Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women

Feskanich, Diane; Willett, Walter C.; Colditz, Graham A.

doi:10.1093/ajcn/77.2.504

Cited by 287 publications

(198 citation statements)

References 53 publications

(67 reference statements)

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“…This finding is consistent with those of other investigations (Suzuki et al, 1997;Feskanich et al, 2003) even though, null associations have also been reported (Appleby et al, 2007). Fish (especially dark meat fish) constitute good sources of calcium (especially when edible bones are consumed) and vitamin D. Moreover, they are rich in o-3 fatty acids.…”

Section: Discussionsupporting

confidence: 93%

“…Nevertheless, the association between calcium intake from usual diet, mainly in the form of dairy products, and fracture risk among middle aged and elderly populations remains inconclusive (Weinsier and Krumdieck, 2000;Prentice, 2004). Observational epidemiological studies have shown that in countries with average mean calcium intakes, no association between calcium intake and hip fracture risk is apparent in older men and women (Kato et al, 2000;Weinsier and Krumdieck, 2000;Feskanich et al, 2003;WHO, 2003;Bischoff-Ferrari et al, 2007), whereas in populations with low mean calcium intakes, an increased risk of hip fractures with declining calcium intake (below around 400-500 mg of calcium/day) has been reported. On the other hand, the beneficial effect of combined calcium and vitamin D supplementation for fracture prevention in the frail elderly population is considered as documented and constitutes a recommended intervention against bone loss (Kannus et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

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Diet and hip fractures among elderly Europeans in the EPIC cohort

et al. 2010

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Background/Objectives: Evidence on the role of diet during adulthood and beyond on fracture occurrence is limited. We investigated diet and hip fracture incidence in a population of elderly Europeans, participants in the European Prospective Investigation into Cancer and nutrition study. Subjects/Methods: 29 122 volunteers (10 538 men, 18 584 women) aged 60 years and above (mean age: 64.3) from five countries were followed up for a median of 8 years and 275 incident hip fractures (222 women and 53 men) were recorded. Diet was assessed at baseline through validated dietary questionnaires. Data were analyzed through Cox proportional-hazards regression with adjustment for potential confounders. Results: No food group or nutrient was significantly associated with hip fracture occurrence. There were suggestive inverse associations, however, with vegetable consumption (hazard ratio (HR) per increasing sex-specific quintile: 0.93, 95% confidence interval (CI): 0.85-1.01), fish consumption (HR per increasing sex-specific quintile: 0.93, 95% CI: 0.85-1.02) and polyunsaturated lipid intake (HR per increasing sex-specific quintile: 0.92, 95% CI: 0.82-1.02), whereas saturated lipid intake was positively associated with hip fracture risk (HR per increasing sex-specific quintile: 1.13, 95% CI: 0.99-1.29). Consumption of dairy products did not appear to influence the risk (HR per increasing sex-specific quintile: 1.02, 95% CI: 0.93-1.12). Conclusions: In a prospective study of the elderly, diet, including consumption of dairy products, alcohol and vitamin D, did not appear to play a major role in hip fracture incidence. There is however, weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial, whereas saturated lipid intake a detrimental effect.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Diet and hip fractures among elderly Europeans in the EPIC cohort

et al. 2010

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“…Consistent with this idea, in the Nurses' Health Study, the exclusion of women with a history of diagnosed osteoporosis did not appreciably affect the association between milk intake and fracture risk. (29) Further, in data provided by Feskanich and colleagues for the Nurses' Health Study, milk accounted for 54% of dairy calcium intake, although this may be lower in some European countries where cheese is a stronger contributor to dairy calcium intake. (30)(31)(32) However, a lower dairy intake from milk in Europe would not have affected the results of this meta-analysis provided that milk intake is a relevant predictor of hip fracture risk overall.…”

Section: Discussionmentioning

confidence: 99%

“…Mean follow-up varied between 3 and 26 years. Three studies were from the United States, (10,22,23) two from Scandinavia, (24,25) one from Japan, (26) and one multicenter pooled project from 11 cohorts around the world (Europe, Australia, and Canada). (27) Primary analyses Figure 2A shows the Forest plots for the RR of hip fracture for a 1 glass increment of total daily milk intake among women.…”

Section: Methodsmentioning

confidence: 99%

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Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies

Bischoff‐Ferrari

Dawson‐Hughes

Baron

et al. 2010

Journal of Bone and Mineral Research

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123

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Milk contains calcium, phosphorus, and protein and is fortified with vitamin D in the United States. All these ingredients may improve bone health. However, the potential benefit of milk on hip fracture prevention is not well established. The objective of this study was to assess the association of milk intake with risk of hip fracture based on a meta-analysis of cohort studies in middle-aged or older men and women. Data sources for this study were English and non-English publications via Medline (Ovid, PubMed) and EMBASE search up to June 2010, experts in the field, and reference lists. The idea was to compare prospective cohort studies on the same scale so that we could calculate the relative risk (RR) of hip fracture per glass of milk intake daily (approximately 300 mg calcium per glass of milk). Pooled analyses were based on random effects models. The data were extracted by two independent observers. The results show that in women (6 studies, 195,102 women, 3574 hip fractures), there was no overall association between total milk intake and hip fracture risk (pooled RR per glass of milk per day ¼ 0.99; 95% confidence interval [CI] 0.96-1.02; Q-test p ¼ .37). In men (3 studies, 75,149 men, 195 hip fractures), the pooled RR per daily glass of milk was 0.91 (95% CI 0.81-1.01). Our conclusion is that in our meta-analysis of cohort studies, there was no overall association between milk intake and hip fracture risk in women but that more data are needed in men. ß

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Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

Sotos-Prieto,

Rodriguez-Artalejo,

Fung

et al. 2024

JAMA Netw Open

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ImportancePrevious research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods.ObjectiveTo examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses’ Health Study.Design, Setting, and ParticipantsThis cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses’ Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023.Main outcomes and MeasuresHip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture.ResultsIn total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend).Conclusions and RelevanceFindings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.

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Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women

Cited by 287 publications

References 53 publications

Diet and hip fractures among elderly Europeans in the EPIC cohort

Diet and hip fractures among elderly Europeans in the EPIC cohort

Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies

Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

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