Dairy intake and bone health across the lifespan: a systematic review and expert narrative

Figures & data

Figure 1. Impact of dairy nutrients on bone strength. 1,25(OH)D = 1,25 dihydroxy vitamin D; FGF = fibroblast growth factor; IGF1 = insulin-like growth factor 1; IL7 = interlukin-7; PTH = parathyroid hormone; RANKL; TNFα = tumor necrosis factor alpha.

Table 1. Evidence grading system.

Level of Evidence^a	Description
A: Strong	Clear evidence from at least one large, well-conducted, generalizable RCT that is adequately powered with a large effect size and is free from bias or other concerns. OR Clear evidence from multiple RCTs or many controlled trials that have few limitations related to bias, measurement precision, inconsistent results, or other concerns.
B: Moderate	Evidence obtained from multiple, well-designed, conducted, and controlled prospective cohort studies that have used adequate and relevant measurements and that gave similar results from different populations. OR Evidence obtained from a well-conducted meta-analysis of prospective cohort studies from different populations.
C: Limited	Evidence obtained from multiple prospective cohort studies from diverse populations that have limitations related to bias, measurement imprecision, or inconsistent results or have other concerns. OR Evidence from only one well-designed prospective study with few limitations. OR Evidence from multiple well-designed and conducted cross-sectional or case-controlled studies that have very few limitations that could invalidate the results from diverse populations. OR Evidence from a meta-analysis that has design limitations.
D: Inadequate	Evidence from studies that have one or more major methodological flaws or many minor methodological flaws that result in low confidence in the effect estimate. OR Insufficient data to support a hypothesis. OR Evidence derived from clinical experience, historical studies (before and after), or uncontrolled descriptive studies or case reports.

Abbreviation: RCT, randomized controlled trial.

Adapted with permission from Woolf (2006).

^aLevel of evidence refers to the body of evidence.

Table 2. Studies assessing maternal dairy intake on offspring bone health.

Reference		Study characteristics	Population description	Subjects (n)	Endpoints	Results
Prospective cohort studies
Ganpule et al. (2006)		Prospective cohort study to evaluate associations of maternal nutrition and lifestyle factors during pregnancy and maternal and paternal bone mass to the child’s bone mass. Cohort name: The Pune Maternal Nutrition Study Exposure: calcium-rich foods. Dietary assessment method: FFQ and 24-hour dietary recall. Follow-up: 6 years postpartum	Sex: Both Age: 27.5 years (mean age of mother at conception) Race: Asian (Indian) Location: India Baseline maternal dairy intake: Median, 61 (IQR, 36, 66) frequency of milk product consumption per month at 18 weeks Baseline maternal calcium intake: Median, 274 (IQR, 223, 354) at 18 weeks Baseline maternal protein intake: 42 g at 18 weeks. Baseline serum 25OHD: NR	797 pregnant women; 698 children.		Correlations between maternal intake and bone mass outcomes in children at age 6 years
					Maternal dairy intake (Frequency per month)	Total BMC	Total BMD	Spine BMC	Spine BMD
					Milk, 18 weeks Milk, 28 weeks Milk products, 18 weeks Milk products, 28 weeks	0.06 0.07 0.10* 0.06	0.09* 0.13* 0.14* 0.09*	0.02 0.04 0.08* 0.09*	0.02 0.05 0.09* 0.04 *p < 0.05
						Total body BMD was greater in children age 6-years according to the mother’s frequency of intake of milk (r = 0.13; p = 0.002), milk products (r = 0.09; p = 0.02), and calcium-rich foods (r = 0.12; p = 0.001) at 28 weeks’ gestation. Data presented in Figure 2 of original manuscript.

Table 3. Studies assessing dairy intake on infant and toddler bone health (age 0- to 36-months).

Reference		Study characteristics	Population description	Subjects (n)	Endpoints	Results
Clinical trials
Specker et al. (1997)		RCT to assess the effect of varying mineral intakes on total body bone mass accretion during the first year of life. Intervention: Cow’s milk Comparator: moderate mineral and high mineral infant formula. Duration: 6-months (phase 2)	Sex: both Age: 6-months Race: white Location: USA Baseline dairy intake: NR Baseline calcium intake: 462 ± 122 mg (moderate mineral formula), 443 ± 109 mg (high mineral formula) and 378 ± 119 mg (cow’s milk) Baseline protein intake: 14.1 ± 3.5 g (moderate mineral formula), 14.2 ± 2.8 g (high mineral formula) and 12.1 ± 3.8 g (cow’s milk) Baseline serum 25OHD: NR	Baseline: 92 Final: 77	BMC, g	Moderate mineral formula	High mineral formula	Cow’s Milk	p-value
					Total body	72.9 ± 21.1	75.9 ± 24.9	71.7 ± 38.1	0.84
Prospective cohort studies
Allison et al. (2020)	Prospective cohort study to evaluate whether the volume or fat content of cow’s milk consumed between ages 1- to 3-years is associated with risk of fracture between ages 3- and 10-years. Cohort name: The Applied Research for Kids (TARGeT Kids!) Study Exposure: volume and percentage of milk fat consumed. Dietary assessment method: FFQ Follow-up: 3.8 years (mean)	Sex: Both Age: 1 to 3 years Race: Mixed (only mother’s ethnicity reported; predominantly white) Location: Canada Baseline dairy intake: 1.88 ± 1.15 cups Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	2466	Measure	Fracture risk, OR (95% CI)		p-value
				Cow’s milk volume (per 25- mL cup/day)	1.04 (0.91–1.18)		0.65
				Cow’s milk-fat content (per 1% increase in milk fat)	1.05 (0.79–1.17)		0.66
Andres et al. (2013)	Prospective cohort study to characterize growth, fat mass, fat-free mass, and bone mineral content longitudinally in healthy infants fed breast milk, cow’s milk formula, or soy formula during the first year of life. Cohort name: The Beginnings Study Exposure: volume and percentage of milk fat consumed. Dietary assessment method: Parental choice prior to enrollment Follow-up: 12-months	Sex: Both Age: Newborn Race: Mixed (mostly white) Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	207	Measure	Breast fed	Cow’s milk formula	Soy formula	p-value
				BMC (g)
				3-months	120.89 (2.16)^a	111.46 (1.97)^b	102.51 (2.20)^c	<0.001
				6-months	152.61 (2.23)^ab	158.61 (2.23)^b	150.44 (2.30)^a	0.10
				9-months	177.59 (2.69)^a	193.00 (2.78)^b	188.33 (3.01)^b	<0.001
				12-months	201.18 (3.50)^a	230.12 (3.71)^b	224.28 (3.94)^b	<0.001
				BMC (g/kg)
				3-months	18.84 (0.21)^a	18.47 (0.19)^a	16.89 (0.21)^b	<0.001
				6-months	19.90 (0.18)^a	20.01 (0.17)^a	18.78 (0.18)^b	<0.001
				9-months	20.59 (0.18)^a	21.20 (0.19)^b	20.39 (0.20)^a	0.002
				12-months	21.80 (0.23)^a	22.84 (0.25)^b	22.49 (0.26)^ab	0.004
				BMC (g/cm)
				3-months	1.98 (0.03)^a	1.86 (0.03)^b	1.71 (0.03)^c	<0.001
				6-months	2.31 (0.03)^ab	2.38 (0.03)^b	2.24 (0.03)^a	0.003
				9-months	2.53 (0.04)^a	2.73 (0.04)^b	2.64 (0.04)^ab	<0.001
				12-months	2.72 (0.04)^a	3.10 (0.05)^b	3.00 (0.05)^a	<0.001
Hillman et al. (1988) Results also presented in Hillman (1988)	Prospective cohort study to evaluate mechanisms of mineral homeostasis and mineralization in term infants with recommended vitamin D intakes. Cohort name: NR Exposure: exposure to breast-milk, cow milk-based formula, or soy-based formula Dietary assessment method: Parental kept infant dietary records. Follow-up: 12-months	Sex: Both Age: newborn (2 weeks) Race: Assumed white Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: 25.6 ± 3.3 ng/mL (breast milk group), 23.8 ± 3.1 ng/mL (cow milk-based formula), and 24.0 ± 5.3 ng/mL (soy-based formula)	31	No differences in BMC were shown at 12 months of age between groups. Data illustrated in Figure 4 of original manuscript.
Cross-sectional studies
Park et al. (1998)	Cross-sectional study to investigate if winter-born infants fed breast-milk vs. cow milk-based formula have lower 25OHD levels and BMC.	Sex: both Age: 2–5 months Race: Asian Location: South Korea Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: 16.0 ± 11.3 ng/mL (breast-milk group) and 29.0 ± 8.9 ng/mL (cow milk-based formula)	35		Breast-milk	Cow Milk-Based Formula
				BMC, total body	0.62 ± 0.2 g/cm	0.65 ± 0.2 g/cm

Abbreviations: BMC, bone mineral content; NR, not reported.

Table 4. Studies assessing dairy intake on child bone health (age 3–10 years).

