Impact of whole dairy matrix on musculoskeletal health and aging–current knowledge and research gaps

  • N.R.W. GeikerEmail author
  • C. Mølgaard
  • S. Iuliano
  • R. Rizzoli
  • Y. Manios
  • L.J.C. van Loon
  • J.-M. Lecerf
  • G. Moschonis
  • J.-Y. Reginster
  • I. Givens
  • A. Astrup
Consensus Statement


Dairy products are included in dietary guidelines worldwide, as milk, yoghurt, and cheese are good sources of calcium and protein, vital nutrients for bones and muscle mass maintenance. Bone growth and mineralization occur during infancy and childhood, peak bone mass being attained after early adulthood. A low peak bone mass has consequences later in life, including increased risk of osteoporosis and fractures. Currently, more than 200 million people worldwide suffer from osteoporosis, with approximately 9 million fractures yearly. This poses a tremendous economic burden on health care. Between 5% and 10% of the elderly suffer from sarcopenia, the loss of muscle mass and strength, further increasing the risk of fractures due to falls. Evidence from interventional and observational studies support that fermented dairy products in particular exert beneficial effects on bone growth and mineralization, attenuation of bone loss, and reduce fracture risk. The effect cannot be explained by single nutrients in dairy, which suggests that a combined or matrix effect may be responsible similar to the matrix effects of foods on cardiometabolic health. Recently, several plant-based beverages and products have become available and marketed as substitutes for dairy products, even though their nutrient content differs substantially from dairy. Some of these products have been fortified, in efforts to mimic the nutritional profile of milk, but it is unknown whether the additives have the same bioavailability and beneficial effect as dairy. We conclude that the dairy matrix exerts an effect on bone and muscle health that is more than the sum of its nutrients, and we suggest that whole foods, not only single nutrients, need to be assessed in future observational and intervention studies of health outcomes. Furthermore, the importance of the matrix effect on health outcomes argues in favor of making future dietary guidelines food based.


Bone Cheese Fermented dairy products Milk Muscle 



Bone mineral density


Bone mineral content




Calcium-to-phosphorus ratio


Coronary heart disease


Confidence interval


Cardiovascular disease


Fibroblast growth factor


High-density lipoprotein


Insulin-like growth factor-1




Low-density lipoprotein


Milk fat globule


Milk fat globule membrane


Monounsaturated fatty acids


Not assessed


Peak bone mass




Randomized controlled trials


Retinol equivalent


Relative risk


Short-chain fatty acids


Saturated fat


Saturated fatty acids


Trans fatty acids




Tumor necrosis factor-alpha


Ultra-high temperature processing



A.A. arranged the workshop and invited the participating scientists. N.R.W.G. drafted the manuscript based on summaries and presentations delivered by the participants of the workshop. All authors made contributions to a number of draft versions, and all approved the final manuscript. A.A. is the guarantor of the manuscript.

Compliance with ethical standards

Disclosure of financial conflicts of interest

The meeting of the Working Group was funded by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), a Belgian not-for-profit organization and held in Geneva, Switzerland on June 18, 2019. The Working Group was entirely funded by the ESCEO. The ESCEO receives Unrestricted Educational Grants, to support its educational and scientific activities, from non-governmental organizations, not-for-profit organizations, and non-commercial and corporate partners. The choice of topics, participants, content, and agenda of the Working Groups as well as the writing, editing, submission, and publication processes of the manuscript are under the sole responsibility of the ESCEO, without any influence from third parties.

N.R.W.G. has received salary from ESCEO for acting as a rapporteur during the workshop and for preparing the manuscript. N.R.W.G. has received research funding from Danish Dairy Research Foundation.

C.M. has received research funding from Danish Dairy Research Foundation, ARLA Food, ARLA Food for Health, and Chr. Hansen.

Y.M. and G.M. have received research funding from Friesland Foods Hellas and FrieslandCampina BV.

L.J.C.v.L. has received research grants, consulting fees, speaking honoraria, or a combination of these, from FrieslandCampina, Nutricia, and PepsiCo.

J.-M.L. and Nutrition Department of Institut Pasteur de Lille collaborates with Lactalis, Syndifrais, Candia, and CNIEL (Centre National Interprofessionnel de l’Economie Laitière). J.-M.L. is member of the Scientific Advisory Board of Institut Olga Triballat, ENSA (European Natural Soyfoods Association), OCHA (Observatoire CNIEL des Habitudes Alimentaires), FICT (Fédération Interprofessionnelle des Charcutiers Traiteurs), and APRIFEL (Agence des Fruits et Légumes frais).

I.G. has received dairy and health research funding from UK BBSRC (Biotechnology and Biological Sciences Research Council), UK MRC (Medical Research Council), GB Dairy Council, UK Agriculture and Horticulture Development Board Dairy (AHDB Dairy), The Dutch Dairy Association, The Global Dairy Platform, The Barham Foundation Trust, and various companies. Is or recently has been a member of UK Food Standards Agency Advisory Committee; Scientific Panel Estonian Biocompetance Centre of Healthy Dairy Products (BioCC); Consultant to the GB Dairy Council on Fats in Dairy Products and Cardiometabolic Disease.

A.A. receives payment as Associate Editor of The American Journal of Clinical Nutrition and as a member of the Editorial Committee of Annual Review of Nutrition.

A.A. is advisor to or a member of advisory boards for a number of food and pharmaceutical producers: BioCare Copenhagen, DK; Dutch Beer Institute, NL; Gelesis, USA; Groupe Éthique et Santé, France; McCain Foods Limited, USA; Novo Nordisk, DK; Ritual, USA; Saniona, DK; Weight Watchers, USA.

A.A.’s recent research at the University of Copenhagen, Denmark, has received funding via unrestricted grants from or contracts with Danish Dairy Foundation, Global Dairy Platform, European Milk Forum, and Gelesis AS, USA.

A.A. is recipient of honoraria as speaker for a wide range of Danish and international concerns and receives royalties from textbooks, and from popular diet and cookery books.

A.A. is co-inventor of a number of patents, including Methods of inducing weight loss, treating obesity and preventing weight gain (licensee Gelesis, USA) and Biomarkers for predicting degree of weight loss (licensee Nestec SA, CH), owned by the University of Copenhagen, in accordance with Danish law.

A.A. is co-founder and co-owner of the University of Copenhagen spin-out companies Mobile Fitness A/S, Personalized Weight Management Research Consortium ApS (, and Flaxslim ApS, where he is also member of the board.

A.A. is not advocate or activist for specific diets, and is not strongly committed to any specific diet, e.g.. veganism, Atkins diet, gluten-free diet, high animal protein diet, or dietary supplements.

The remaining authors reported no conflicts of interest related to the present work.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksberg CDenmark
  2. 2.Department of EndocrinologyUniversity of Melbourne, Austin HealthMelbourneAustralia
  3. 3.Division of Bone DiseasesGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  4. 4.Department of Nutrition & DieteticsHarokopio UniversityAthensGreece
  5. 5.NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human BiologyMaastricht University Medical Centre+Maastrichtthe Netherlands
  6. 6.Department of Nutrition and Physical ActivityInstitut Pasteur de LilleLilleFrance
  7. 7.Department of Dietetics, Nutrition and SportLa Trobe UniversityMelbourneAustralia
  8. 8.World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and AgingUniversity of LiègeLiègeBelgium
  9. 9.Institute for Food, Nutrition and HealthUniversity of ReadingReadingUnited Kingdom

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