Dairy Intake and Fracture Risk in Older Women: A 25-Year Longitudinal Study

With aging populations worldwide, fractures have become a major contributor to pain, loss of independence, decreased quality of life, and premature death in older adults. Research on preventative strategies, namely those related to diet, has therefore been of growing interest. While dairy products are well recognized for their nutrient density and contribution to bone health, studies have not captured a consistent reduction in fracture incidence, highlighting the complexity of studying fracture outcomes in older adults. 

In light of this, a 25-year longitudinal study of 14,220 older Finnish women (baseline mean age of 52.3 years) examined the association between dairy intake, separately considering cheese and liquid dairy (milk, sour milk, and yogurt), and bone-related health outcomes.¹ Data on lifestyle habits and fracture history were collected every five years from 1989 to 2019. The analyses controlled for factors such as body mass index (BMI), alcohol use, physical activity, age, calcium or vitamin D supplementation, and the use of medications known to impact bone. 

Over the study period, 4,358 women experienced fractures, of which 2,326 (53%) were classified as osteoporotic and 427 (10%) were hip fractures; the remaining fractures (approx. 40%) were considered non-osteoporotic. Among participants, 6.5% did not consume liquid dairy, 45.7% consumed moderate amounts (≤400 ml/day), and 47.8% consumed high amounts (>400 ml/day). For cheese, 9.4% reported no intake, 46.2% consumed moderate amounts (≤3 slices/day), and 44.4% consumed high amounts (>3 slices/day). Notably, cheese intake tended to be higher among those with lower liquid dairy consumption. 

Survival analyses showed that women who did not consume liquid dairy had a higher risk of both total fractures and osteoporotic fractures compared with moderate or high consumers. 

• Moderate dairy intake was associated with a 23% lower risk of total fractures and a 31% lower risk of osteoporotic fractures. 

• High dairy intake was linked to 26% and 36% lower risks of total and osteoporotic fractures, respectively. 

When analyzed as a continuous variable, higher liquid dairy intake was linked to reduced rates of both types of fractures. These associations were not observed for cheese.  

While no association was detected between liquid dairy intake and hip fractures, cheese intake was linked to a reduced risk of hip fracture.  

• Women who consumed high amounts of cheese had a 38% lower risk of hip fracture compared to non-consumers. 

When cheese intake was analyzed as a continuous variable, the association remained significant, indicating a consistent trend across varying intake levels. 

In their discussion, the authors consider the broader body of evidence on dairy intake and fracture risk, describing it as generally neutral to beneficial. They note that findings from large cohort studies and randomized controlled trials have often linked higher dairy intake with reduced fracture risk. Examples include: 

• A cohort study of postmenopausal Japanese women, in which each additional cup of milk per day was associated with a 4% lower risk of fracture;² 

• A 24-year prospective study of 103,003 women that found higher dairy intake was associated with a lower risk of osteoporotic fractures;³ 

• A two-year randomized controlled trial in adults living in long-term care facilities, where providing additional dairy servings led to a 33% reduction in overall fracture risk.⁴ 

They further note that the lack of updated data on dairy intake and verified fractures may explain why some studies found no association. 

The authors also emphasize that certain bone types, particularly those rich in trabecular tissue like the spine, may be more responsive to dietary calcium. Finally, they explain that dairy products differ in their nutritional and physiological properties, and should not be treated as a single category. For example, cheese contains less D-galactose and provides additional components such as probiotics, prebiotics, and vitamin K, as well as a distinct calcium-to-protein ratio and sodium profile. 

This study has a few limitations to consider, including self-reported data and a homogeneous sample.  

Overall, this study reinforces the contributions of dairy foods on fracture risk by providing valuable long-term data collected at multiple points over 25 years.