Reference	Study characteristics	Population description	Subjects (n)	Endpoints	Results
Clinical trials
Gibbons et al. (2004)	RCT to assess the effect of a calcium-enriched cocoa flavored dairy drink on bone density, growth, and size in prepubertal boys Intervention: High-calcium milk group: high-calcium milk (600 mg calcium per 40-g serving or 1200 mg/day) Comparator: enriched drink reconstituted in water (200 mg calcium per 40-g serving or 400 mg/day) Duration: 18-months with additional 12-months follow-up	Sex: both Age: 8–10 years Race: assumed white Location: New Zealand Baseline dairy intake: NR Baseline calcium intake: 934 ± 44 mg (high-calcium group) and 985 ± 53 mg (control) Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 154 Final: 123		High-calcium milk group	Control group	nterp-value
				BMD (%Δ)
				Total body	9.4 ± 1.0	8.9 ± 1.1	0.737
				L1–L4 spine	16.3 ± 1.9	16.8 ± 2.1	0.616
				Total hip	14.0 ± 1.9	12.4 ± 2.0	0.081
				Trochanter	15.8 ± 2.2	14.9 ± 2.2	0.447
				L1–L4 (%Δ)
				Width	12.1 ± 1.2	12.1 ± 1.3	0.676
				Area	25.0 ± 2.0	25.8 ± 2.4	0.511
				Height	10.1 ± 1.6	12.1 ± 1.1	0.293
				Volumetric density	54.3 ± 6.5	60.5 ± 7.3	0.603
Lau et al. (2004)	RCT to examine the effects of milk powder supplementation on bone accretion in children Intervention: (1) 80 g calcium-enriched milk powder (1300 mg calcium); (2) 40 g calcium-enriched milk powder (650 mg calcium) Comparator: control Duration: 18-months	Sex: both Age: 9–10 years Race: Asian Location: Hong Kong Baseline dairy intake: NR Baseline calcium intake: 417 ± 197 mg (40 g milk powder group), 494 ± 216 mg (80 g milk powder group), and 463 ± 241 (control group). Baseline protein intake: 77 ± 23 g (40 g milk powder group), 86 ± 25 g (80 g milk powder group), and 80 ± 25 (control group). Baseline serum 25OHD: NR	Baseline: 344 Final: 324	Mean rate of change (% baseline/years)	80 g milk powder	40 g milk powder	Control	Linear mixed effect models
				BMC
				Hip	22.77 ± 1.05*	24.42 ± 1.14	25.89 ± 1.19	Subjects randomized to the 80 g calcium-enriched milk powder (1300 mg calcium) had significantly higher increase in BMD at both the total hip (7.4 ± 0.4% in treatment group versus 6.4 ± 0.4% in the control) and spine (8.4% ± 0.5% in the treatment group versus 7.0 ± 0.5% in the control). Subjects randomized to the 40 g calcium-enriched milk powder showed an increase in total body BMD (3.1 ± 0.3% in the treatment group versus 2.4 ± 0.2% in the control).
				Femoral neck	10.64 ± 1.09	10.01 ± 1.14	13.16 ± 1.21
				Spine	19.23 ± 0.85	20.88 ± 0.94	21.51 ± 0.96
				Total body	16.88 ± 0.60	17.02 ± 0.65	18.46 ± 0.67
				BMD
				Hip	6.34 ± 0.38*	7.28 ± 0.41	7.41 ± 0.42
				Femoral neck	5.40 ± 0.43	6.16 ± 0.46	6.48 ± 0.49
				Spine	7.01 ± 0.48*	8.05 ± 0.52	8.37 ± 0.54
				Total body	2.39 ± 0.24	3.06 ± 0.26*	2.87 ± 0.27
					*p < 0.05 for treatment vs. control
Prospective cohort studies
Goulding et al. (2004)†	Prospective cohort study to obtain more information about fractures in children with a history of avoiding cow’s milk and to compare their observed fracture frequencies with those expected in children of similar age and sex from the general community Cohort name: NR Exposure: avoided milk; did not use calcium-rich food substitutes Dietary assessment method: NR Follow-up: 2 years	Sex: both Age: 3–13 years Race: white Location: UK Baseline dairy intake: NR Baseline calcium intake: 449 ± 250 mg (children with fractures) and 438 ± 189 mg (children without fractures). Baseline protein intake: NR Baseline serum 25OHD: NR	50		Age group (years)							p-value
					0–2.9	2–4.9	5–6.9	7–8.9	9–10.9	11–13	0–13
				Time exposed (years)	150	96.1	83.4	44	16.2	6.3	396	<0.05
				Observed fractures (n)	9	5	4	4	0	0	22	<0.05
				Expected fractures (n)	1.97	2.08	1.99	1.15	0.8	0.45	8.44	<0.05
				Fracture rate per 1000 person-years	13.1	21.7	23.8	26	49.3	72.4
van den Hooven et al. (2015)	Prospective cohort to investigate associations between dietary patterns assessed in infancy and bone health at the age of 6 years Cohort name: Generation R Study Exposure: dairy and whole grains Dietary assessment method: FFQ Follow-up: 6 years	Sex: both Age: 6 years Race: mixed Location: Netherlands Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	2850		Dairy and whole grain intake
					Continuously (per SD)	Q1	Q2	Q3	Q4
				BMD (mg/cm^2)	1.48 (0.17 to 2.79)*	1.00 (ref)	0.73 (−2.77 to 4.23)	2.12 (−1.50 to 5.74)	3.98 (0.36 to 7.61)*
				BMC (g)	0.66 (−0.93 to 2.25)	1.00 (ref)	−0.16 (−4.40 to 4.07)	2.47 (−1.92 to 6.86)	1.88 (−2.52 to 6.27)
				aBMC (g)	1.84 (0.51 to 3.17)*	1.00 (ref)	1.18 (−2.38 to 4.73)	2.04 (−1.65 to 5.72)	4.96 (1.27 to 8.64)*
				BA (cm^2)	−1.53 (−3.48 to 0.43)	1.00 (ref)	−1.73 (−6.95 to 3.49)	0.56 (−4.84 to 5.96)	−3.98 (−9.40 to 1.43)	*p < 0.05
Cross-sectional studies
Black et al. (2002)†	Cross-sectional study to evaluate dietary calcium intakes, anthropometric measures, and bone health in prepubertal children with a history of long-term milk avoidance	Sex: both Age: 3–10 years Race: white Location: New Zealand Baseline dairy intake: NR Baseline calcium intake: 420 ± 228 mg (girls) and 478 ± 234 mg (boys) Baseline protein intake: NR Baseline serum 25OHD: NR	50		Age-adjusted z scores	p-value
				Total body BMC (g)	−0.45 ± 1.16	<0.01
				Total body BA (cm^2)	−0.56 ± 1.34	<0.01
				aBMD (g/cm^2)
				Total body	0.13 ± 0.77	NS
				Femoral neck	−1.11 ± 2.27	<0.001
				Trochanteric	−0.47 ± 1.58	<0.05
				L2–L4	−0.45 ± 1.05	<0.01
				Ultradistal radius	−0.31 ± 0.99	<0.05
				33% radius	−0.74 ± 1.40	<0.01
				BMAD (g/cm^3)
				L2–L4	−0.72 ± 1.17	<0.001
				33% radius	−0.72 ± 1.35	<0.001

Abbreviations: aBMC, areal bone mineral content; aBMD, areal bone mineral density; BA, bone area; BMAD, bone mineral apparent density; BMC, bone mineral content; BMD, bone mineral density; FFQ, food frequency questionnaire; NR, not reported; NS, not significant; RCT, randomized controlled trial.

^†Age group spans into another life-stage; however, data are in this table.

Table 5. Studies assessing dairy intake on adolescent bone health (age 10–19 years).

