Osteoporosis Prevention - Improving Bone Health in Adults

What is osteoporosis? 

Osteoporosis is a metabolic bone disease characterized by reduced bone mass and deterioration of bone structure, resulting from progressive bone loss over time.^1,2 As bones become weaker and thinner, fracture risk increases, particularly at the hip, wrist, spine and shoulder.² Often referred to as the “silent thief”, it affects about 2.3 million Canadians and is a major contributor to fractures, disabilities and mortality risk.² Beyond physical consequences, osteoporosis can impact quality of life, often leading to psychological consequences, such as social isolation, anxiety and depression.¹ 

Although osteoporosis can occur at any age, in Canada, it is more commonly seen among those over 50 years old.² In fact, according to a report from the Public Health Agency of Canada, the likelihood of an osteoporosis diagnosis doubles every 5 years between the ages of 40 and 60.¹ It is estimated that nearly 1 in 3 women and 1 in 5 men will experience fractures caused by osteoporosis, also known as “fragility fractures”.² Menopausal women, particularly those over the age of 50, are at higher risk, with fragility fractures accounting for 80% of all fractures in this population.²  

Bone Health and Fracture Risk: The Evidence

The role of diet in osteoporosis prevention has been recognized by various health organizations around the world, with adequate calcium intake being a key component.^3-6  In fact, the updated 2023 Canadian guidelines for osteoporosis and fracture prevention recommend maintaining a healthy, balanced diet that provides adequate amounts of protein and meets calcium requirements to support optimal bone health.⁷ In addition to calcium and protein, the beneficial role of vitamin D in the development and maintenance of bone health is also well known, and low intakes of these 3 nutrients can be a risk factor.^3,4,8-10 In Canada, dairy products provide readily available calcium and high-quality protein as well as vitamin D in fortified products (such as milk, as well as some yogurts and kefirs).^3,4,11  

Building upon these insights, the following is a brief overview of key findings from some recent available evidence. 

Key Primary Studies: Trials and Cohort Studies 

In a 2025 study of 14,000 older Finnish women with a 25-year follow-up period, high liquid dairy intake was associated with 26% and 36% lower risks of total and osteoporotic fractures, respectively.¹² High cheese consumption was linked to a 38% lower risk of hip fracture, with the association remaining significant across intake levels.

A 2023 prospective study of 103,003 women from the Nurses’ Health Study cohort measured the association between dairy intake (total dairy, milk, yogurt and cheese) and fragility fracture risk over a 24-year follow-up period.¹³ Among the main findings, the authors highlight the following:  

• Women with the highest dairy intake (≥2 servings/day) had a 26% lower risk of fragility fractures compared to low dairy consumers (<1 serving/week). 

• Each additional serving of dairy was linked to a 6% decrease in fracture risk. 

• High milk (≥2 servings/day) and high cheese (≥1 serving/day) intakes were associated with 15% and 11% reductions in fracture risk, respectively.  

• Each additional serving of milk was linked to a 7% decrease in fragility fracture risk. 

A 2022 prospective cohort study of 1,746 Danish adults found an inverse association between total fermented dairy intake and fracture risk after a 30-year follow-up.¹⁴  

A 2021 landmark two-year cluster randomized trial in 60 Australian aged care facilities examined whether increasing dairy intake could reduce fractures and falls in older adults.¹⁵ Among 7,195 residents (mean age 86 years), facilities providing additional milk, yogurt and cheese achieved higher calcium (1,142 mg/day) and protein (1.1 g/kg/day) intakes compared with control facilities. Importantly, after only 3 to 5 months, key results were observed: 

• 33% reduction in total fractures 

• 46% reduction in hip fractures 

• 11% reduction in falls 

• No adverse effects on serum lipid profile¹⁶ 

These findings highlight dairy as a practical strategy to improve bone health and reduce falls in aged care residents. 

A 2018 prospective cohort study analyzed the bone microstructure of 483 healthy postmenopausal women from the Geneva Retirees Cohort.¹⁷ At baseline, women who consumed fermented dairy products (i.e., yogurt, fresh cheese, quark, kefir) had larger bone size, and those who consumed milk and fermented dairy products had a lower prevalence of osteoporosis. Over the 3-year follow-up period, this study found that: 

• Fermented dairy product consumption was associated with reduced bone loss, independent of total energy, calcium and protein intakes. 

• Women who consumed fermented dairy products also had lower levels of markers associated with bone loss.   

A 2015 prospective cohort study using data from the Canadian Multicentre Osteoporosis Study (CaMos) assessed the relationships between total protein intake and different protein sources with bone mineral density in 6,510 participants.¹⁸ In adults aged over 50 years who were followed for 5 years, this study found that: 

• Dairy protein was associated with increased bone mineral density. 

