofructose ( mean difference + /- SE of difference : 10.8+/-5.6 ; P < 0.05 , one sided ) . The results are discussed in relation to the methods used . CONCLUSION Fifteen grams of oligofructose per day stimulates fractional calcium absorption in male adolescents BACKGROUND Short-term studies in adolescents have generally shown an enhancement of calcium absorption by inulin-type fructans ( prebiotics ) . Results have been inconsistent ; however , and no studies have been conducted to determine whether this effect persists with long-term use . OBJECTIVE The objective was to assess the effects on calcium absorption and bone mineral accretion after 8 wk and 1 y of supplementation with an inulin-type fructan . DESIGN Pubertal adolescents were r and omly assigned to receive 8 g/d of a mixed short and long degree of polymerization inulin-type fructan product ( fructan group ) or maltodextrin placebo ( control group ) .  Bone mineral content and bone mineral density were measured before r and omization and after 1 y. Calcium absorption was measured with the use of stable isotopes at baseline and 8 wk and 1 y after supplementation . Polymorphisms of the Fok1 vitamin D receptor gene were determined . RESULTS Calcium absorption was significantly greater in the fructan group than in the control group at 8 wk ( difference : 8.5 + /- 1.6 % ; P < 0.001 ) and at 1 y ( difference : 5.9 + /- 2.8 % ; P = 0.04 ) . An interaction with Fok1 genotype was present such that subjects with an ff genotype had the least initial response to fructan . After 1 y , the fructan group had a greater increment in both whole-body bone mineral content ( difference : 35 + /- 16 g ; P = 0.03 ) and whole-body bone mineral density ( difference : 0.015 + /- 0.004 g/cm(2 ) ; P = 0.01 ) than did the control group . CONCLUSION Daily consumption of a combination of prebiotic short- and long-chain inulin-type fructans significantly increases calcium absorption and enhances bone mineralization during pubertal growth . Effects of dietary factors on calcium absorption may be modulated by genetic factors , including specific vitamin D receptor gene polymorphisms Background : Previous studies showed beneficial effects of specific dairy foods on bone health in middle-aged adults . Objective : We examined the association of milk , yogurt , cheese , cream , fluid dairy ( milk + yogurt ) , and milk + yogurt + cheese intakes with bone mineral density ( BMD ) and 4-y percentage of change in BMD [ ▵ % BMD ; femoral neck , trochanter , and lumbar spine ( LS ) ] . We further assessed whether these associations were modified by vitamin D supplement use in this cohort of older adults . Methods : Food-frequency question naire responses , baseline BMD ( hip and spine , n = 862 in 1988 - 1989 ) , and follow-up BMD ( n = 628 in 1992 - 1993 ) were measured in the Framingham study , a prospect i ve cohort study of older Caucasian men and women aged 67 - 93 y. Outcomes included baseline BMD and ▵ % BMD . Dairy-food intakes ( servings per week ) were converted to energy-adjusted residuals , and linear regression was used , adjusting for covariates . These associations were further examined by vitamin D supplement use . Results : The mean age of the participants was 75 y. In the full sample , dairy-food items were not associated with BMD ( P = 0.11 - 0.99 ) or with ▵ % BMD ( P = 0.29 - 0.96 ) . Among vitamin D supplement users , but not among nonusers , higher milk , fluid dairy , and milk + yogurt + cheese intakes were associated with higher LS BMD ( P = 0.011 - 0.009 ) . Among vitamin D supplement users , but not among nonusers , higher milk + yogurt + cheese intakes were protective against trochanter BMD loss ( P = 0.009 ) . Conclusions : In this population of older adults , higher intakes of milk , fluid dairy , and milk + yogurt + cheese were associated with higher LS BMD , and a higher intake of milk + yogurt + cheese was protective against trochanter BMD loss among vitamin D supplement users but not among nonusers . These findings underscore that the benefits of dairy intake on the skeleton may be dependent on vitamin D intake OBJECTIVE To determine the effect of the daily intake of calcium and vitamin D-enriched milk ( with or without fructooligosaccharides [ FOS ] ) on vitamin D , bone metabolism , and cardiovascular risk factors . MATERIAL S AND METHODS Two-year r and omized controlled study , including 500 healthy postmenopausal women , assigned to 500 mL/day of skimmed milk to one of three groups : Low-dose ( L ) : ( 120 mg/100 mL calcium , vitamin D3 30 UI/100 mL ) , group A : calcium and vitamin D ( 180 mg/100 mL and 120 UI/100 mL ) , and group B : calcium and vitamin D ( 180 mg/100 mL and 120 UI/100 mL ) and FOS ( 5 g/L ) . We evaluated serum 25(OH)D , bone mineral density ( BMD ) by Dual Energy X-ray Absorptiometry , and biochemical data of glucose and lipid metabolism . RESULTS After 24 months , vitamin D concentrations did not change in the control group , but increased in group A and group B , p < 0.001 . We observed an increase in femoral neck BMD and an improvement in fasting plasma glucose , HbA1c , total cholesterol , low-density lipoprotein cholesterol , and apolipoprotein B 100 . CONCLUSIONS Daily intake of milk enriched with calcium and vitamin D in postmenopausal healthy women induces a significant improvement in vitamin D status , a significant increase in BMD at femoral neck , and also favorable effects on glucose and lipid profile OBJECTIVE We compared the effect of supplementation with a fortified skimmed milk product ( high calcium skim milk ) with or without added phylloquinone ( vitamin K(1 ) ) on markers of bone formation and resorption in premenopausal women . METHODS Eighty-two women 20 to 35 y of age were r and omly allocated to three groups . Two groups received two daily servings of high calcium skim milk ( 1000 mg/d of extra calcium ) with or without added phylloquinone ( 80 microg/d ) for 16 wk , and a third control group received no supplementation .  Bone density was assessed at baseline and the bone markers , total osteocalcin , type I N-terminal procollagen peptide , and cross-linked C-telopeptide of type I collagen were measured at baseline and at weeks 2 , 12 , and 16 . Serum phylloquinone and undercarboxylated osteocalcin were measured in the control and vitamin K-supplemented groups at weeks 0 and 16 . RESULTS Baseline values for age , body mass index , and bone density did not differ across groups . In vitamin K-supplemented women , mean serum phylloquinone concentrations increased from 0.27 to 0.76 microg/L ( P < 0.05 ) and undercarboxylated osteocalcin concentrations decreased from 9.68 to 4.46 microg/L ( P < 0.05 ) over 16 wk . Plasma cross-linked C-telopeptide of type I collagen , total osteocalcin , and type I N-terminal procollagen peptide levels decreased significantly in both supplemented groups compared with the control group over 16 wk ( cross-linked C-telopeptide of type I collagen > 30 % , total osteocalcin and type I N-terminal procollagen peptide > 15 % ) . CONCLUSION Fortified milk supplementation  in premenopausal women reduced bone turnover significantly . Phylloquinone fortification substantially improved vitamin K status but had no demonstrable additive effect on bone turnover in this short-term study Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk . In the absence of osteoporosis , risk preventive measures , particularly those modifying nutritional lifestyle , are appropriate . We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that , in the long term , may be expected to reduce  postmenopausal bone loss .  Thirty healthy postmenopausal women aged 59.3 ( SD 3.3 ) years were enrolled in a prospect i ve crossover trial of 16 weeks . After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk , participants were maintained during 6 weeks under the same 600 mg calcium diet and r and omized to receive either 500 ml semi-skimmed milk , thus providing a total of 1200 mg calcium , or no milk supplement . In the next 6 weeks they were switched to the alternative regimen . At the end of the each period , i.e. after 4 , 10 and 16 weeks , blood and urinary sample s were collected . The changes in blood variables between the periods of 6 weeks without and with milk supplementation were : for parathyroid hormone , -3.2 pg/ml ( P=0.0054 ) ; for crosslinked telopeptide of type I collagen , -624 pg/ml ( P<0.0001 ) ; for propeptide of type I procollagen , -5.5 ng/ml ( P=0.0092 ) ; for osteocalcin , -2.8 ng/ml ( P=0.0014 ) . In conclusion , a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion . This nutritional approach to postmenopausal alteration in bone metabolism may be a valuable measure in the primary prevention of osteoporosis Our objective in this study was to determine the effects of a high-protein and high-potential renal acid load ( PRAL ) diet on calcium ( Ca ) absorption and retention and markers of bone metabolism . In a r and omized crossover design , 16 postmenopausal women consumed 2 diets : 1 with low protein and low PRAL ( LPLP ; total protein : 61 g/d ; PRAL : -48 mEq/d ) and 1 with high protein and high PRAL ( HPHP ; total protein : 118 g/d ; PRAL : 33 mEq/d ) for 7 wk each separated by a 1-wk break . Ca absorption was measured by whole body scintillation counting of radio-labeled (47)Ca . Compared with the LPLP diet , the HPHP diet increased participants ' serum IGF-I concentrations ( P < 0.0001 ) , decreased serum intact PTH concentrations ( P < 0.001 ) , and increased fractional (47)Ca absorption ( mean ± pooled SD : 22.3 vs. 26.5 ± 5.4 % ; P < 0.05 ) and urinary Ca excretion ( 156 vs. 203 ± 63 mg/d ; P = 0.005 ) . The net difference between the amount of Ca absorbed and excreted in urine did not differ between 2 diet periods ( 55 vs. 28 ± 51 mg/d ) . The dietary treatments did not affect other markers of bone metabolism . In summary , a diet high in protein and PRAL  increases the fractional absorption of dietary Ca , which partially compensates for increased urinary Ca , in postmenopausal women . The increased IGF-I and decreased PTH concentrations in serum , with no change in biomarkers of bone resorption or formation , indicate a high-protein diet has no adverse effects on bone health PURPOSE We aim ed to determine whether women consuming fat-free milk versus isoenergetic carbohydrate after resistance exercise  would see augmented gains in lean mass and reductions in fat mass similar to what we observed in young men . METHODS Young women were r and omized to drink either fat-free milk ( MILK : n = 10 ; age ( mean + /- SD ) = 23.2 + /- 2.8 yr ; BMI = 26.2 + /- 4.2 kg x m(-2 ) ) or isoenergetic carbohydrate  ( CON : n = 10 ; age = 22.4 + /- 2.4 yr ; BMI = 25.2 + /- 3.8 kg x m(-2 ) ) immediately after and 1 h after exercise ( 2 x 500 mL ) . Subjects exercised 5 d x wk(-1 ) for 12 wk . Body composition changes were measured by dual-energy x-ray absorptiometry , and subjects ' strength and fasting blood were measured before and after training . RESULTS CON gained weight after training ( CON : + 0.86 + /- 0.4 kg , P < 0.05 ; MILK : + 0.50 + /- 0.4 kg , P = 0.29 ) . Lean mass increased with training in both groups ( P < 0.01 ) , with a greater net gain in MILK versus CON ( 1.9 + /- 0.2 vs 1.1 + /- 0.2 kg , respectively , P < 0.01 ) . Fat mass decreased with training in MILK only ( -1.6 + /- 0.4 kg , P < 0.01 ; CON : -0.3 + /- 0.3 kg , P = 0.41 ) . Isotonic strength increased more in MILK than CON ( P < 0.05 ) for some exercises . Serum 25-hydroxyvitamin D increased in both groups but to a greater extent in MILK than CON ( + 6.5 + /- 1.1 vs + 2.8 + /- 1.3 nM , respectively , P < 0.05 ) , and parathyroid hormone decreased only in MILK ( -1.2 + /- 0.2 pM , P < 0.01 ) . CONCLUSIONS Heavy , whole-body resistance exercise with the consumption of milk versus carbohydrate in the early postexercise period result ed in greater muscle mass accretion , strength gains , fat mass loss , and a possible reduction in bone turnover in women after 12 wk . Our results , similar to those in men , highlight that milk is an effective drink to support favorable body composition changes in women with resistance training Non-digestible oligosaccharides such as inulin and oligofructose have been shown to consistently increase calcium absorption in experimental animals , but data in humans are less clear-cut . The objective of this study was to assess the effect of 8 g/d of oligofructose or a mixture of inulin and oligofructose on calcium absorption in girls at or near menarche . A total of fifty-nine subjects were studied using a balanced , r and omized , cross-over design . They received , in r and om order , 8 g/d placebo ( sucrose ) , oligofructose or the mixture inulin+oligofructose for 3 weeks , separated by a 2-week washout period . Throughout the study , subjects consumed a total of approximately 1500 mg/d dietary calcium , by adding two glasses of calcium-fortified orange juice to their diet . Four grams of placebo , oligofructose or the mixture inulin+oligofructose was added to each glass of orange juice immediately before it was consumed . At the end of each 3-week adaptation period , calcium absorption was measured , using a dual stable isotope technique , from the cumulative fractional excretion of an oral and an intravenous tracer over 48 hours . Calcium absorption was significantly higher in the group receiving the inulin+oligofructose mixture than in the placebo group v. P=0.01 ) , but no significant difference was seen between the oligofructose group and the placebo group v. P = NS ) . We conclude that modest intakes of an inulin+oligofructose mixture increases calcium absorption in girls at or near menarche Background The acid-ash hypothesis , the alkaline diet , and related products are marketed to the general public . Websites , lay literature , and direct mail marketing encourage people to measure their urine pH to assess their health status and their risk of osteoporosis . The objectives of this study were to determine whether 1 ) low urine pH , or 2 ) acid excretion in urine [ sulfate + chloride + 1.8x phosphate + organic acids ] minus [ sodium + potassium + 2x calcium + 2x magnesium mEq ] in fasting morning urine predict : a ) fragility fractures ; and b ) five-year change of bone mineral density ( BMD ) in adults . Methods Design : Cohort study : the prospect i ve population -based Canadian Multicentre Osteoporosis Study .  Multiple logistic regression was used to examine associations between acid excretion ( urine pH and urine acid excretion ) in fasting morning with the incidence of fractures ( 6804 person years ) . Multiple linear regression was used to examine associations between acid excretion with changes in BMD over 5-years at three sites : lumbar spine , femoral neck , and total hip ( n = 651 ) . Potential confounders controlled included : age , gender , family history of osteoporosis , physical activity , smoking , calcium intake , vitamin D status , estrogen status , medications , renal function , urine creatinine , body mass index , and change of body mass index . Results There were no associations between either urine pH or acid excretion and either the incidence of fractures or change of BMD after adjustment for confounders . Conclusion Urine pH and urine acid excretion do not predict osteoporosis risk Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) Summary A longitudinal analysis of bone microstructure in postmenopausal women of the Geneva Retirees Cohort indicates that age-related cortical bone loss is attenuated at non-bearing bone sites in fermented dairy products consumers , not in milk or ripened cheese consumers , independently of total energy , calcium , or protein intakes . Introduction Fermented dairy products ( FDP ) , including yogurts , provide calcium , phosphorus , and proteins together with prebiotics and probiotics , all being potentially beneficial for bone . In this prospect i ve cohort study , we investigated whether FDP , milk , or ripened cheese consumptions influence age-related changes of bone mineral density ( BMD ) and microstructure . Methods Dietary intakes were assessed at baseline and after 3.0 ± 0.5 years with a food frequency question naire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort . Cortical ( Ct ) and trabecular ( Tb ) volumetric ( v ) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography , in addition to areal ( a ) BMD and body composition by dual-energy X-ray absorptiometry , at the same time points . Results At baseline , FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia . Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption . In the longitudinal analysis , FDP consumption ( mean of the two assessment s ) was associated with attenuated loss of radius total vBMD and of Ct vBMD , area , and thickness . There was no difference in aBMD and at the tibia . These associations were independent of total energy , calcium , or protein intakes . For other dairy products categories , only milk consumption was associated with lower decrease of aBMD and of failure load at the radius . Conclusion In this prospect i ve cohort of healthy postmenopausal women , age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers , not in milk or ripened cheese consumers , independently of total energy , calcium , or protein intakes . Study registration IS RCT N11865958 ( http://www.is rct n.com 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 Although high-protein diets induce hypercalciuria in humans , the source of the additional urinary calcium remains unclear . One hypothesis is that the high endogenous acid load of a high-protein diet is partially buffered by bone , leading to increased skeletal resorption and hypercalciuria . We used dual stable calcium isotopes to quantify the effect of a high-protein diet on calcium kinetics in women . The study consisted of 2 wk of a lead-in , well-balanced diet followed by 10 d of an experimental diet containing either moderate ( 1.0 g/kg ) or high ( 2.1 g/kg ) protein .  