Reference	Study characteristics	Population description	Subjects (n)	Endpoints	Results
Clinical trials
Cadogan et al. (1997)	RCT to investigate the effect of milk supplementation on total body bone mineral acquisition in adolescent girls Intervention: 568 ml (1 pint) whole milk/day Comparator: Habitual diet (control) Duration: 18-months	Sex: girls Age: 12 years Race: white Location: UK	Baseline: 82 Final: 80		Milk group	Control	p-value
				Total body BMD (%Δ)	9.6	8.5	0.017
				BMC (%Δ)
				Total body	27	24.1	0.009
				Head	16.1 ± 6.5	14.5 ± 6.7	0.39
				Arm	9.9 ± 3.0	9.8 ± 4.2	0.54
				Rib	5.7 ± 2.9	5.3 ± 2.7	0.53
				Thoracic spine	17.9 ± 5.5	16.2 ± 6.0	0.09
				Lumbar spine	17.9 ± 6.8	16.2 ± 6.7	0.47
				Trunk	14.5 ± 3.7	13.1 ± 4.4	0.17
				Pelvis	14.0 ± 5.0	11.6 ± 4.3	0.003
				Leg	10.4 ± 3.3	9.1 ± 4.0	0.005
Chan, Hoffman, and McMurry (1995)	RCT to assess the effect of calcium supplementation with dairy products on the bone and body composition of pubertal girls Intervention: diet with dairy products to the RDA of 1200 mg calcium daily Comparator: control (usual diet) Duration: 12-months	Sex: girls Age: 9–13 years Race: white Location: USA Baseline dairy intake: NR Baseline calcium intake: 728 ± 321 mg (control group not statistically different; no baseline values reported for dairy group). Baseline protein intake: 52 ± 16 g (control group not statistically different; no baseline values reported for dairy group). Baseline serum 25OHD: NR	Baseline: 48 Final: 48		Baseline		12-months		p-value
					Dairy group	Control	Dairy group	Control
				Total body bone mineral (g)	1490 ± 291	1508 ± 167	1695 ± 317	1617 ± 152	<0.001
				Lumbar spine bone density (g/cm^2)	0.633 ± 0.096	0.665 ± 0.077	0.772 ± 0.086	0.748 ± 0.084	<0.001
Cheng et al. (2005)	RCT to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition in girls Intervention: (1) calcium (1000 mg) + vitamin D (200 IU)/day; (2) calcium (1000 mg); (3) cheese (1000 mg calcium) Comparator: reference group with dietary calcium intake >900 mg, daily Duration: 2 years	Sex: girls Age: 10–12 years Race: assumed white Location: Finland Baseline dairy intake: NR Baseline calcium intake: 671 ± 135 mg (placebo group), 664 ± 191 mg (Ca D group), 667 ± 171 mg (Ca group), 680 ± 183 mg (cheese group), 1351 ± 323 mg (reference group). Baseline protein intake: 15.0 ± 3.0% total calories (placebo group), 14.3 ± 2.5% total calories (Ca D group), 14.9 ± 3.0% total calories (Ca group), 14.9 ± 2.5% total calories (cheese group), and 16.5 ± 2.0% total calories (reference group). Baseline serum 25OHD: NR	Baseline: 195 Final: 181		Placebo group	Ca D group	Ca group	Cheese group	Reference group
				Total body (%Δ)
				BA	24.0 ± 1.0	22.7 ± 0.9	23.0 ± 1.0	25.1 ± 1.0	24.4 ± 1.1
				BMC	35 ± 1.4	35 ± 1.4	35 ± 1.4	38.1 ± 1.4	36.9 ± 1.4
				aBMD	8.9 ± 0.5	8.9 ± 0.5	9.7 ± 0.5	10.4 ± 0.5	10.2 ± 0.6
				Femoral neck (%Δ)
				BA	15 ± 1.6	12.6 ± 1.5	14.9 ± 1.6	13.1 ± 1.6	11.1 ± 2.3
				BMC	22.4 ± 1.5	24 ± 1.4	23.3 ± 1.5	26.5 ± 1.4	26.1 ± 1.6
				aBMD	12.9 ± 1	14.2 ± 1	14.5 ± 1	14.8 ± 1	13.9 ± 1.1
				Total femur (%Δ)
				BA	17.3 ± 0.8	17.0 ± 0.7	17.8 ± 0.98	18.1 ± 0.8	17.4 ± 0.9
				BMC	33.6 ± 1.6	33.6 ± 1.6	36.4 ± 1.7	36.9 ± 1.6	34.8 ± 1.7
				aBMD	14.1 ± 1.0	14.2 ± 1.0	15.1 ± 1.0	15.5 ± 1.0	14.9 ± 1.0
				L2–L4 (%Δ)
				BA	23.4 ± 0.9	23 ± 0.9	24.4 ± 0.9	25.3 ± 0.9	26.6 ± 1
				BMC	47 ± 2.2	46.9 ± 2	48.9 ± 2.2	52.4 ± 2.2	55 ± 2.3
				aBMD	19 ± 1.1	19.2 ± 1.0	19.4 ± 1.1	21.5 ± 1.1	22.5 ± 1.1
				Radius (%Δ)
				Cross-sectional area	21.3 ± 2.0	23 ± 1.9	26 ± 2.1	26.2 ± 2.0	26.1 ± 2.2
				BMC	22.2 ± 2.0	22.6 ± 1.8	24.4 ± 2.0	25.9 ± 1.9	25.5 ± 1.9
				vBMD	1.99 ± 1.5	3.35 ± 1.4	2.61 ± 1.5	3.07 ± 1.5	0.84 ± 1.5
				Polar momentum inertia	51.8 ± 4.2	53.3 ± 4.1	62 ± 4.4	61.8 ± 4.2	62.4 ± 4.3
				Tibia (%Δ)
				Cross-sectional area	14.8 ± 1.1	15.6 ± 1.0	15.8 ± 1.1	15.9 ± 1.1	14.4 ± 1.2	Note: Efficacy analysis indicated cortical bone thickness of the tibia increased more in the cheese group with compliance >50% vs. the placebo (data not reported).
				BMC	22.7 ± 1	23 ± 0.9	24.3 ± 1	25.2 ± 1	22.6 ± 1
				vBMD	7.76 ± 0.6	6.87 ± 0.5	7.53 ± 0.6	8.3 ± 0.6	8.76 ± 0.6
				Cortical bone thickness	31.1 ± 1.4	31.7 ± 1.3	29.8 ± 1.4	37.1 ± 1.3	32.7 ± 1.5
				Polar momentum inertia	39.7 ± 2.3	41.3 ± 2.2	41.5 ± 2.3	42.6 ± 2.3	43.6 ± 2.3
Du et al. (2004)	RCT to assess the effect of calcium fortified milk with or without cholecalciferol on bone mineralization Intervention: (1) 330 mL calcium fortified milk; (2) 330 mL calcium fortified milk with cholecalciferol. Comparator: Control Duration: 2 years	Sex: girls Age 10 years Race: Chinese Location: China Baseline dairy intake: 113 ± 89 g (milk + calcium group), 113 ± 95 g (milk + CaD), 135 ± 101 g (control) Baseline calcium intake: 418.2 ± 145.3 mg (milk + calcium group), 418.1 ± 162.5 mg (milk + CaD), 455.3 ± 166.1 mg (control) Baseline protein intake: 52.4 ± 16.1 mg (milk + calcium group), 53.1 ± 15.2 g (milk + CaD), 55.9 ± 17.9 g (control) Baseline serum 25OHD: NR	Baseline: 757 Final: 698		Adjusted percentage difference in change
					(Milk + Calcium) – (Control)		(Milk + CaD) – (Control)		(Milk + CaD) – (Milk + Calcium)
					Mean ± SE	p-value	Mean ± SE	p-value	Mean ± SE	p-value
				Total body
				BMC (g)	1.8 ± 0.8	0.03	2.6 ± 0.8	0.002	0.8 ± 0.8	0.3
				Size-adjusted BMC	1.2 ± 0.5	0.012	2.4 ± 0.5	<0.0005	1.3 ± 0.5	0.006
				BA (cm^2)	−1.0 ± 0.9	0.2	−1.8 ± 0.9	0.04	−0.8 ± 0.7	0.3
				BMD (g/cm^2)	3.2 ± 0.8	<0.0005	5.3 ± 0.8	<0.0005	2.0 ± 0.8	0.009
Lu et al. (2019)	RCT to assess the effect of milk powder fortified with calcium on bone density in healthy adolescents. Intervention: (1; Ca300D) milk powder fortified with vitamin D (400 IU) and calcium (300 mg); (2; Ca600D) milk powder fortified with vitamin D (400 IU) and calcium (600 mg); (3; Ca900D) milk powder fortified with vitamin D (400 IU) and calcium (900 mg); Comparator: Control Duration: 1.5 years	Sex: both Age 12–15 years Race: Chinese Location: China Baseline dairy intake: NR Baseline dietary calcium intake: 372.6 ± 265.9 mg (Ca300D group), 372.5 ± 239.9 mg (Ca600D group), 410.2 ± 318.2 mg (Ca900D group), and 315.8 ± 260.9 mg (control). Baseline protein intake: NR Baseline serum 25OHD: 29.93 ± 9.10 nmol/L (Ca300D group), 28.58 ± 8.89 nmol/L (Ca600D group), 29.66 ± 8.95 nmol/L (Ca900D group), and 29.51 ± 9.10 nmol/L (control).	Baseline: 232 Final: 207		Control	Ca300D	Ca600D	Ca900D	p-value (time)	p-value (group by time)
				Total body BMD (g/cm^2)
				Baseline	1831.2 ± 278.3	1874.8 ± 347.7	1784.6 ± 322.8	1801.2 ± 356.0	<0.0001	0.5142
				1 year	2039.9 ± 281.9	2071.4 ± 309.4	2015.3 ± 334.3	2004.5 ± 399.2
				1.5 years	2171.3 ± 328.9	2180.9 ± 324.2	2136.0 ± 337.8	2146.3 ± 435.4
				Total body aBMD (g/cm^2)
				Baseline	0.749 ± 0.071	0.816 ± 0.170	0.781 ± 0.131	0.805 ± 0.127	<0.0001	0.6132
				1 year	0.781 ± 0.073	0.918 ± 0.165	0.869 ± 0.160	0.895 ± 0.169
				1.5 years	0.816 ± 0.089	0.946 ± 0.164	0.933 ± 0.153	0.937 ± 0.138
				Lumbar spine aBMD (g/cm^2)
				Baseline	0.812 ± 0.139	0.816 ± 0.170	0.781 ± 0.131	0.805 ± 0.127	<0.0001	0.6132
				1 year	0.918 ± 0.169	0.918 ± 0.165	0.869 ± 0.160	0.985 ± 0.169
				1.5 years	0.952 ± 0.135	0.946 ± 0.164	0.933 ± 0.153	0.937 ± 0.138
				Total hip aBMD (g/cm^2)
				Baseline	0.845 ± 0.102	0.855 ± 0.131	0.837 ± 0.118	0.856 ± 0.108	<0.0001	0.1780
				1 year	0.870 ± 0.108	0.889 ± 0.124	0.856 ± 0.116	0.865 ± 0.120
				1.5 years	0.892 ± 0.124	0.888 ± 0.123	0.900 ± 0.150	0.892 ± 0.133
Malpeli et al. (2012)	RCT to determine the effect of calcium supplementation on BMD and BMC and identify predictors of bone mass changes in adolescent mothers 6-months postpartum Intervention: dairy products (932 mg Ca) Comparator: calcium citrate (1000 mg Ca/day) Duration: 6-months	Sex: women, adolescent mothers Age: <19 years Race: Hispanic (assumed Argentinian) Location: Argentina Baseline dairy intake: NR Baseline calcium intake: 1004 ± 496 mg (dairy products group) and 1223 ± 890 mg (calcium citrate group). Baseline protein intake: 116 ± 37 mg (dairy products group) and 121 ± 42 mg (calcium citrate group). Baseline serum 25OHD: NR	Baseline: 37 Final: 37		Baseline		6 months postpartum			p-value
