Protective association of milk intake on the risk of hip fracture: results from the Framingham Original Cohort. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Milk consumption during teenage years and risk of hip fractures in older adults. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. Dairy intakes affect bone density in the elderly. Nutrition influences skeletal development from childhood to adulthood: a study of hip, spine, and forearm in adolescent females. Diet and hip fractures among elderly Europeans in the EPIC cohort DIETARY CALCIUM AND RISK OF HIP FRACTURE: 14-YEAR PROSPECTIVE POPULATION STUDY Protein consumption and bone fractures in women. Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Adherence to a vegetable-fruit-soy dietary pattern or the Alternative Healthy Eating Index is associated with lower hip fracture risk among Singapore Chinese. Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study Dietary calcium and hip fracture risk: The NHANES I Epidemiologic Follow-Up Study Dairy products, calcium, and prostate cancer risk in the Physicians' Health Study. Dairy Intake Is Protective against Bone Loss in Older Vitamin D Supplement Users: The Framingham Study.
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 OBJECTIVES This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of  osteoporotic fractures .  METHODS This was a 12-year prospect i ve study among 77761 women , aged 34 through 59 years in 1980 , who had never used calcium supplements .  Dietary intake was assessed with a food-frequency question naire in 1980 , 1984 , and 1986 . Fractures of the proximal femur ( n = 133 ) and distal radius ( n = 1046 ) from low or moderate trauma were self-reported on biennial question naires . RESULTS We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence . Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture ( 95 % confidence interval [ CI ] = 0.87 , 2.43 ) and 1.05 for forearm fracture ( 95 % CI = 0.88 , 1.25 ) when compared with women consuming one glass or less per week . Likewise , higher intakes of total  dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture . CONCLUSIONS These data do not support the hypothesis that higher consumption of milk or other food sources of calcium  by adult women protects against hip or forearm fractures 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 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 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 OBJECTIVE To identify nutrients , foods , and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners . DESIGN AND SETTING Two-year , prospect i ve cohort study . Observational data were collected in the course of a multicenter r and omized trial of the effect of oral contraceptives on bone health . PARTICIPANTS One hundred and twenty-five female competitive distance runners ages 18 - 26 years . ASSESSMENT OF RISK FACTORS Dietary variables were assessed with a food frequency question naire . MAIN OUTCOME MEASUREMENTS Bone mineral density and content ( BMD/ BMC ) of the spine , hip , and total body were measured annually by dual x-ray absorptiometry ( DEXA ) .  Stress fractures were recorded on monthly calendars , and had to be confirmed by radiograph , bone scan , or magnetic resonance imaging . RESULTS Seventeen participants had at least one stress fracture during follow-up . Higher intakes of calcium , skim milk , and dairy products were associated with lower rates of stress fracture . Each additional cup of skim milk consumed per day was associated with a 62 % reduction in stress fracture incidence ( P < .05 ) ; and a dietary pattern of high dairy and low fat intake was associated with a 68 % reduction ( P < .05 ) . Higher intakes of skim milk , dairy foods , calcium , animal protein , and potassium were associated with significant ( P < .05 ) gains in whole-body BMD and BMC . Higher intakes of calcium , vitamin D , skim milk , dairy foods , potassium , and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD . CONCLUSIONS In young female runners , low-fat dairy products and the major nutrients in milk ( calcium , vitamin D , and protein ) were associated with greater bone gains and a lower stress fracture rate . Potassium intake was also associated with greater gains in hip and whole-body BMD BACKGROUND Race and sex differences in the effect of diet on bone mineral density ( BMD ) at the hip in the elderly are unknown . OBJECTIVES This study related cross-sectional nutrient and dairy product consumption to hip BMD in white and black men and women aged > 60 y and evaluated the influence of nutrient and dairy product consumption on changes in BMD in a white cohort participating in a calcium , vitamin D , or placebo trial . DESIGN The Health Habits and History Question naire was used in 289 white women and 116 white men who participated in the trial and in 265 black women and 75 black men to predict total hip and femoral neck BMD or  changes in BMD . RESULTS Blacks had higher calcium intakes than did whites ( 700 and 654 mg/d , respectively ; P = 0.0094 ) , and men had higher calcium intakes than did women ( 735 and 655 mg/d , respectively ; P = 0.0007 ) . For men , the correlation between total hip BMD and dairy calcium intake after adjustment for age , race , and weight was 0.23 ( P < 0.005 ) ; this relation was not significant in women ( r = 0.02 , P = 0.12 ) . Similar results were found for femoral neck BMD . In the longitudinal study , calcium supplementation reduced bone loss from the total hip and femoral neck in those who consumed < 1.5 servings of dairy products/d and were < 72 y old . CONCLUSIONS Cross-sectional results indicated that higher dairy product consumption is associated with greater hip BMD in men , but not in women . Calcium supplementation protected both men and women from bone loss in the longitudinal study of whites This study evaluated the long-term efficacy of supplemental calcium and dairy products on bone mineral areal density of the hip and spine and on the bone geometry and volumetric bone mineral density of the forearm in young females during late adolescence . The study was conducted among participants of a r and omized double-blinded , placebo-controlled clinical trial with calcium supplements and among participants of an observational study with higher consumption of dairy products .  