The Likely Importance of Specific Dairy Foods in Relation to Bone Health: Current Knowledge and Future Challenges

  • Shivani SahniEmail author
  • Douglas P. Kiel
  • Marian T. Hannan


Osteoporosis is a major public health problem affecting over 200 million people worldwide. The 2010 dietary guidelines for Americans recommend consuming 3 cups/day of fat-free or low-fat dairy products for adults. Although individual nutrients usually found in dairy products may be beneficial for bone health, few studies have directly compared specific types of dairy foods. Yet it has been suggested that dairy foods are not equivalent vehicles of calcium due to their different nutrient profile. While studies of milk intake and bone mineral density (BMD) are plentiful and mostly positive, the evidence for hip fracture risk reduction remains weak. Studies on yogurt intake and bone health have been very few but promising though the role of probiotics in yogurt on bone is unclear. It is unclear how other dairy foods may relate to bone health. Few studies that have examined cheese intake have focused either on intake of total cheese or a specific low-fat variety. High-fat/high-sugar dairy foods like cream and ice cream have low nutrient density and are widely consumed, yet very little is known about their impact on the skeleton. The additive and synergistic role of sodium and saturated fats along with other bone-specific nutrients (e.g., calcium, vitamin D, phosphorus, protein) in cream and cheese is complicated and needs further clarification. Future studies should (i) aim to resolve the disparate findings from BMD studies versus fracture studies on milk intake, (ii) clarify the role of probiotics in calcium absorption and bone health, (iii) focus on the skeletal effects of low-fat cheese and the influence of sodium content of the different cheeses, and (iv) focus on dairy food products instead of single nutrients within dairy while at the same time considering nutrient profiles of specific dairy foods. Overall, the studies that are highlighted in this chapter suggest a significant role for dairy intake in maintaining bone health.


Dairy Milk Yogurt Cheese Cream Bone mineral density Hip ­fracture Dietary intake Bone health 


Potential Conflict of Interest/Disclosure

Dr. Shivani Sahni has grants from General Mills Bell Institute of Health and Nutrition.