					Dairy products	Calcium citrate	Dairy products		Calcium citrate
				BMD (g/cm^2)
				L2–L4	1.060 ± 0.085	1.077 ± 0.121	1.069 ± 0.091		1.105 ± 0.137	NS
				Femoral neck	1.013 ± 0.085	1.046 ± 0.148	0.960 ± 0.112		1.011 ± 0.173	NS
				Trochanter	0.765 ± 0.0882	0.790 ± 0.143	0.732 ± 0.091		0.782 ± 0.155	NS
				Total hip	0.996 ± 0.0902	1.021 ± 0.146	0.953 ± 0.107		0.998 ± 0.167	NS
				Total body	1.099 ± 0.0560	1.128 ± 0.087	1.083 ± 0.0634		1.120 ± 0.0965	NS
				BMC (g)	2165 ± 220	2305 ± 381	2116 ± 249		2315 ± 437	NS
Merrilees et al. (2000)	RCT to examine healthy late adolescent females for effects and benefits of high calcium intake from dairy product foods on BMD Intervention: dairy food products to at least 1000 mg/day Comparator: control Duration: 2 years with additional 1-year follow-up Note: BMD raw data not shown	Sex: girls Age: 15–18 years Race: white Location: New Zealand Baseline dairy intake: NR Baseline calcium intake: 765.3 ± 54.5 mg (control) and 744.1 ± 54.1 (dairy group). Baseline protein intake: 66.2 ± 3.5 g (control) and 62.5 ± 3.5 g (dairy group). Baseline serum 25OHD: NR	Baseline: 105 Final: 91		Control	Dairy group	p-value
				Total body BMC (g)
				0–2 years	167.4 ± 16.2	168.9 ± 24.7	NS
				2–3 years	9.3 ± 10.7	13.6 ± 11.7	NS
				Lumbar spine BMC (g)
				0–2 years	2.58 ± 0.36	3.83 ± 0.53	NS
				2–3 years	0.05 ± 0.53	0.44 ± 0.21	NS
				Femoral neck BMC (g)
				0–2 years	0.06 ± 0.05	0.12 ± 0.06	NS
				2–3 years	0.04 ± 0.02	0.04 ± 0.02	NS
				Trochanter BMC (g)
				0–2 years	0.24 ± 0.13	0.75 ± 0.16	<0.05
				2–3 years	−0.12 ± 0.10	−0.05 ± 0.11	NS
				Vertebral height (cm)
				0–2 years	0.14 ± 0.04	0.11 ± 0.03	NS
				2–3 years	0.08 ± 0.02	0.10 ± 0.02	NS
				Vertebral width (cm)
				0–2 years	0.08 ± 0.02	0.07 ± 0.01	NS
				2–3 years	0.03 ± 0.01	0.03 ± 0.01	NS
Vogel et al. (2017)†	RCT to compare children who were overweight with children who were healthy weight for the accrual of bone mass in response to an extra 3 servings dairy/day Intervention: (1) 3 servings dairy (healthy patients; ∼900 mg calcium/day); (2) 3 servings dairy (overweight patients; ∼900 mg calcium/day) Comparator: (1) control (healthy patients); (2) control (overweight patients) Duration: 18 months	Sex: both, early pubertal Age: 8–15 years Race: assumed white Location: USA Baseline dairy intake: NR Baseline calcium intake: 602 ± 173 mg (control; healthy weight), 598 ± 243 mg (control; overweight), 674 ± 272 mg (dairy intervention; healthy weight), and 608 ± 180 mg (dairy intervention; overweight). Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 240 Final: 181	Prediction	r^2	Control vs. dairy intervention	Healthy vs. overweight		Boys vs. girls	Blacks vs. others
				BMC (g)
				Total body	0.67	0.77	0.0094		0.0026	0.75
				Total hip	0.49	0.7	0.93		0.57	0.88
				L1–L4	0.61	0.56	0.16		0.02	0.35
				Radius	0.39	0.72	0.07		0.14	0.36
				4% tibia (pQCT)
				BMC (mg/mm)	0.45	0.02	0.01		0.60	0.64
				Area (mm^2)	0.52	0.17	0.02		0.99	0.71
				BSI (mm^2/mm^4)	0.55	0.50	0.30		0.31	0.27
				Trabecular BMD (mg/cm^3) Note: BMD measured using DXA. BMC, area, BSI, and trabecular density measured using pQCT.	0.26	0.06	0.55		0.04	0.55
Volek et al. (2003)	RCT to examine the effects of increasing milk on bone and body composition responses to resistance training in adolescent boys Intervention: 3 servings (708 ml or 24 oz) 1% fluid milk/day Comparator: 3 servings juice (not fortified with calcium)/day Duration: 12 weeks	Sex: boys Age: 14 years Race: mixed Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: 100.6 ± 18.5 g (milk group) and 87.0 ± 33.2 g (juice group) Baseline serum 25OHD: NR	Baseline: 28 Final: 28		Milk		Juice			p-value
					Baseline	Week 12	Baseline		Week 12	Time	Group	Interaction
				BMC (g)
				Arm	322 ± 135	344 ± 139	340 ± 93		360 ± 93	0.000	0.738	0.142
				Leg	1022 ± 356	1051 ± 350	1077 ± 215		1107 ± 225	0.000	0.605	0.537
				Trunk	813 ± 324	846 ± 309	793 ± 211		818 ± 193	0.002	0.830	0.794
				Rib	259 ± 98	263 ± 88	247 ± 73		255 ± 70	0.230	0.836	0.192
				Pelvis	348 ± 154	365 ± 147	345 ± 92		356 ± 86	0.003	0.885	0.697
				Spine	206 ± 75	218 ± 77	201 ± 49		207 ± 41	0.001	0.725	0.543
				Total body	567 ± 883	2657 ± 874	2591 ± 540		2667 ± 525	0.000	0.945	0.729
				BMD (g/cm^2)
				Arm	0.852 ± 0.12	0.877 ± 0.138	0.853 ± 0.077		0.871 ± 0.077	0.000	0.930	0.365
				Leg	1.289 ± 0.237	1.323 ± 0.242	1.283 ± 0.110		1.297 ± 0.109	0.000	0.818	0.104
				Trunk	0.917 ± 0.157	0.948 ± 0.156	0.917 ± 0.089		0.933 ± 0.080	0.000	0.849	0.096
				Rib	0.698 ± 0.084	0.715 ± 0.086	0.690 ± 0.065		0.696 ± 0.054	0.007	0.618	0.352
				Pelvis	1.165 ± 0.227	1.215 ± 0.224	1.178 ± 0.134		1.207 ± 0.129	0.000	0.938	0.157
				Spine	0.961 ± 0.202	0.984 ± 0.189	0.939 ± 0.103		0.960 ± 0.103	0.003	0.684	0.889
				Total body	1.126 ± 1.167	1.154 ± 0.172	1.111 ± 0.089		1.125 ± 0.087	0.000	0.656	0.017
Zhu et al. (2006)	RCT to evaluate whether the effects of fortified milk with both calcium and vitamin D found in the Du et al. (2004) study were sustained 3 years after supplement withdrawal in girls Intervention: (1) milk fortified with 560 mg calcium/330 ml; (2) milk fortified with 560 mg calcium and 5–9 µg vitamin D/330 mL Comparator: control Duration: 3-year follow-up after 2-year intervention study	Sex: girls Age: 10–12 years Race: Asian Location: China Baseline dairy intake: 120 ± 92 g (calcium milk group), 106 ± 91 g (CaD milk group), and 136 ± 97 g (control group). Baseline calcium intake: 415 ± 142 mg (calcium milk group), 420 ± 183 mg (CaD milk group), 456 ± 174 mg (control group) Baseline protein intake: 52 ± 15 g (calcium milk group), 54 ± 15 g (CaD milk group), and 55 ± 17 g (control group) Baseline serum 25OHD: 17.8 ± 8.1 nmol/L (calcium milk group), 20.2 ± 8.4 nmol/L (CaD milk group), and 19.3 ± 7.5 nmol/L (control).	Baseline: 501 Final: 501	Difference in %Δ since baseline	Calcium milk group – control group		CaD milk group – control group			CaD milk group – Ca milk group
					%	p-value	%		p-value	%	p-value
				Total body BMC
				2-year intervention	1.0 ± 1.1	0.4	2.9 ± 1.2		0.04	1.9 ± 1.2	0.2
				3-year follow-up	0.2 ± 0.9	0.9	−0.4 ± 0.9		0.7	−0.5 ± 0.9	0.6
				Total body BA
				2-year intervention	−1.4 ± 0.9	0.2	−2.0 ± 0.9		0.07	−0.6 ± 0.9	0.6
				3-year follow-up	1.0 ± 0.6	0.1	0.4 ± 0.6		0.5	−0.6 ± 0.6	0.4
				Total body BMD
				2-year intervention	2.3 ± 0.8	0.03	5.0 ± 0.8		0.001	2.8 ± 1.0	0.02
				3-year follow-up	−0.5 ± 0.8	0.5	−0.3 ± 0.8		0.6	0.2 ± 0.8	0.8
				Size-adjusted total body BMC
				2-year intervention	1.5 ± 0.7	0.07	3.8 ± 0.7		0.002	2.4 ± 0.7	0.02
				3-year follow-up	−0.3 ± 0.8	0.7	0.04 ± 0.8		1.0	0.3 ± 0.7	0.7
Zhu et al. (2008)	RCT to investigate the effects of milk supplementation on body size-corrected BMD in girls with low habitual dietary calcium intake Intervention: (1) milk fortified with 560 mg calcium/330 ml; (2) milk fortified with 560 mg calcium and 5–9 µg vitamin D/330 ml Comparator: control Duration: 4.8 years	Sex: girls Age: 10–12 years Race: Asian Location: China Baseline dairy intake: NR Baseline calcium intake: 422 ± 146 mg (calcium milk group), 422 ± 165 mg (CaD milk group), 454 ± 171 mg (control). Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 501 Final: 501	BMDsc	Ca milk		CaD milk
					Mean (95% CI)	p-value	Mean (95% CI)		p-value
				Total body	3.6 (1.8 to 5 .4)	<0.001	5.8 (4.0 to 7.6)		<0.001
				Arms	2.5 (0.1 to 4.8)	0.04	2.3 (0.0 to 4.7)		0.05
				Legs	3.3 (1.2 to 5.3)	0.002	6.0 (4.0 to 8.1)		<0.001
				Midriff	−1.5 (−6.5 to 3.5)	0.55	3.2 (−1.7 to 8.2)		0.20
				Pelvis	0.4 (−3.0 to 3.9)	0.81	1.7 (−1.7 to 5.1)		0.32
Prospective cohort studies
