Abstract
Results indicating that a high milk intake is associated with both higher and lower risks of fragility fractures, or that indicate no association, can all be presented in the same meta-analysis, depending on how it is performed. In this narrative review, we discuss the available studies examining milk intake in relation to fragility fractures, highlight potential problems with meta-analyses of such studies, and discuss potential mechanisms and biases underlying the different results. We conclude that studies examining milk and dairy intakes in relation to fragility fracture risk need to study the different milk products separately. Meta-analyses should consider the doses in the individual studies. Additional studies in populations with a large range of intake of fermented milk are warranted.
Highlights
Milk and dairy products have long been promoted as part of a healthy diet, since they contain many essential nutrients (18 of 22), including calcium, phosphorous, and vitamin D [1]
The net effect on the fragility fracture risk will be the average of these mechanisms and is likely to depend on both the type of milk and amount ingested
0.91 for the highest vs. lowest milk intakes and 1.00 (0.94–1.07) per 200 g of milk per day presented as the main results by Bian et al [9], the dose response analysis in the same study, based on 11 effect sizes from eight cohort studies, indicated a relative risk of 1.09 per 200 g of milk/day, similar to the meta-regression results reported by Malmir et al [10]
Summary
Milk and dairy products have long been promoted as part of a healthy diet, since they contain many essential nutrients (18 of 22), including calcium, phosphorous, and vitamin D [1]. Systematic reviews and meta-analyses of studies investigating the role of milk and dairy products in relation to fragility fracture risk have been performed and cover the available original research until 2019 [9,10]. In this narrative review, our aim is not to conduct another systematic review and meta-analysis but, rather, to discuss the available studies with regards to their relative merits, highlight potential problems with meta-analyses of milk and dairy intakes in relation to fracture risk, and discuss potential mechanisms underlying the different results. The studies included are mainly based on European and North American populations, and we only consider cow milk products
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