Hip and spine measurements by dual-energy X-ray absorptiometry were done every 6 mo ( dairy group every 12 mo ) during last 3 y of the follow-up while peripheral quantitative computerized tomography of the forearm was done at the last visit . The results of the study show a positive influence of calcium supplementation and dairy products on bone mineral density of the hip and the forearm . Dairy products were also associated with a higher bone mineral density of the spine while calcium supplementation did not have an effect . Calcium exerts its action on bone accretion during growth primarily by influencing volumetric bone mineral density while milk may have an additional impact on bone growth and periosteal bone expansion 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 Prospect i ve 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 vali date d dietary question naires . 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 prospect i ve 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 To assess the effect of dietary calcium intake on risk of hip fracture  , a geographically defined caucasian population in southern California was studied prospect ively . Between 1973 and 1975 , a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline . Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures . The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density ( mg per 1000 kcal ) . No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium . The association between  calcium  and fracture persisted after adjustment for cigarette smoking , alcohol intake , exercise , and obesity . The significant independent inverse association of  dietary calcium  with subsequent risk of hip fracture ( relative risk = 0.6 per 198 mg/1000 kcal ) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture Dietary protein increases urinary calcium losses and has been associated with higher rates of hip fracture in cross-cultural studies . However , the relation between protein and risk of  osteoporotic bone fractures among individuals has not been examined in detail . In this prospect i ve study , usual dietary intake was measured in 1980 in a cohort of 85,900 women , aged 35 - 59 years , who were participants in the Nurses ' Health Study . A mailed food frequency question naire was used and incident hip ( n = 234 ) and distal forearm ( n = 1,628 ) fractures were identified by self-report during the following 12 years . Information on other factors related to osteoporosis , including obesity , use of postmenopausal estrogen , smoking , and physical activity , was collected on biennial question naires . Dietary measures were up date d in 1984 and 1986 . Protein was associated with an increased risk of forearm fracture ( relative risk ( RR ) = 1.22 , 95 % confidence interval ( Cl ) 1.04 - 1.43 , p for trend = 0.01 ) for women who consumed more than 95 g per day compared with those who consumed less than 68 g per day . A similar increase in risk was observed for animal protein , but no association was found for consumption of vegetable protein . Women who consumed five or more servings of red meat per week also had a significantly increased risk of forearm fracture ( RR = 1.23 , 95 % Cl 1.01 - 1.50 ) compared with women who ate red meat less than once per week . Recall of teenage diet did not reveal any increased risk of forearm fracture for women with higher consumption of animal protein or red meat during this earlier period of life . No association was observed between  adult protein intake  and the incidence of hip fractures , though power to assess this association was low Although there is some epidemiologic evidence that soy may reduce risk of osteoporotic fracture in women , it is not known whether this risk reduction also occurs for men . The authors examined gender-specific associations between soy intake and hip fracture risk in the Singapore Chinese Health Study , a prospect i ve cohort of 63,257 Chinese living in Singapore . At recruitment between 1993 and 1998 , each subject was administered a food frequency question naire and questions on medical history and lifestyle factors . As of December 31 , 2006 , 276 incident cases of hip fracture in men and 692 cases in women were identified via linkage with hospital discharge data bases . For both genders , hip fracture risk was positively associated with cigarette smoking and was inversely associated with body mass index . There was a statistically significant association of tofu equivalents , soy protein , and isoflavones with hip fracture risk among women but not among men . Compared with women in the lowest quartile of intakes for tofu equivalents ( < 49.4 g/day ) , soy protein ( < 2.7 g/day ) , and isoflavones ( < 5.8 mg/1,000 kcal/day ) , those in the second-fourth quartiles exhibited 21%-36 % reductions in risk ( all P < 0.036 ) . Risk levels were comparable across the second , third , and fourth quartiles of soy intake categories Data on overall  dietary pattern  and osteoporotic fracture risk from population -based cohorts are limited , especially from Asian population s. This study examined the relation between overall diet and hip fracture risk by using principal components analysis ( PCA ) to identify dietary pattern specific to the study population and by using the Alternative Healthy Eating Index ( AHEI ) 2010 to assess dietary quality . The Singapore Chinese Health Study is a prospect i ve population -based cohort that enrolled 63,257 Chinese men and women ( including both pre- and postmenopausal women ) aged 45 - 74 y between 1993 and 1998 in Singapore . Habitual diet was assessed by using a vali date d food-frequency question naire . Two dietary patterns , the vegetable-fruit-soy ( VFS ) pattern and the meat-dim-sum ( MDS ) pattern , were derived by PCA . Overall dietary quality was assessed according to the AHEI 2010 , which was defined a priori for chronic disease prevention . A Cox regression model was applied with adjustment for potential confounders . In both genders , higher scores for the VFS pattern and the AHEI 2010 were associated with lower risk of hip fracture in a dose-dependent manner ( all P-trend ≤ 0.008 ) . Compared with the lowest quintile , participants in the highest quintile had a 34 % reduction in risk ( HR : 0.66 ; 95 % CI : 0.55 , 0.78 ) for the VFS pattern and a 32 % reduction in risk ( HR : 0.68 ; 95 % CI : 0.58 , 0.79 ) for the AHEI 2010 . The MDS pattern score was not associated with hip fracture risk . An Asian diet rich in plant-based foods , namely vegetables , fruit , and legumes such as soy , may reduce the risk of hip fracture Summary Association between dietary protein and fracture risk is unclear . We examined association between energy-adjusted protein intake  and  hip fracture risk in elders . The risk of hip fracture was reduced in upper quartiles of protein intake when compared with lowest quartile . Introduction Studies of the association between dietary protein intake and hip fracture risk are conflicting . Therefore , we examined protein intake and hip fracture risk in a population -based group of elderly men and women . Methods Five hundred seventy-six women and 370 men from the Framingham Osteoporosis Study with no previous history of hip fracture completed Food Frequency Question naires .  Energy-adjusted protein intake  was evaluated as a continuous variable and as quartiles . Incidence rates and hazard ratios were calculated , adjusting for age , BMI , sex , and energy intake . Results Among 946 participants ( mean age 75 years ) , mean protein intake  was found to be 68 gm/d . Increased protein intake was associated with a decreased risk of hip fracture compared to those in the lowest quartile of protein intake ( Q2 HR = 0.70 , Q3 HR = 0.56 , and Q4 HR = 0.63 ; all p values ≥ 0.044 ) , p for trend was 0.07 . When a threshold effect was considered ( Q2–4 vs Q1 ) , intakes in the higher quartiles combined were associated with a significantly lower risk for hip fracture ( HR = 0.63 ; p = 0.04 ) . Conclusion Our results are consistent with reduced risk of hip fracture with higher dietary protein intake . Larger prospect i ve studies are needed to confirm and extend this finding in elderly men and women The effect of dietary calcium on  hip fracture risk was examined prospect ively using the NHANES I Epidemiologic Follow-Up Study cohort , which is derived from a nationally representative sample of the United States population . A cohort of 4342 white men and postmenopausal women ages 50–74 years at baseline ( 1971–1975 ) were observed through 1987 for up to 16 years of follow-up . Quantitative estimates of calcium intake were obtained at baseline from a 24-h recall , while weekly frequency of dairy food consumption was obtained from a qualitative food frequency . By 1987 , 44 men and 122 women had experienced a hip fracture according to hospital records or death certificates . In the total sample of women the risk of hip fracture was only slightly lower for the highest quartile compared with the lowest . However , although not statistically significant , the age-adjusted risk of hip fracture was approximately 50 % lower in the highest quartile of calcium intake compared with the lowest quartile in the subgroup of women who were at least 6 years postmenopausal and not taking postmenopausal hormone . The low relative risk observed among men , although interesting , must be interpreted cautiously due to small sample size . Adjusting for other risk factors did not appreciably change the results for either sex . The pattern of relative risks for calcium quartiles and by selected cutpoints was not consistent with a dose-response effect of calcium . Our results suggest that calcium may lower hip fracture risk in late menopausal women BACKGROUND A high calcium intake , mainly from dairy products , may increase prostate cancer risk by lowering concentrations of 1,25-dihydroxyvitamin D(3 ) [ 1,25(OH)(2)D(3 ) ] , a hormone thought to protect against prostate cancer . The results of epidemiologic studies of this hypothesis are inconclusive . OBJECTIVE We investigated the association between dairy product and calcium intakes and prostate cancer risk in the Physicians ' Health Study , a cohort of male US physicians . DESIGN At baseline , the men answered abbreviated dietary question naires . During 11 y of follow-up , we documented 1012 incident cases of prostate cancer among 20885 men . We estimated dairy calcium intake on the basis of consumption of 5 major dairy products and used logistic regression to estimate relative risk . RESULTS At baseline , men who consumed > 600 mg Ca/d from skim milk had lower plasma 1,25(OH)(2)D(3 ) concentrations than did those consuming < or = 150 mg Ca/d [ 71 compared with 85 pmol/L ( 30.06 compared with 35.64 pg/mL ) ; P = 0.005 ] . Compared with men consuming < or = 0.5 daily servings of dairy products , those consuming > 2.5 servings had a multivariate relative risk of prostate cancer of 1.34 ( 95 % CI : 1.04 , 1.71 ) after adjustment for baseline age , body mass index , smoking , exercise , and r and omized treatment assignment in the original placebo-controlled trial . Compared with men consuming < or = 150 mg Ca/d from dairy products , men consuming > 600 mg/d had a 32 % higher risk of prostate cancer ( 95 % CI : 1.08 , 1.63 ) . CONCLUSIONS These results support the hypothesis that dairy products and calcium are associated with a greater risk of prostate cancer 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
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
Although dairy products contain bone-beneficial nutrients , the association between dairy consumption and the risk of hip fracture remains equivocal .