Matkovic et al. (2004)	One cohort participated in a long-term RCT with calcium supplementation and the other participated in a prospective cohort study of higher calcium intake from dairy products. This study reports data for several skeletal regions of interest measured during late adolescence, from age ∼15 to ∼18 years. Cohort name: NR Exposure: dairy intake Dietary assessment method: annual 3-day food records. Follow-up: 7 years	Sex: female Age: 10.8 years (mean) at beginning but age ∼15 to ∼18 years during this assessment. Race: white Location: USA Baseline dairy intake at age 15 years: NR Baseline calcium intake at age 15 years: 881 ± 47 mg (calcium supplement group), 785 ± 41 mg (placebo), and 1213 ± 60 mg (dairy group). Baseline protein intake at age 15 years: 63 ± 2 g (calcium supplement group), 63 ± 2 g (placebo), and 75 ± 2 g (dairy group) Baseline serum 25OHD: NR	264	BMD, g/cm^2	Results
				Anterior posterior (L2 – L4) Lumbar spine Femur trochanter Femoral neck Hip Proximal radius	aBMD of the anterior posterior spine increased in all three groups from the average age of 16 to 18 years. There was no difference in BMD of the lumbar spine between the calcium supplemented and placebo groups (p = 0.313), however the dairy group had higher spine BMD at age ∼15 years, and this was maintained up to age ∼18 years. Calcium supplemented individuals had a 3% higher BMD at the femur trochanter (p = 0.0024); however, the difference (1.8%) was not significant at the femoral neck. BMD of the hip in the dairy group was similar to that of the calcium supplemented individuals. No significant differences in the three groups were noted at the proximal radius. Dividing the subjects into subgroups according to average total cumulative calcium intake over time revealed a significantly higher vBMD at the proximal radius in the high calcium intake subgroup (1008 ± 6 mg/cm^3) compared to the low calcium intake subgroup (982 ± 6 mg/cm^3) and dairy group (996 ± 7 mg/cm^3) (p = 0.045). Raw data not available but illustrated in Figures 2–5 and 7 of the original manuscript.
Moore et al. (2008)	Prospective cohort study to evaluate the effects of usual childhood dairy intake on adolescent bone health Cohort name: Framingham Children's Study Exposure: dairy intake Dietary assessment method: multiple 3-day food diaries Follow-up: 12 years	Sex: both Age: 15–17 years Race: mixed Location: USA Baseline dairy intake: 2.6 ± 0.08 servings (dairy ≥2 servings group) and 1.6 ± 0.09 servings (dairy < 2 servings group). Baseline calcium intake: 1036.6 ± 24.7 mg (dairy ≥2 servings group) and 747.8 ± 30.3 mg (dairy <2 servings group). Baseline protein intake: NR Baseline serum 25OHD: NR	106		Mean dairy intake
					≥2 servings/day	<2 servings/day	p-value
				BMC (g)
				Arms	334.5 ± 6.8	309.7 ± 8.4	0.0456
				Legs	1089.9 ± 13.6	1042.0 ± 16.9	0.0528
				Trunk	1069.3 ± 16.7	982.4 ± 20.7	0.0047
				Ribs	403.1 ± 8.4	361.5 ± 10.4	0.0130
				Pelvis	399.1 ± 6.8	368.3 ± 8.4	0.0130
				Spine	267.1 ± 5.1	252.6 ± 6.3	0.1146
				Bone area (cm^2)
				Arms	365.2 ± 4.8	354.9 ± 5.9	0.2291
				Legs	842.4 ± 5.5	836.1 ± 6.9	0.5218
				Trunk	1037.7 ± 9.9	990.8 ± 12.3	0.0097
				Ribs	501.8 ± 6.6	469.2 ± 8.2	0.0074
				Pelvis	315.3 ± 3.8	304.7 ± 4.7	0.1116
				Spine	220.4 ± 3.3	216.9 ± 4.0	0.5516
Cross-sectional studies
Budek et al. (2007)	Cross-sectional study to test the hypotheses that total protein intake is positively associated with bone mass, and if milk and meat protein intake is differently associated with bone mass in adolescents	Sex: both Age: 17 years Race: assumed white Location: Denmark Baseline dairy intake: NR Baseline calcium intake: 1067 ± 439 mg (girls) and 1319 ± 570 mg (boys). Baseline protein intake: 67.9 ± 19.9 mg (girls) and 93.5 ± 26.9 mg (boys). Baseline serum 25OHD: NR	109	BMC	Milk protein		Dairy protein
					β	p-value	β		p-value
				Model 1
				Total body	0.02	0.003	0.02		0.11
				Lumbar spine	0.03	0.01	0.001		0.97
				Model 2
				Total body	0.04	0.007	−0.01		0.72
				Lumbar spine	0.06	0.01	−0.06		0.42
Du et al. (2002)	Cross-sectional study to investigate the relationship of intakes of foods (segregated into 13 groups) and more than 20 nutrients to bone mineral status in a random sample of Chinese adolescent girls	Sex: girls Age: 12–14 years Race: Asian Location: China Baseline dairy intake: 50 ± 68 g Baseline dietary calcium intake: 356 ± 97 mg Baseline protein intake: 50 ± 9 g Baseline serum 25OHD: NR	649		No-milk group (mean ± SD)	Low-milk group (mean ± SD)	p-value		High-milk group (mean ± SD)	p-value	Total	p-value
				Distal 33% radius
				BMC (g/cm)	0.684 ± 0.134	0.711 ± 0.189	NS		0.708 ± 0.218	NS	0.701 ± 0.183	NS
				BMD (g/cm^2)	0.606 ± 0.081	0.633 ± 0.097	<0.05		0.642 ± 0.114	<0.01	0.627 ± 0.099	NS
				BW (cm)	1.123 ± 0.141	1.116 ± 0.213	NS		1.093 ± 0.176	NS	1.111 ± 0.179	NS
				Distal 33% ulna
				BMC (g/cm)	0.589 ± 0.125	0.593 ± 0.146	NS		0.596 ± 0.150	NS	0.593 ± 0.140	NS
				BMD (g/cm^2)	0.597 ± 0.087	0.612 ± 0.110	NS		0.614 ± 0.112	NS	0.608 ± 0.104	NS
				BW (cm)	0.979 ± 0.125	0.962 ± 0.131	NS		0.962 ± 0.134	NS	0.968 ± 0.130	NS
				Distal 10% radius
				BMC (g/cm)	0.554 ± 0.178	0.620 ± 0.322	<0.05		0.596 ± 0.259	NS	0.590 ± 0.260	NS
				BMD (g/cm^2)	0.352 ± 0.065	0.379 ± 0.113	<0.05		0.389 ± 0.118	<0.01	0.373 ± 0.102	NS
				BW (cm)	1.543 ± 0.309	1.567 ± 0.423	NS		1.499 ± 0.312	NS	1.537 ± 0.352	NS
				Distal 10% ulna
				BMC (g/cm)	0.335 ± 0.098	0.361 ± 0.162	NS		0.359 ± 0.161	NS	0.351 ± 0.143	NS
				BMD (g/cm^2)	0.372 ± 0.062	0.393 ± 0.103	NS		0.403 ± 0.115	<0.01	0.389 ± 0.096	NS
				BW (cm) Note: measures assessed via a portable bone mineral analyzer utilizing single photon absorptiometry.	0.880 ± 0.181	0.886 ± 0.242	NS		0.859 ± 0.187	NS	0.875 ± 0.205	NS
Esterle et al. (2009)†	Cross-sectional study to identify dietary foods and nutrients associated with lumbar BMC and BMD in adolescent girls with a special emphasis on milk, dairy products, and nutrients likely to have an impact on bone mass	Sex: women Age: 12–22 years Race: assumed white Location: France Baseline dairy intake: 166 mL (range 0–525) Baseline calcium intake: 901 mg (range 436–1764) Baseline protein intake: NR Baseline serum 25OHD: 16.9 ± 1.5 ng/mL (tertile 1), 20.1 ± 1.6 ng/mL (tertile 2), and 19.0 ± 1.2 ng/mL (tertile 3).	192		Calcium sources from milk		Calcium sources from dairy products except milk			Calcium sources from nondairy products
					β	p-value	β		p-value	β	p-value
				BMC (g)	0.143	<0.001	0.18		0.7446	−0.003	0.9634
				BMD (g/cm^2)	0.204	0.0088	0.044		0.5698	−0.011	0.8885
				Le–L4 area (cm^2)	0.015	0.8469	0.108		0.1590	0.043	0.5753
					Calcium from milk		Calcium from other foods
				BMD (g/cm^2)	0.201	0.0096	0.017		0.8212
				BMC (g)	0.0142	0.0018	0.009		0.8742
					Phosphates from milk		Phosphates from other foods
				BMD (g/cm^2)	0.203	0.0096	0.022		0.7824
				BMC (g)	0.144	0.0091	0.015		0.7836
					Magnesium from milk		Magnesium from other foods
				BMD (g/cm^2)	0.200	0.0091	0.034		0.6603
				BMC (g)	0.143	0.0083	0.034		0.5401
					Protein from milk		Protein from other foods
				BMD (g/cm^2)	0.21	0.198	0.012		0.8808
				BMC (g)	0.61	0.141	0.006		0.9085
					Energy from milk		Energy from other foods
				BMD (g/cm^2)	0.021	0.192	0.027		0.7350
				BMC (g)	0.136	0.0153	0.020		0.7232
Case-controlled studies
Konstantynowicz et al. (2007)	Case-controlled study to assess to examine the association between consumption of a milk-free diet and fracture risk.	Sex: both Age: 13 years (mean) Race: assumed white Location: Poland Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	91		Controls Number (percent)	Cases with fractures Number (percent)	p-value
				Girls Milk free diet Normal diet Boys Milk free diet Normal diet	12 (11.8) 90 (88.2) 32 (18.7) 139 (81.3)	10 (29.4) 24 (70.6) 13 (22.8) 44 (77.2)	0.016 0.501
					Milk-free diet
					Girls	Boys
				Fracture risk, OR (95% CI)	4.26 (1.24–14.69)	1.18 (0.56–2.53)
Petridou et al. (1997)†	Case-controlled study to assess intake of calcium-rich dairy products, nonalcoholic beverages, and physical activity on risk fractures among school-age children	Sex: both Age: 7–14 years Race: assumed white Location: Greece Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	100		Milk and yogurt		Cheese and other milk products
					OR (95% CI)	p-value	OR (95% CI)	p-value
				Bone fractures	0.9 (0.6–1.4)	0.623	1.1 (0.7–1.6)	0.697

