Nutritional Pearls: Drinking Milk and the Risk of Hip Fractures

Sarah is a 72-year-old woman concerned about her risk of hip fracture. She tells you that as a child, she often drank 2 to 3 glasses of milk a day, but drinks far less now. She asks if she should begin drinking more milk again to help strengthen her bones.

How do you advise your patient?

(Answer and discussion on next page)

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Answer: The bone-related content of the milk (calcium, vitamin D) is likely available through other foods that offer you multiple other benefits, such as fiber or antioxidants.

It's a tenet of nutrition, handed down from our parents and grandparents, and backed up by clever marketing campaigns. The specific message might vary, but the underlying belief is "drink milk for strong bones."

Milk contains a number of vitamins and minerals and the presumption behind much of the research into bone health and milk has been, essentially, that (1) milk contains higher levels of calcium and vitamin D, and (2) calcium and vitamin D are beneficial to bone health, therefore (3) milk is beneficial to bone health.

For decades this belief wasn't closely questioned—to the point that the USDA's MyPlate actually includes dairy milk as a beverage in its dietary recommendations.

More recent research, however, has looked at dairy intake (and more specifically at dairy intake in the form of cow's milk) and any link there might be between consuming cows' milk itself or consuming supplements of calcium and Vitamin D and the risk of bone fracture. The results, however, have been mixed.

For a health care provider who sees patients nearly every day, the really relevant question is the one my patients who are concerned about their bones often ask me: "Should I drink milk?"

The Research

Today's article was authored by a team of Norwegian researchers who analyzed data gathered through 2 large-scale, long term studies carried out in Norway.

The first source of data was the Norwegian Counties Study (with over 35,000 participants included in the analysis) and includes those participants from a larger cardiovascular health screening that recruited participants between 1985 to 1986 and 1987 to 1988. The second source of data comes from the Five Counties study (with about 23,300 people included in the analysis), which includes 5 Norwegian counties of varying economic and locational areas and began collecting data between 2000 and 2003 and continues today.

Both data sources included, at minimum, the height, weight, and smoking status for all participants. Among other food groups queried, the participants reported their usual intake of milk, measured in "glasses of milk per day."

The Results

After an average of more than 10 years' follow-up, the authors could access the country's hospital data to ascertain which participants might have experienced a hip fracture. They then compared the milk intake of those who fractured their hip with those who did not, taking into account such variables as body mass index, age, gender, smoking status, chronic diseases, and other variables.

The authors found "no clear association [either for or against] between milk consumption and risk of hip fracture."

What’s the Take Home?

These are results from people who are largely white, and the results could be and probably are complicated by race, class, or gender. What this does suggest, to me, is that if you're drinking milk solely—or even mostly—for your bone health, you might want to reconsider.

First, those glasses of milk may be calories you don't need, while the bone-related content of the milk (calcium, vitamin D) is likely available through other foods that offer you multiple other benefits, such as fiber or antioxidants.

Reference:

Holvik K, Meyer HE, Laake I, Feskanich D. Milk drinking and risk of hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) [published online January 31, 2019]. BJN. https://doi.org/10.1017/S0007114518003823