  1. 1.
    Cooper C, Campion G, Melton 3rd LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285–9.PubMedCrossRefGoogle Scholar
  2. 2.
    U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans. 7th ed. Washington, D.C.: U.S. Government Printing Office; December 2010.Google Scholar
  3. 3.
    Heaney RP. Dairy and bone health. J Am Coll Nutr. 2009;28 Suppl 1:82S–90. 28/Supplement_1/82S [pii].PubMedGoogle Scholar
  4. 4.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary guidelines for Americans. Dietary Guidelines Advisory Committee Report, 6th edn. Washington, D.C.: U.S. Government; 2005.Google Scholar
  5. 5.
    Sahni S, Tucker KL, Kiel DP, Quach L, Casey VA, Hannan MT. Total dairy intake and milk consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study. Arch Osteoporos. 2013;8:119. doi: 10.1007/s11657-013-0119-2 Google Scholar
  6. 6.
    Teegarden D, Legowski P, Gunther CW, McCabe GP, Peacock M, Lyle RM. Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. J Clin Endocrinol Metab. 2005;90(9):5127–33. doi: 10.1210/jc.2004-0924. jc.2004-0924 [pii].PubMedCrossRefGoogle Scholar
  7. 7.
    Baran D, Sorensen A, Grimes J, Lew R, Karellas A, Johnson B, Roche J. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. J Clin Endocrinol Metab. 1990;70(1):264–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337(10):670–6. doi: 10.1056/NEJM199709043371003.PubMedCrossRefGoogle Scholar
  9. 9.
    Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP. Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res. 2000;15(12):2504–12. doi: 10.1359/jbmr.2000.15.12.2504.PubMedCrossRefGoogle Scholar
  10. 10.
    Sahni S, Cupples LA, McLean RR, Tucker KL, Broe KE, Kiel DP, Hannan MT. Protective effect of high protein and calcium intake on the risk of hip fracture in the Framingham offspring cohort. J Bone Miner Res. 2010;25(12):2770–6. doi: 10.1002/jbmr.194.PubMedCrossRefGoogle Scholar
  11. 11.
    Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727–36.PubMedGoogle Scholar
  12. 12.
    Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr. 1995;62(4):740–5.PubMedGoogle Scholar
  13. 13.
    Weinsier RL, Krumdieck CL. Dairy foods and bone health: examination of the evidence. Am J Clin Nutr. 2000;72(3):681–9.PubMedGoogle Scholar
  14. 14.
    Unal G, El SN, Kilic S. In vitro determination of calcium bioavailability of milk, dairy products and infant formulas. Int J Food Sci Nutr. 2005;56(1):13–22. doi: 10.1080/09637480500081423. RR54364580742841 [pii].PubMedCrossRefGoogle Scholar
  15. 15.
    Murphy S, Khaw KT, May H, Compston JE. Milk consumption and bone mineral density in middle aged and elderly women. BMJ. 1994;308(6934):939–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Kull M, Kallikorm R, Lember M. Impact of molecularly defined hypolactasia, self-perceived milk intolerance and milk consumption on bone mineral density in a population sample in Northern Europe. Scand J Gastroenterol. 2009;44(4):415–21. doi: 10.1080/00365520802588117. 906066060 [pii].PubMedCrossRefGoogle Scholar
  17. 17.
    McCabe LD, Martin BR, McCabe GP, Johnston CC, Weaver CM, Peacock M. Dairy intakes affect bone density in the elderly. Am J Clin Nutr. 2004;80(4):1066–74. 80/4/1066 [pii].PubMedGoogle Scholar
  18. 18.
    Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutr. 2003;77(1):257–65.PubMedGoogle Scholar
  19. 19.
    Teegarden D, Lyle RM, Proulx WR, Johnston CC, Weaver CM. Previous milk consumption is associated with greater bone density in young women. Am J Clin Nutr. 1999;69(5):1014–7.PubMedGoogle Scholar
  20. 20.
    Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis JA, Orav EJ, Staehelin HB, Kiel DP, Burckhardt P, Henschkowski J, Spiegelman D, Li R, Wong JB, Feskanich D, Willett WC. Milk intake and risk of hip fracture in men and women: a meta-analysis of ­prospective cohort studies. J Bone Miner Res. 2011;26(4):833–9. doi: 10.1002/jbmr.279.PubMedCrossRefGoogle Scholar
  21. 21.
    Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr. 2003;77(2):504–11.PubMedGoogle Scholar
  22. 22.
    Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Public Health. 1997;87(6):992–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Soroko S, Holbrook TL, Edelstein S, Barrett-Connor E. Lifetime milk consumption and bone mineral ­density in older women. Am J Public Health. 1994;84(8):1319–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Daly RM, Petrass N, Bass S, Nowson CA. The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18-mo follow-up study. Am J Clin Nutr. 2008;87(3):771–7. 87/3/771 [pii].PubMedGoogle Scholar
  25. 25.
    Heaney RP, McCarron DA, Dawson-Hughes B, Oparil S, Berga SL, Stern JS, Barr SI, Rosen CJ. Dietary changes favorably affect bone remodeling in older adults. J Am Diet Assoc. 1999;99(10):1228–33. doi: 10.1016/S0002-8223(99)00302-8. S0002-8223(99)00302-8 [pii].PubMedCrossRefGoogle Scholar
  26. 26.
    Bonjour JP, Brandolini-Bunlon M, Boirie Y, Morel-Laporte F, Braesco V, Bertiere MC, Souberbielle JC. Inhibition of bone turnover by milk intake in ­postmenopausal women. Br J Nutr. 2008;100(4):866–74. doi: 10.1017/S0007114508937429. S0007114508937429 [pii].PubMedCrossRefGoogle Scholar
  27. 27.
    Cleghorn DB, O’Loughlin PD, Schroeder BJ, Nordin BE. An open, crossover trial of calcium-fortified milk in prevention of early postmenopausal bone loss. Med J Aust. 2001;175(5):242–5.PubMedGoogle Scholar
  28. 28.
    Kruger MC, Ha PC, Todd JM, Kuhn-Sherlock B, Schollum LM, Ma J, Qin G, Lau E. High-calcium, vitamin D fortified milk is effective in improving bone turnover markers and vitamin D status in healthy postmenopausal Chinese women. Eur J Clin Nutr. 2012;66(7):856–61. doi: 10.1038/ejcn.2012.54. ejcn201254 [pii].PubMedCrossRefGoogle Scholar
  29. 29.
    Chee WS, Suriah AR, Chan SP, Zaitun Y, Chan YM. The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia. Osteoporos Int. 2003;14(10):828–34. doi: 10.1007/s00198-003-1448-6.PubMedCrossRefGoogle Scholar
  30. 30.
    Heaney RP, Rafferty K, Dowell MS. Effect of yogurt on a urinary marker of bone resorption in postmenopausal women. J Am Diet Assoc. 2002;102(11):1672–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Bonjour JP, Benoit V, Pourchaire O, Ferry M, Rousseau B, Souberbielle JC. Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women. Br J Nutr. 2009;102(7):962–6. doi: 10.1017/S0007114509371743. S0007114509371743 [pii].PubMedCrossRefGoogle Scholar
  32. 32.
    Bonjour JP, Benoit V, Rousseau B, Souberbielle JC. Consumption of vitamin D-and calcium-fortified soft white cheese lowers the biochemical marker of bone resorption TRAP 5b in postmenopausal women at moderate risk of osteoporosis fracture. J Nutr. 2012;142(4):698–703. doi: 10.3945/jn.111.153692. jn.111.153692 [pii].PubMedCrossRefGoogle Scholar
  33. 33.
    Bonjour JP, Benoit V, Pourchaire O, Rousseau B, Souberbielle JC. Nutritional approach for inhibiting bone resorption in institutionalized elderly women with vitamin D insufficiency and high prevalence of fracture. J Nutr Health Aging. 2011;15(5):404–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Fox PF, O’Connor TP, McSweeney PL, Guinee TP, O’Brien NM. Cheese: physical, biochemical, and nutritional aspects. Adv Food Nutr Res. 1996;39:163–328.PubMedCrossRefGoogle Scholar
  35. 35.
    Ferrar L, van der Hee RM, Berry M, Watson C, Miret S, Wilkinson J, Bradburn M, Eastell R. Effects of calcium-fortified ice cream on markers of bone health. Osteoporos Int. 2011;22(10):2721–31. doi: 10.1007/s00198-010-1513-x.PubMedCrossRefGoogle Scholar
  36. 36.
    Aoe S, Koyama T, Toba Y, Itabashi A, Takada Y. A controlled trial of the effect of milk basic protein (MBP) supplementation on bone metabolism in healthy menopausal women. Osteoporos Int. 2005;16(12):2123–8. doi: 10.1007/s00198-005-2012-3.PubMedCrossRefGoogle Scholar
  37. 37.
    Aoe S, Toba Y, Yamamura J, Kawakami H, Yahiro M, Kumegawa M, Itabashi A, Takada Y. Controlled trial of the effects of milk basic protein (MBP) supplementation on bone metabolism in healthy adult women. Biosci Biotechnol Biochem. 2001;65(4):913–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Shivani Sahni
    • 1
    Email author
  • Douglas P. Kiel
    • 1
  • Marian T. Hannan
    • 1
  1. 1.Musculoskeletal ResearchInstitute for Aging Research, Hebrew SeniorLife and Harvard Medical SchoolBostonUSA

Personalised recommendations