Abbreviations: aBMD, areal bone mineral density; BA, bone area; BMC, bone mineral content; BMD, bone mineral density; BSI, bone strength index; BW, bone width; CI, confidence interval; FFQ, food frequency questionnaire; NR, not reported; NS, not significant; OR, odds ratio; pQCT, peripheral quantitative computed tomography; RCT, randomized controlled trial; RDA, recommended dietary allowance; vBMD, volumetric bone mineral density.

^†Age group spans into another life-stage; however, data are in this table.

Table 6. Studies assessing dairy intake on adult bone health.

Reference	Study characteristics	Population description	Number of subjects	Endpoints	Results
Clinical trials
Labouesse et al. (2014)	Controlled feeding study to determine if adequate dairy intake attenuates weight loss-induced bone loss Intervention: 3–4 servings milk, yogurt, and cheese/day (1339 mg/day calcium) Comparator: <1 serving dairy/day (460 mg/day) Duration: 15 weeks	Sex: women Age: 19–45 years Race: mixed Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: 39.0 ± 16.0 nmol/L (low dairy) and 33.0 ± 12.5 nmol/L (adequate dairy).	Baseline: 51 Final: 51	Lumbar spine BMD, Lumbar spine BMC, hip BMD, hip BMC, and select bone turnover markers	Following weight loss, adequate dairy intake resulted in significantly greater lumbar spine BMD (p < 0.004) and serum osteocalcin concentration (p < 0.004) but not lumbar spine BMC, hip BMD or hip BMC compared to a low-dairy diet.
Liu et al. (2011)	RCT to determine the effects of calcium and milk supplementation on maternal BMD in pregnant women with low habitual calcium intake Intervention: (1) 45 g milk powder/day; (2) 45 g milk powder + 600 mg calcium/day Comparator: control (habitual diet) Duration: 25 weeks	Sex: both Age: 24–31 years Race: Asian Location: China Baseline dairy intake: NR Baseline calcium intake: 480 ± 95 mg (control), 479 ± 89 mg (milk group), 486 ± 92 mg (milk + calcium tablet group) Baseline protein intake: 63.4 ± 2.6 g (control), 63.8 ± 2.9 g (milk group), 62.7 ± 2.6 g (milk + calcium tablet group). Baseline serum 25OHD: NR	Baseline: 36 Final: 35	BMD (g/cm^2)	Control	Milk	p-value	Milk + calcium	p-value
				Arm	0.607 ± 0.025	0.635 ± 0.054	NS	0.658 ± 0.035	<0.01
				Leg	1.045 ± 0.093	1.074 ± 0.078	NS	1.103 ± 0.108	NS
				Thoracic spine	0.785 ± 0.041	0.841 ± 0.065	<0.05	0.928 ± 0.063	<0.01
				Lumbar spine	0.921 ± 0.066	0.976 ± 0.090	NS	1.074 ± 0.050	<0.01
				Whole body	0.975 ± 0.037	1.014 ± 0.050	<0.05	1.047 ± 0.060	<0.01
				Right spine	0.894 ± 0.054	0.955 ± 0.054	NS	1.054 ± 0.043	<0.01
				Lateral spine	0.640 ± 0.039	0.685 ± 0.030	<0.05	0.758 ± 0.033	NS
				Femoral neck	0.782 ± 0.086	0.831 ± 0.092	NS	0.846 ± 0.088	NS
				Trochanter	0.611 ± 0.061	0.640 ± 0.065	NS	0.697 ± 0.120	<0.05
				Intertrochanter	0.992 ± 0.108	1.056 ± 0.149	NS	1.071 ± 0.146	NS
				Ward’s	0.751 ± 0.127	0.820 ± 0.121	NS	0.846 ± 0.133	NS
				Total hip	0.858 ± 0.087	0.903 ± 0.107	NS	0.934 ± 0.128	NS
Rosado et al. (2011)	RCT to evaluate the effect of the intake of low-fat milk and low-fat milk with added micronutrients on BMC. Intervention: (1) 250 ml low-fat milk 3×/day in addition to an energy-restricted diet (−500 kcal/day); (2) 250 ml low-fat milk with micronutrients consumed 3×/day in addition to an energy-restricted diet (−500 kcal/day) Comparator: control: energy-restricted diet (−500 kcal/day); no milk Duration: 16 weeks	Sex: women Age: 25–45 years Race: assumed Hispanic Location: Mexico Baseline dairy intake: 107 ± 101 mg (low-fat milk group), 136 ± 120 mg (low-fat milk + micronutrients group), and 125 ± 113 mg (control group) Baseline calcium intake: 1215 ± 40 mg (low-fat milk group), 1296 ± 47 mg (low-fat milk + micronutrients group), and 585 ± 94 mg (control group) Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 139 Final: 139	BMC (g)	Low-fat milk (95 % CI)	Milk + micronutrients (95% CI)	Control	p-value
				Baseline	2014.1 (1948.2 to 2080.0)	1893.2 (1825.2 to 1961.2)	1931.9 (1850.7 to 2013.1)	NS
				Final	2043.2 (1975.7 to 2110.7)	1920.5 (1849.2 to 1991.8)	1929.7 (1850.1 to 2009.3)	NS
				Unadjusted change, final	29.0 (15.7 to 42.4)	27.4 (12.6 to 42.2)	−2.3 (−17.6 to 13.0)	<0.05
				Adjusted change, final	29.0 (15.0 to 44.0)	27.0 (13.0 to 41.0)	−2.0 (−17.0 to 14.0)	<0.05
Prospective cohort studies
Feskanich et al. (1997)†	Prospective cohort study to examine whether higher intakes of milk and other calcium-rich foods can reduce the risk of osteoporotic fractures Cohort name: Nurses’ Health Study Exposure: intake of milk and other calcium-rich foods Dietary assessment method: FFQ Follow-up: 12 years	Sex: women Age: 30–55 years Race: white (98%) Location: USA Baseline dairy intake: Drank 2 or more glasses of milk per day as a teenager: 29.4% (≤1 glass milk/wk), 43.3% (2–6 glasses milk/wk), 52.5% (1 glass milk/d), and 67.3% ((≥2 glasses milk/d) Baseline calcium intake: 435 ± 198 mg (≤1 glass milk/wk), 588 ± 187 mg (2–6 glasses milk/wk), 749 ± 198 mg (1 glass milk/d), and 1202 ± 367 mg (≥2 glasses milk/d). Baseline protein intake: 64 ± 24 g (≤1 glass milk/wk), 70 ± 22 g (2–6 glasses milk/wk), 76 ± 23 g (1 glass milk/d), and 91 ± 26 g (≥2 glasses milk/d). Baseline serum 25OHD: NR	77,761		Total dietary calcium (mg/day)
					<450	451–625	626–900	>900	p-value (trend)
				Hip fractures
				Person-years	167,189	159,033	163,707	155,101
				Cases	27	43	33	30
				RR (95% CI)	1.00 (ref)	2.02 (1.23–3.32)	1.85 (1.06–3.22)	2.04 (1.12–3.71)	0.07
				Forearm fractures
				Cases	250	256	261	279
				RR (95% CI)	1.00 (ref)	1.02 (0.85–1.23)	0.96 (0.80–1.17)	1.08 (0.86–1.33)	0.40
					Dairy calcium (mg/day)
					<175	176–350	351–550	>550	p-value (trend)
				Hip fractures
				Person-years	157,287	174,992	155,929	156,824
				Cases	25	39	37	32
				RR (95% CI)	1.00 (ref)	1.61 (0.97–2.68)	1.94 (1.15–3.28)	1.93 (1.09–3.42)	0.05
				Forearm fractures
				Cases	246	284	235	281
				RR (95% CI)	1.00 (ref)	1.01 (0.85–1.20)	0.92 (0.76–1.11)	1.07 (0.89–1.30)	0.41
					Nondairy calcium (mg/day)
					<200	201–275	276–350	>350	p-value (trend)
				Hip fractures
				Person-years	131,938	203,891	166,620	142,581
				Cases	35	45	23	30
				RR (95% CI)	1.00 (ref)	0.91 (0.57–1.48)	0.66 (0.36–1.23)	1.17 (0.60–2.31)	0.29
				Forearm fractures
				Cases	186	315	278	267
				RR (95% CI)	1.00 (ref)	1.03 (0.85–1.26)	1.07 (0.85–1.33)	1.12 (0.87–1.44)	0.37
					Frequency of milk consumption
					<1 serving/week	2–6 servings/week	1 serving/day	2–3 servings/day	>3 servings/day	p-value (trend)
				Hip fractures
				Person-years	123,527	129,749	134,227	293,757	49,516
				Cases	40	37	32	76	8
				RR (95% CI)	1.00 (ref)	0.88 (0.56–1.38)	0.71 (0.44–1.14)	0.82 (0.55–1.22)	0.53 (0.25–1.16)	0.20
				Forearm fractures
				Cases	232	244	252	515	90
				RR (95% CI)	1.0 (ref)	1.01 (0.84–1.21)	0.99 (0.82–1.19)	0.95 (0.80–1.11)	0.96 (0.76–1.25)	0.46
Feskanich, Willett, and Colditz (2003)†	Prospective cohort study to assess relations between postmenopausal hip fracture risk and calcium, vitamin D, and milk consumption Cohort name: Nurses’ Health Study Exposure: intake of milk and other calcium-rich foods Dietary assessment method: FFQ Follow-up: 18 years	Sex: women Age: 30–55 years Race: white Location: USA Baseline dairy intake: ∼240 mL (one glass) milk Baseline calcium intake: 730 mg from food. Baseline protein intake: NR Baseline serum 25OHD: NR	72,337		Milk
					<1×/week	1–3.9×/week	4–6.9×/week	1–1.4×/day	≥1.5×/day	p-value (trend)
				Person-years	192,409	194,209	151,797	154,176	167,763
				Age-adjusted	1.00 (ref)	1.01 (0.80–1.27)	0.73 (0.56–0.95)	0.90 (0.70–1.16)	0.75 (0.58–0.96)	0.06
				Multivariate	1.00(ref)	1.13 (0.89–1.44)	0.85 (0.65–1.12)	1.02 (0.78–1.33)	0.83 (0.61–1.10)	0.21
Meyer et al (1997)	Prospective cohort study to relate factors that influence calcium balance to the incidence of hip fracture Cohort name: National Health Screening Service of Norway Exposure: milk intake Dietary assessment method: FFQ Follow-up: 11.4 years	Sex: both Age: mean 47 years Race: assumed white Location: Norway Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 23OHD: NR	39,787		Milk consumption (glasses per day)
				Hip fracture, RR (95% CI)	≤1	2	3	≥4
				Women Men	1.00 (ref) 1.00 (ref)	0.78 (0.53–1.14) 0.57 (0.27–1.19)	0.79 (0.48–1.30 0.95 (0.48–1.88)	0.83 (0.44–1.56) 0.46 (0.22–0.98)
Nieves et al. (2010)	Prospective cohort study to identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in BMD among young female runners Cohort name: NR Exposure: dairy Dietary assessment method: modified FFQ Follow-up: 2 years	Sex: women Age: 22.1 years (mean) Race: mixed Location: USA Baseline dairy intake: 2.9 ± 1.8 servings Baseline calcium intake: 1340 ± 655 mg. Baseline protein intake: NR Baseline serum 25OHD: NR	122		Dairy (per serving)	Skim milk (per additional cup/day)	Total milk (per additional cup/day)
				Spine BMD (gm/cm^2/year)	0.00069 ± 0.00058	0.00095 ± 0.00096	0.00063 ± 0.00093
				Total hip BMD (gm/cm^2/year)	0.00127 ± 0.00054*	0.00258 ± 0.00089**	0.00262 ± 0.00086**
				Whole-body BMD (gm/cm^2/year)	0.00129 ± 0.00056*	0.00132 ± 0.00094	0.00103 ± 0.00092
				Whole-body BMC (kg/year)	4.1 ± 1.3	5.2 ± 2.2*	5.1 ± 2.1*
					Dairy products (per serving)	Skim milk (cups/day)	Total milk (cups/day)
				Stress fractures (RR, 95% CI)	0.60 (0.40–0.89)*	0.38 (0.16–0.90)*	0.43 (0.20–0.89)*	*p < 0.05 **p < 0.01
Cross-sectional studies
Bahtiri et al. (2014)†	Cross-sectional study to assess dairy product consumption and dietary calcium intake, as well as to evaluate the association of different types of dairy products with BMD in adult females	Sex: women Age: 22–65 years Race: NR Location: Kosovo Baseline dairy intake: 35.04 ± 16.34 portions per week Baseline calcium intake: 818.41 ± 239.84 mg. Baseline protein intake: NR Baseline serum 25OHD: NR.	185	BMD parameter	Dairy products consumption (portions/week)
					Milk	Cheese	Yogurt	Pudding	Total dairy consumption
				< −1 SD	10.84 ± 7.83	13.93 ± 8.56	9.26 ± 8.96	1.86 ± 1.93	35.89 ± 16.51
				≥ −1 SD	9.38 ± 7.38	12.87 ± 8.90	9.39 ± 8.14	1.97 ± 2.56	33.61 ± 16.06
				p-value	0.223	0.428	0.647	0.8	0.306
				Tertile 1	9.12 ± 7.18	13.02 ± 8.70	9.08 ± 7.92	2.17 ± 2.67	33.20 ± 15.31
				Tertile 2	9.59 ± 7.77	13.16 ± 8.73	8.55 ± 8.85	1.72 ± 2.16	33.02 ± 17.13
				Tertile 3	12.20 ± 7.82	14.44 ± 8.68	10.33 ± 9.14	1.88 ± 1.61	38.85 ± 16.03
				p-value	0.065	0.616	0.315	0.563	0.065
					Calcium intake from dairy products (mg/day)
				BMD parameter	Milk	Cheese	Yogurt	Pudding	Total calcium from dairy	Total dietary calcium
				< −1 SD	464.78 ± 335.73	62.19 ± 38.22	238.08 ± 230.47	46.57 ± 48.22	811.60 ± 406.41	833.29 ± 247.91
				≥ −1 SD	401.86 ± 316.14	57.45 ± 39.74	241.49 ± 209.42	49.27 ± 64.16	750.08 ± 362.51	795.76 ± 221.131
				p-value	0.199	0.428	0.711	0.8	0.225	0.225
				Tertile 1	390.71 ± 307.54	58.11 ± 38.85	233.57 ± 203.59	52.92 ± 66.72	735.31 ± 347.05	786.75 ± 211.70