• Plant protein was associated with decreased bone mineral density. 

Reviews, Systematic Reviews and Meta-analyses 

A 2024 review assessed recent observational studies and randomized controlled trials evaluating the effectiveness and safety of nutrients, specific foods and overall dietary patterns in preventing osteoporosis and fractures.¹⁹ Among the main findings, the authors highlight the following:  

• Fracture risk was higher among individuals following dietary patterns that avoid dairy products, such as vegan diets. 

• Fermented dairy products showed protective effects against age-related bone loss, which is important among older adults considering their elevated risk of bone-related conditions.  

The authors also highlight that the complex and unique dairy matrix is an important contributor to the various health effects observed with dairy products.  

A 2025 review examined the association between milk and osteoporosis among high-risk Asian populations, highlighting its benefits and addressing common challenges like lactose intolerance and milk allergies.²⁰ The authors outline the following findings:  

• Milk proteins are highly digestible and well-absorbed, supporting bone metabolism. They also help preserve muscle mass, indirectly reducing the risk of sarcopenia, falls and fractures among those at risk of osteoporosis.  

• Calcium is important for bone structure and metabolism, enhancing osteoblast activity. Given milk’s high calcium content, ease of consumption, availability and affordability, the authors highlight milk as a leading option for dietary calcium supplementation.  

• Regular milk intake has been linked to higher bone mineral density, improved bone strength and decreased risk of fractures, especially among high-risk populations, including the elderly and postmenopausal women. This is particularly relevant for regions with an ageing population. 

• Milk can be an effective way to fill common nutrient gaps in populations with traditionally low calcium and vitamin D intake, and fortified dairy products further enhance bone health by improving calcium absorption. 

A 2020 systematic review and expert review assessing the effects of dairy intake on bone health across the lifespan found that daily intakes of low-fat or fat-free dairy options were linked to enhanced bone mineral density in the whole body, and at one or more sites when consumed with a healthy diet.¹⁰ It was also associated with decreased fracture incidence among older adults.  

A 2019 systematic review and meta-analysis of randomized controlled trials, prospective cohort and case-control studies examined the effect of fermented milk products on bone health indicators in postmenopausal women and found:²¹ 

• Yogurt and cheese decreased bone resorption markers. 

• Yogurt was associated with a 24% reduced risk of hip fractures. 

• Cheese had either no association or a protective association with osteoporosis. 

In 2019, a systematic review and meta-analysis of prospective cohort and case-control studies on dairy foods and fracture risk assessed dairy food consumption and changes in bone mineral density:²²  

• Dairy intake was linked to a decreased risk of vertebral fractures. 

• Low milk intake during youth was associated with 1.7–3% lower hip bone mineral density in young and postmenopausal women. 

• Higher baseline milk consumption in older adults was positively associated with bone mineral density changes at the trochanter and radius. 

• A 2013 meta-analysis of randomized controlled trials investigated the effects of milk consumption on bone mass and bone turnover markers.²³ The analysis consisted of 11 studies that included 2,397 participants (adults and children). The authors concluded that milk has a favourable impact on bone density and attenuates bone loss. Compared to the control group, those who consumed milk had increased bone mineral content, total body bone mineral density and a decrease in bone turnover markers associated with bone loss. 

A study outlined the influence of individual nutrients from everyday diets on bone health, including their underlying mechanisms, while evaluating the advantages and disadvantages associated with 4 common dietary patterns.²⁴  

• The authors note that dairy-derived proteins are considered superior for skeletal health compared to non-dairy proteins, likely due to their high quality and dairy’s high calcium and vitamin D content. 

• Milk-derived peptides support bone health by enhancing calcium absorption, improving mineral bioavailability, and stimulating osteoblast activity. 

• Mediterranean diets, composed of a variety of whole foods including dairy, are linked to higher bone mass among premenopausal women and reduced falls and hip fractures among older adults.  

• The lower dairy product consumption among Eastern diets may result in calcium deficiencies, ultimately contributing to reduced peak bone mass and bone loss.   

These findings are further supported by new dietary recommendations for osteoporosis prevention and treatment in France, which recommend a Mediterranean-type diet and daily consumption of 2-3 servings of dairy.²⁵ 

Conclusion

Maintaining bone mineral density is central to reducing the risk of osteoporosis and fragility fractures. Collectively, the evidence shows that dairy foods contribute meaningfully to bone health across the lifespan, with benefits that likely extend beyond individual nutrients and include, among other factors, their provision of calcium, protein and vitamin D. Regular consumption of milk and milk products has shown positive associations with higher bone mineral density and lower rates of bone loss, supporting their role as a practical dietary strategy for bone health.