Thirteen healthy women received both levels of protein in r and om order . Intestinal calcium absorption increased during the high-protein diet in comparison with the moderate ( 26.2 + /- 1.9 % vs. 18.5 + /- 1.6 % , P < 0.0001 , mean + /- sem ) as did urinary calcium ( 5.23 + /- 0.37 vs. 3.57 + /- 0.35 mmol/d , P < 0.0001 , mean + /- sem ) . The high-protein diet caused a significant reduction in the fraction of urinary calcium of bone origin and a nonsignificant trend toward a reduction in the rate of bone turnover . There were no protein-induced effects on net bone balance . These data directly demonstrate that , at least in the short term , high-protein diets are not detrimental to bone The long-term effects of calcium and vitamin D supplementation on bone material and structural properties in older men are not known . The aim of this study was to examine the effects of high calcium ( 1000 mg/day)- and vitamin-D(3 ) ( 800 IU/day)-fortified milk on cortical and trabecular volumetric BMD ( vBMD ) and bone geometry at the axial and appendicular skeleton in men aged over 50 years . One hundred and eleven men who were part of a larger 2-year r and omized controlled trial had QCT scans  of the mid-femur and lumbar spine ( L(1)-L(3 ) ) to assess vBMD , bone geometry and indices of bone strength [ polar moment of inertia ( I(polar ) ) ] . After 2 years , there were no significant differences between the milk supplementation and control group for the change in any mid-femur or L(1)-L(3 ) bone parameters for all men aged over 50 years . However , the mid-femur skeletal responses to the fortified milk varied according to age , with a split of < or=62 versus > 62 years being the most significant for discriminating the changes between the two groups . Subsequent analysis revealed that , in the older men ( > 62 years ) , the expansion in mid-femur medullary area was 2.8 % ( P < 0.01 ) less in the milk supplementation compared to control group , which helped to preserve cortical area in the milk supplementation group ( between group difference 1.1 % , P < 0.01 ) . Similarly , for mid-femur cortical vBMD and I(polar ) , the net loss was 2.3 and 2.8 % less in the milk supplementation compared to control group ( P < 0.01 and < 0.001 , respectively ) . In conclusion , calcium-vitamin-D(3)-fortified milk may represent an effective strategy to maintain bone strength by preventing endocortical bone loss and slowing the loss in cortical vBMD in elderly men ABSTRACT Objective : The development of alternative approaches to prevent and /or treat osteoporosis , as a chronic progressive bone disease , is being considered currently . Among dietary supplements , probiotics may have favorable effects on bone metabolism . Therefore , the aim of this study was to evaluate the effects of a multispecies probiotic supplementation on bone biomarkers and bone density in osteopenic postmenopausal women . Methods : This r and omized double-blind placebo-controlled clinical trial was performed on 50 patients with osteopenia aged 50–72 years . Participants were r and omly assigned to take either a multispecies probiotic supplement ( GeriLact ; n = 25 ) or placebo ( n = 25 ) for 6 months . GeriLact contains 7 probiotic bacteria species . Participants received 500 mg Ca plus 200 IU vitamin D  daily . Bone mineral density ( BMD ) of lumbar spine and total hip and blood biomarkers including bone-specific alkaline phosphatase ( BALP ) , osteocalcin ( OC ) , collagen type 1 cross-linked C-telopeptide ( CTX ) , deoxypyridinoline ( DPD ) , parathyroid hormone ( PTH ) , 25-OH vitamin D , and serum pro-inflammatory cytokines ( tumor necrosis factor [TNF]-α and interleukin [IL]-1β ) were assessed at baseline and at the end of the study . Results : The multispecies probiotic significantly decreased BALP ( p = 0.03 ) and CTX ( p = 0.04 ) levels in comparison with the control group but had no effect on BMD of the spine and total hip . Moreover , there was a statistically significant decrease in serum PTH ( p = 0.01 ) and TNF-α ( p = 0.02 ) in the intervention group compared to the placebo group . Conclusions : These results may suggest the favorable effects of the multispecies probiotic supplementation for 6 months on bone health in postmenopausal women due to slowing down the rate of bone turnover 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 BACKGROUND The importance of the gut microbiome for bone metabolism in mice has recently been demonstrated , but no studies are available in humans . Lactobacillus reuteri ATCCPTA 6475 ( L. reuteri 6475 ) has been reported to increase bone mineral density ( BMD ) in mice but its effect on the human skeleton is unknown . The objective of this trial was to investigate if L. reuteri 6475 affects bone loss in older women with low BMD . METHODS In this double-blind , placebo-controlled study , women from the population who were 75 to 80 years old and had low BMD were r and omized to orally receive 1010 colony-forming units of L. reuteri 6475 daily or placebo . The predefined primary end-point was relative change after 12 months in tibia total volumetric BMD ( vBMD ) . RESULTS Ninety women were included and 70 completed the study .  