				Tertile 2	411.16 ± 333.08	58.73 ± 38.98	219.78 ± 227.51	42.97 ± 54.09	732.61 ± 415.67	785.12 ± 253.56
				Tertile 3	522.72 ± 335.26	64.48 ± 38.75	265.57 ± 235.10	47.13 ± 40.33	899.90 ± 386.78	887.15 ± 235.94*
				p-value	0.065	0.616	0.315	0.563	0.016	0.016
										*p < 0.05 (compared to tertiles 1 and 2)
Bierhals et al. (2019)	Cross-sectional study investigated the impact of milk consumption on BMD in young adults.	Sex: both Age: 22 years Race: mixed Location: Brazil Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	3,109		Men			Women
					Low	Moderate	High	Low	Moderate	High
				BMD (mean (95%CI))
				Whole body	1.273 (1.259–1.287)	1.273 (1.261–1.284)	1.259 (1.241–1.278)	1.160 (1.151–1.169)	1.162 (1.153–1.171)	1.148 (1.132–1.165)
				Lumbar spine	1.255 (1.234–1.276)	1.240 (1.223–1.257)	1.212 (1.184–1.240)	1.206 (1.192–1.221)	1.207 (1.193–1.222)	1.191 (1.163–1.218)
				Right femur	1.190 (1.165–1.215)	1.191 (1.171–1.210)	1.148 (1.116–1.181)	1.026 (1.021–1.051)	1.041 (1.026–1.056)	1.013 (0.985–1.041)
Kalkwarf, Khoury, and Lanphear (2003)	Cross-sectional study to determine whether milk intake during childhood and adolescence, when controlled for current calcium intake, is associated with adult bone mass (i.e., BMC), BMD, and the incidence of fractures	Sex: women Age: ≥20 years Race: white Location: USA Baseline dairy intake: 84.2 and 70.4% reported ≥ 1 glasses of milk per day during childhood and adolescence, respectively. Reported current intake ≥1 glasses of milk per day was 48.1 and 52.2% for women aged 20–49 years and ≥50 years, respectively Baseline calcium intake: 699 mg (669, 730) (20–49 y age group) and 672 mg (644–701) (≥50 y age group). Baseline protein intake: NR Baseline serum 25OHD: NR	3,251	Fractures	<1 serving/week	1–6 servings/week	1 serving/day	>1 serving/day	p-value
				Lifetime, child milk intake	2.02 (1.13, 3.59)	1.72 (0.84, 3.54)	1.39 (0.97, 1.99)	1.00	0.0083
				Lifetime, adolescent milk intake	1.49 (0.90, 2.46)	2.07 (1.27, 3.37)	1.13 (0.78, 1.64)	1.00	0.02
				Osteoporotic, child milk intake	2.25 (1.26, 4.00)	1.39 (0.67, 2.89)	1.00 (0.67, 1.49)	1.00	0.04
				Osteoporotic, adolescent milk intake	1.29 (0.75, 2.19)	1.59 (0.84, 3.04)	0.87 (0.57, 1.29)	1.00	0.36
					≤1 serving/week	>1, ≤1 serving/week	>1 serving/week
				Lifetime, child and adolescent milk intake	1.60 (1.17, 2.18)	0.96 (0.58, 1.57)	1.00		0.008
				Osteoporotic, child and adolescent milk intake	1.19 (0.83, 1.70)	0.85 (0.49, 1.48)	1.00		0.36
Movassagh et al. (2017)	Cross-sectional study investigated the impact of food group intake during adolescence on bone structure and strength during adulthood	Sex: both Age: 29 years Race: NR Location: Canada Baseline dairy intake: NR Baseline calcium intake: 760 ± 300 mg (low intake; females), 861 ± 314 mg (moderate intake; females), 843 ± 221 mg (high intake; females), 968 ± 437 mg (low intake; males), 1245 ± 515 mg (moderate intake; males), and 1099 ± 394 mg (high intake; males). Baseline protein intake: NR Baseline serum 25OHD: NR	116		Milk and alternative intake
					Low	Moderate	High
				Female distal radius
				Total area (mm^2)	355 ± 9	358 ± 6	343 ± 9
				Total density (mg/cm^3)	284 ± 11	299 ± 7	302 ± 11
				Trabecular area (mm^2)	307 ± 12	305 ± 8	287 ± 12
				Trabecular content (mg/mm)	67 ± 3	68 ± 2	62 ± 3
				Trabecular density (mg/cm^3)	218 ± 6	225 ± 4	217 ± 6
				Bone strength in torsion (mg^2/mm^4)	28 ± 2	32 ± 1	32 ± 2
				Female radius shaft
				Shaft total area (mm^2)	112 ± 3	117 ± 2	128 ± 3*
				Cortical area (mm^2)	78 ± 2	83 ± 1	90 ± 2**
				Shaft cortical content (mg/mm)	87 ± 2	94 ± 2	102 ± 3**
				Shaft cortical density (mg/cm^3)	1117 ± 8	1129 ± 5	1132 ± 8
				Shaft bone strength in torsion (mm^3)	235 ± 11	251 ± 8	286 ± 12
				Female distal tibia
				Total area (mm^2)	1039 ± 29	1051 ± 19	1066 ± 29
				Total density (mg/cm^3)	284 ± 10	289 ± 6	301 ± 10
				Trabecular area (mm^2)	949 ± 34	953 ± 23	957 ± 34
				Trabecular content (mg/mm)	233 ± 9	233 ± 5	243 ± 9
				Trabecular density (mg/cm^3)	246 ± 7	246 ± 4	254 ± 7
				Bone strength in torsion (mg^2/mm^4)	84 ± 5	89 ± 3	97 ± 5
				Female tibia shaft
				Total area (mm^2)	524 ± 14	537 ± 9	575 ± 13
				Cortical area (mm^2)	310 ± 7	315 ± 5	330 ± 7
				Cortical content (mg/mm)	341 ± 8	349 ± 5	361 ± 8
				Cortical density (mg/cm3)	1100 ± 6	1108 ± 4	1095 ± 6
				Bone strength in torsion (mm^3)	2126 ± 73	2237 ± 46	2362 ± 70
				Male distal radius
				Total area (mm^2)	455 ± 22	474 ± 15	476 ± 23
				Total density (mg/cm^3)	401 ± 17	355 ± 11	373 ± 17
				Trabecular area (mm^2)	357 ± 25	388 ± 17	384 ± 25
				Trabecular content (mg/mm)	104 ± 6	105 ± 4	101 ± 7
				Trabecular density (mg/cm^3)	293 ± 8	270 ± 6	267 ± 9
				Bone strength in torsion (mg^2/mm^4)	71 ± 4	60 ± 3	64 ± 4
				Male radius shaft
				Total area (mm^2)	168 ± 6	165 ± 4	165 ± 6
				Cortical area (mm^2)	116 ± 3	115 ± 2	113 ± 3
				Cortical content (mg/mm)	129 ± 4	127 ± 3	127 ± 4
				Cortical density (mg/cm^3)	1117 ± 8	1104 ± 5	1119 ± 8
				Bone strength in torsion (mm^3)	440 ± 22	414 ± 15	411 ± 22
				Male distal tibia
				Total area (mm^2)	1324 ± 57	1324 ± 40	1341 ± 60
				Total density (mg/cm^3)	361 ± 12	340 ± 8	349 ± 13
				Trabecular area (mm^2)	1153 ± 61	1164 ± 43	1150 ± 64
				Trabecular content (mg/mm)	354 ± 18	336 ± 12	331 ± 19
				Trabecular density (mg/cm^3)	308 ± 9	289 ± 6	292 ± 9
				BSI in compression (mg^2/mm^4)	173 ± 11	154 ± 8	163 ± 12
				Male tibia shaft
				Total area (mm^2)	726 ± 18	724 ± 12	716 ± 18
				Cortical area (mm^2)	418 ± 12	437 ± 8	420 ± 12
				Cortical content (mg/mm)	450 ± 13	477 ± 9	458 ± 13
				Cortical density (mg/cm^3)	1077 ± 7	1093 ± 5	1090 ± 7
				Bone strength in torsion (mm^3) Note: measures assessed using pQCT.	3398 ± 120	3502 ± 81	3369 ± 120	*p < 0.05 **p < 0.01
Opotowsky and Bilezikian (2003)	Cross-sectional study to explore the differential effects of childhood and teenage milk consumption on hip BMD in white and black postmenopausal women	Sex: women and postmenopausal women Age: 20–39 years and postmenopausal (age NR) Race: black and white Location: USA Baseline dairy intake: NR Baseline calcium intake: 608 ± 74 mg (white; <1 glass/wk), 656 ± 21 mg (white; intermediate), 879 ± 23 mg (white; >1 glass/d), 4708 ± 52 mg (black; <1 glass/wk), 573 ± 18 mg (black; intermediate), 614 ± 23 mg (black; >1 glass/d). Baseline protein intake: NR Baseline serum 25OHD: NR	19,804	Regression coefficient of BMD	20- to 39-years-old women
					1 glass/week	Intermediate	1 glass/day	p-value (for trend)
				Childhood
				Total hip, white	1.00 (ref)	0.036	0.053	0.03
				Total hip, black	1.00 (ref)	0.0137	0.0140	>0.15
				Trochanter, white	1.00 (ref)	0.021	0.040	0.02
				Trochanter, black	1.00 (ref)	0.005	0.004	>0.15
				Intertrochanter, white	1.00 (ref)	0.32	0.047	0.08
				Intertrochanter, black	1.00 (ref)	0.005	0.005	>0.15
				Femoral neck, white	1.00 (ref)	0.028	0.041	0.13
				Femoral neck, black	1.00 (ref)	0.026	0.023	>0.15
				Teenage
				Total hip, white	1.00 (ref)	0.026	0.051	<0.01
				Total hip, black	1.00 (ref)	−0.002	0.000	>0.15
				Trochanter, white	1.00 (ref)	0.017	0.039	0.01
				Trochanter, black	1.00 (ref)	−0.007	−0.005	>0.15
				Intertrochanter, white	1.00 (ref)	0.027	0.054	<0.01
				Intertrochanter, black	1.00 (ref)	−0.005	−0.004	>0.15
				Femoral neck, white	1.00 (ref)	0.02	0.041	0.02
				Femoral neck, black	1.00 (ref)	0.007	0.004	>0.15
					Postmenopausal women
					1 glass/week	Intermediate	1 glass/day	p-value (for trend)
				Childhood
				Total hip, white	1.00 (ref)	0.025	0.024	0.12
				Total hip, black	1.00 (ref)	−0.029	−0.023	>0.15
				Trochanter, white	1.00 (ref)	0.025	0.029	0.04
				Trochanter, black	1.00 (ref)	−0.019	−0.016	>0.15
				Intertrochanter, white	1.00 (ref)	0.021	0.019	>0.15
				Intertrochanter, black	1.00 (ref)	−0.012	−0.006	>0.015
				Femoral neck, white	1.00 (ref)	0.013	0.016	>0.15
				Femoral neck, black	1.00 (ref)	−0.012	−0.006	>0.15
				Teenage
				Total hip, white	1.00 (ref)	0.020	0.020	0.12
				Total hip, black	1.00 (ref)	−0.009	−0.020	>0.15
				Trochanter, white	1.00 (ref)	0.020	0.020	0.11
				Trochanter, black	1.00 (ref)	−0.007	−0.020	0.09
				Intertrochanter, white	1.00 (ref)	0.021	0.021	>0.15
				Intertrochanter, black	1.00 (ref)	−0.013	−0.028	>0.15
				Femoral neck, white	1.00 (ref)	0.016	0.018	>0.15
				Femoral neck, black	1.00 (ref)	−0.015	−0.021	>0.15
Rulu et al. (2019)	Cross-sectional study to identify risk factors for low bone mineral density. Note: study did not separate BMD findings by age (i.e. 20–45 years and >45 years) as it did some other variables. Assumption that majority of individuals with BMD measurements by QUS were 20–45 years based on other reported non-bone variables.	Sex: both Age: 20–70 years Race: Asian Location: Indonesia Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	233	Diagnosis of osteopenia or osteoporosis by BMD	Milk Intake Status	p-value
				Odds Ratio (95% Confidence Interval)	2.769 (1.207–6.351)	<0.05
Torres-Costoso et al. (2019)	Cross-sectional study to assess the relationship between milk consumption and BMD in young adults, and to examine whether this relationship is mediated by BMI and total lean and fat mass.	Sex: both Age: 18–30 years Race: Hispanic Location: Spain Baseline dairy intake: 392.26 ± 277.40 g Baseline calcium intake: 1219.77 ± 555.30 mg. Baseline protein intake: NR Baseline serum 25OHD: NR	239			Total body BMD (g/cm^2)
				Regular milk consumption		Model 0 (age + height)	Model 1 (Model 0 + physical activity)	Model 2 (Model 1 + calcium)	Model 3 (Model 2 + weight)
					n	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
				Less than daily intake	185	0.07 (0.07)	0.15 (0.95)	0.17 (0.95)	0.11 (0.08)
				Daily intake	51	−0.24 (0.13)	−0.43 (0.20)	−0.50 (0.21)	−0.24 (0.18)
				p-value		0.042	0.001	0.005	0.081
Wadolowska et al. (2013)†	Cross-sectional study to analyze the consumption of dairy products and dietary calcium by women in the context of BMD and to assess opportunities to prevent osteoporosis	Sex: women Age: 29–59 years Race: white Location: Poland Baseline dairy intake: 44.5 ± 14.0 servings per week Baseline calcium intake: 507 ± 363 mg. Baseline protein intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	882	BMD	Daily consumption of dairy during preschool period, OR (95% CI)	Daily consumption of dairy during school period, OR (95% CI)	Consumption of ≥28 servings/week dairy, OR (95% CI)	Consumption of dietary calcium >400 mg/day, OR (95% CI)	Consumption of calcium-enriched food, OR (95% CI)
				< −1.0 SD	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
				≥ −1.0 SD	4.01 (0.86–18.63)	1.22 (0.31–4.83)	1.36 (0.23–7.88)	0.62 (0.16–2.36)	0.64 (0.07–5.87)
				Tertile 1	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
				Tertile 2	1.26 (0.56–2.81)	0.71 (0.32–1.56)	1.52 (0.45–5.12)	0.50 (0.23–1.11)	0.40 (0.10–1.68)
				Tertile 3	2.73 (1.14–6.55)*	2.40 (1.01–5.70)*	1.26 (0.36–4.44)	0.47 (0.21–1.05)	0.46 (0.13–1.70)	*p < 0.05