L. reuteri 6475 reduced loss of total vBMD compared to placebo both in the intention-to-treat ( ITT ) analysis [ -0.83 % ( 95 % confidence interval [ CI ] , -1.47 to -0.19 % ) vs. -1.85 % ( 95 % CI , -2.64 to -1.07 % ) ; mean difference 1.02 % ( 95 % CI , 0.02 - 2.03 ) ] and per protocol analysis [ -0.93 % ( 95 % CI , -1.45 to -0.40 ) vs. -1.86 % ( 95 % CI , -2.35 to -1.36 ) ; mean difference 0.93 % ( 95 % CI , 0.21 - 1.65 ) ] . In general , similar but smaller effects were observed in the secondary bone variable outcomes , but these differences did not reach statistical significance in the ITT population . Adverse events did not differ between groups . CONCLUSIONS Supplementation with L. reuteri 6475 should be further explored as a novel approach to prevent age-associated bone loss and osteoporosis Background Controversy has emerged about the benefits compared with harms of dairy fat , including concerns over long-term effects . Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline , which may lead to suboptimal estimation of true risk . Objective The aim of this study was to investigate prospect i ve associations of serial measures of plasma phospholipid fatty acids pentadecanoic ( 15:0 ) , heptadecanoic ( 17:0 ) , and trans-palmitoleic ( trans-16:1n-7 ) acids with total mortality , cause-specific mortality  , and cardiovascular disease ( CVD ) risk among older adults . Design Among 2907 US adults aged ≥65 y and free of CVD at baseline , circulating fatty acid concentrations were measured serially at baseline , 6 y , and 13 y. Deaths and CVD events were assessed and adjudicated central ly . Prospect i ve associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates . Results During 22 y of follow-up , 2428 deaths occurred , including 833 from CVD , 1595 from non-CVD causes , and 1301 incident CVD events . In multivariable models , circulating pentadecanoic , heptadecanoic , and trans-palmitoleic acids were not significantly associated with total mortality , with extreme-quintile HRs of 1.05 for pentadecanoic ( 95 % CI : 0.91 , 1.22 ) , 1.07 for heptadecanoic ( 95 % CI : 0.93 , 1.23 ) , and 1.05 for trans-palmitoleic ( 95 % CI : 0.91 , 1.20 ) acids . Circulating heptadecanoic acid was associated with lower CVD mortality ( extreme-quintile HR : 0.77 ; 95 % CI : 0.61 , 0.98 ) , especially stroke mortality , with a 42 % lower risk when comparing extreme quintiles of heptadecanoic acid concentrations ( HR : 0.58 ; 95 % CI : 0.35 , 0.97 ) . In contrast , heptadecanoic acid was associated with a higher risk of non-CVD mortality ( HR : 1.27 ; 95 % CI : 1.07 , 1.52 ) , which was not clearly related to any single subtype of non-CVD death . No significant associations of pentadecanoic , heptadecanoic , or trans-palmitoleic acids were seen for total incident CVD , coronary heart disease , or stroke . Conclusions Long-term exposure to circulating phospholipid pentadecanoic , heptadecanoic , or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults . High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death
target: In the present meta- analysis , reductions in the risk of hip fracture  with milk consumption were only observed among American adults , but not among Sc and inavian adults , possibly because milk products are more commonly fortified with vitamin D in the former population than in Sc and inavian countries .
  The reduction in the risk of hip fracture was also observed with yogurt consumption , which is often associated with healthy lifestyles and dietary patterns that contribute to improved bone health .
  Fueling this uncertainty , the elevated  risk of hip fracture  in association with  milk consumption was observed in a cohort of Swedish women .
  The cumulative evidence from prospect i ve cohort studies reassuringly suggests that the risk of hip fracture may not be elevated among people who consume milk , yogurt , and cheese , and that a greater consumption of milk or yogurt may even be associated with a lower risk of hip fracture depending on the factors that may differ across the population of interest
background: Although dairy products contain bone-beneficial nutrients , the association between dairy consumption and the risk of hip fracture remains equivocal .