Abbreviations: BA, bone area; BMC, bone mineral content; BMD, bone mineral density; BSI, bone strength index; BW, bone width; CI, confidence interval; FFQ, food frequency questionnaire; NR, not reported; NS, not significant; OR, odds ratio; pQCT, peripheral quantitative computed tomography; RCT, randomized controlled trial; RDA, recommended dietary allowance; RR, relative risk; vBMD, volumetric bone mineral density.

^†Age group spans into another life-stage; however, data are in this table.

Table 7. Studies assessing dairy intake on middle-aged to older adult bone health (age ≥50 years).

Reference	Study characteristics	Population description	Subjects (n)	Endpoints	Results
Clinical trials
Chee et al. (2003)	RCT to examine the effectiveness of high calcium skimmed milk to reduce bone loss in postmenopausal women. Intervention: high-calcium milk: 50 g high-calcium skimmed milk powder (calcium 1200 mg and vitamin D 10 µg) taken as 2-glasses per day. Comparator: control (usual diet) Duration: 24-months	Sex: women, postmenopausal Age: 59 years (range: 55 to 65 years) Race: Asian Location: Malaysia Baseline dairy intake: NR Baseline calcium intake: 470 ± 214 mg (high calcium milk group) and 466 ± 220 mg control group) Baseline protein intake: 65 ± 15 g (high calcium milk group) and 66 ± 17 g (control) Baseline serum 25OHD: 69.1 ± 16.1 nmol/L (high calcium milk group) and 68.4 ± 15.7 nmol/L (control)	Baseline: 200 Final: 173	Change in BMD (%)	High-calcium Milk Powder		p-value
				Total body Lumbar spine Femoral neck Total hip	−0.13 ± 0.18 −0.13 ± 0.38 0.51 ± 0.43 −0.50 ± 0.50		<0.001 <0.05 <0.01 <0.01
Chen et al. (2015)	RCT to assess the effect of high-calcium milk powder on BMD in postmenopausal women Intervention: 50 g high-calcium milk powder (containing 450 mg calcium and 400 IU vitamin D) twice daily Comparator: control Duration: 2 years	Sex: women, postmenopausal Age: 50–65 years Race: Asian Location: China Baseline dairy intake: NR Baseline calcium intake: 594.24 ± 240.62 mg (control) and 532.33 ± 165.94 mg (milk powder group). Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 282 Final: 141	T-score (%Δ)	All			Milk powder group (by compliance)
					Control	Milk powder group	p-value (control vs. intervention)	Compliers	Noncompliers	p-value (compliers vs. noncompliers)
				Spine at 1 year	0.27 ± 0.82	0.25 ± 0.63	<0.05	0.28 ± 0.64	0.05 ± 0.56	NS
				Spine at 2 years	−0.16 ± 0.80	0.03 ± 0.75	<0.05	−0.03 ± 0.76	0.34 ± 0.68	<0.05
				Hip at 1 year	−0.20 ± 0.50	0.05 ± 0.44	NS	0.04 ± 0.45	0.15 ± 0.38	NS
				Hip at 2 years	−0.19 ± 0.53	0.07 ± 0.48	NS	0.07 ± 0.47	0.08 ± 0.57	NS
Daly et al. (2005)	RCT to assess the effects of calcium and vitamin D3 fortified milk on BMD in community-living men Intervention: 400 ml reduced-fat (1%) UHT milk containing 1000 mg calcium and 800 IU vitamin D3, daily Comparator: control Duration: 2 years	Sex: men Age: >50 years Race: white Location: Australia Baseline dairy intake: NR Baseline calcium intake: 997 ± 419 mg (milk group) and 883 ± 343 mg (control group). Baseline protein intake: 97 ± 25 g (milk group) and 96 ± 26 g (control group) Baseline serum 25OHD: 77.2 ± 22.6 nM (milk group) and 76.1 ± 23.5 nM (control group).	Baseline: 167 Final: 149	BMD (%Δ)	Milk group	Control	p-value
				Femoral neck	−0.7	−2.22	<0.001
				Total hip	0.52	−0.38	<0.05
				Lumbar spine	2.13	1.44	0.08
				Ultradistal radius	−0.71	−2.28	<0.001
				33% radius	−0.17	−0.57	<0.05
Daly et al. (2008) Follow- up from Daly et al. (2005)	RCT to determine whether the skeletal benefits of fortified milk post 2-year intervention were sustained an additional 18-months after withdrawal of supplementation in older men Intervention: 400 ml reduced-fat (1%) UHT milk containing 1000 mg calcium and 800 IU vitamin D3, daily Comparator: control Duration: 2-years with 18-months additional follow-up	Sex: men Age: >50 years Race: white Location: Australia Baseline dairy intake: Frequency of intake was 12.7 vs. 18.5% (rarely or never), 47.3 vs. 27.8 (<1 glass per day), 25.5 vs. 37.0 (1–2 glasses per day), and 14.5 vs. 16.7 (>2 glasses per day) for milk group and control group, respectively Baseline calcium intake: 1058 ± 433 mg (milk group) and 887 ± 337 mg (control group). Baseline protein intake: 97 ± 27 g (milk group) and 93 ± 23 g (control group) Baseline serum 25OHD: NR	Baseline: 167 Final: 109	BMD (%Δ)	Milk group - control group (95% CI)	p-value
				Femoral neck	1.4 (0.1 to 2.7)	<0.05
				Total hip	0.7 (−0.4 to 1.8)	0.1
				Lumbar spine	−0.1 (−1.6 to 1.4)	0.92
				Ultradistal radius	1.1 (0.0 to 2.2)	<0.05
				33% radius	0.2 (−0.7 to 1.0)	0.71
Gui et al. (2012)	RCT to determine the effect of daily consumption of 250 mg calcium through cow’s milk or soymilk on BMD in postmenopausal women. Intervention: (1) milk with 250 mg calcium; (2) soymilk with 250 mg calcium. Comparator: control Duration: 18-months	Sex: women Age: 45–55 years Race: Asian Location: China Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 141 Final: 98	BMD (g/cm2)	Milk	Control	p-value
				Spine (L1-L4) Total hip Femoral neck	0.964 ± 0.092 0.912 ± 0.093* 0.714 ± 0.101*	0.929 ± 0.080 0.859 ± 0.091 0.708 ± 0.085*	0.150 0.006 0.001 *p < 0.05 compared with the mean of baseline BMD at the same site within the group.
Ilich et al. (2019)	RCT to test whether low-fat dairy foods affect BMD in postmenopausal women during weight loss. Intervention: low-fat dairy foods (4–5 servings/day Comparator: control Duration: 6-months	Sex: women, postmenopausal Age: 56 years Race: White Location: USA Baseline dairy intake: NR Baseline calcium intake: 863.9 ± 323.6 mg (control group), 942.4 ± 334.9 mg (dairy group). Baseline protein intake: 70.4 ± 16.9 g (control group) and 75.4 ± 22.0 g (dairy group) Baseline serum 25OHD: 66.6 ± 27.9 nmol/L.	Baseline: 189 Final: 97		Baseline		6-months
				BMD (g/cm2)	Control	Dairy group	Control	Dairy group
				Total body	1.159 ± 0.11	1.123 ± 0.09	1.154 ± 0.11	1.112 ± 0.10
				Lumbar spine	1.201 ± 0.16	1.174 ± 0.14	1.176 ± 0.16	1.156 ± 0.14
				Femoral neck	0.962 ± 0.13	0.919 ± 0.10	0.954 ± 0.12	0.911 ± 0.10
				Whole femur	1.009 ± 0.12	0.972 ± 0.10	1.004 ± 0.11	0.968 ± 0.10
				Radius 1/3 of Styloid process	0.700 ± 0.06	0.669 ± 0.06	0.695 ± 0.06	0.651 ± 0.07
				Whole forearms	0.512 ± 0.05	0.485 ± 0.05	0.482 ± 0.05*	0.480 ± 0.05	*p < 0.05
Lau et al. (2001)	RCT to test whether supplementing the diet of postmenopausal women prevents bone loss Intervention: milk powder (800 mg calcium) Comparator: control Duration: 24-months	Sex: women, postmenopausal Age: 55–59 years Race: Asian Location: Hong Kong Baseline dairy intake: NR Baseline calcium intake: 499 ± 261 mg (milk group) and 455 ± 195 mg (control). Baseline protein intake: 80 ± 30 g (milk group) and 73 ± 30 g (control). Baseline serum 25OHD: 66 ± 17 nmol/L (milk group).	Baseline: 185 Final: 185	BMD (mean %Δ)	Control	p-value
				Total body	−1.2 ± 0.19	<0.001
				Lumbar spine	−1.5 ± 0.29	<0.01
				Femoral neck	−1.1 ± 0.30	<0.05
				Intertrochanteric area	−1.2 ± 0.28	NS
				Total hip	−0.88 ± 0.26	<0.05
Lau et al. (2002) Follow-up from Lau et al. (2001)	RCT to determine whether the effect of calcium supplementation shown in Lau et al. (2001) could be sustained for an additional year Intervention: milk powder (contains 800 mg calcium, 240 IU vitamin D) Comparator: control Duration: 3 years	Sex: women, postmenopausal Age: 55–59 years Race: Asian Location: Hong Kong Baseline dairy intake: NR Baseline calcium intake: 497 ± 256 mg (milk group) and 464 ± 197 mg (control). Baseline protein intake: NR (described previously in Lau et al. 2001) Baseline serum 25OHD: NR (described previously in Lau et al. 2001)	Baseline: 200 Final: 197	Cumulative %Δ	Control	Milk group	% difference	p-value
				BA
				Total body	−0.65 ± 0.20	−0.06 ± 0.25	91	NS
				Lumbar spine	1.96 ± 0.38	0.35 ± 0.52	−82	<0.05
				Total hip	1.83 ± 0.32	2.28 ± 0.34	25	NS
				Femoral neck	−0.18 ± 0.45	0.01 ± 0.40	107	NS
				Intertrochanter	3.88 ± 0.64	4.31 ± 0.69	11	NS
				BMC
				Total body	−1.74 ± 0.25	−0.61 ± 0.30	65	<0.01
				Lumbar spine	0.52 ± 0.79	−0.24 ± 0.75	−147	NS
				Total hip	−0.76 ± 1.22	0.72 ± 1.14	195	NS
				Femoral neck	−2.23 ± 0.55	−0.72 ± 0.53	68	<0.05
				Intertrochanter	1.84 ± 0.58	3.00 ± 0.67	64	NS
				BMD
				Total body	−1.10 ± 0.18	−0.52 ± 0.20	53	<0.05
				Lumbar spine	−1.86 ± 0.35	−0.66 ± 0.38	65	<0.05
				Total hip	−1.30 ± 0.25	−0.25 ± 0.28	81	<0.01
				Femoral neck	−2.26 ± 0.41	−0.61 ± 0.39	73	<0.01
				Intertrochanter	−1.91 ± 0.33	−1.22 ± 0.34	36	NS
				Adjusted rate of change % baseline/year	Control	Milk	Mean (95% CI)	p-value
				Total body	−0.39	−0.16	0.23 (0.07–0.39)	<0.001
				Lumbar spine	−0.59	−0.27	0.31 (0.02–0.65)	0.06
				Total hip BMD	−0.5	−0.06	0.44 (0.19–0.69)	<0.001
				Femoral neck BMD	−0.58	0.01	0.59 (0.24–0.93)	<0.001
				Intertrochanter BMD	−0.91	−0.5	0.41 (0.11–0.71)	<0.001
Manios et al. (2007)	RCT to examine whether calcium supplementation could be as effective in achieving favorable bone mass changes in postmenopausal women as is dairy products fortified with calcium and vitamin D Intervention: (1) 1200 mg calcium and 7.5 μg via 3 portions of fortified dairy products; (2) 1200 mg calcium supplement Comparator: control Duration: 12-months	Sex: women, postmenopausal Age: 55–65 years Race: white Location: Sweden Baseline dairy intake: NR Baseline calcium intake: 664.7 ± 39.4 mg (dairy group), 531.4 ± 76.8 mg (calcium supplement group) 710.1 ± 42.9 mg (control group) Baseline protein intake: 51.8 ± 2.4 mg (dairy group), 56.8 ± 4.6 mg (calcium supplement group) 55.7 ± 2.6 mg (control group) Baseline serum 25OHD: 28.1 ± 1.4 ng/mL (dairy group), 25.1 ± 2.6 ng/mL (calcium supplement group) 25.5 ± 1.5 ng/mL (control group)	Baseline: 112 Final: 101	BMD (g/cm^2)	Dairy Group	Control	p-value
				Lumbar spine Pelvis Total spine Arms Legs Total body	2.0 (0.5–3.5) 0.9 (0.1–2.3) 4.7 (2.5–7.2) −2.4 (−4.0 – −0.6) −0.6 (−1.3–0.2) 1.5 (0.9–2.2)	−0.8 (−3.1–3.3) −0.3 (−1.6–1.1) −4.0 (−6.6 – −1.1) −4.1 (−6.2 – −1.8) 0.3 (−0.5–1.3) −0.7 (−1.4 – −0.1)	0.346 0.040 <0.001 0.126 0.150 <0.001
Moschonis et al. (2011)	RCT to examine whether a holistic approach combining nutrition and lifestyle counseling with the consumption of milk and yogurt enriched with calcium, vitamin D, and vitamin K would have any additional benefit on BMD Intervention: (1) 800 mg calcium and 10 µg vitamin D–fortified milk and yogurt; (2) 800 mg calcium, 10 µg vitamin D3, and 100 µg vitamin K1 fortified milk and yogurt; (3) 800 mg calcium, 10 µg vitamin D3, and 100 µg vitamin K2 fortified milk and yogurt Comparator: control Duration: 12-months	Sex: women, postmenopausal Age: 55–65 years Race: white Location: Greece Baseline dairy intake: NR Baseline calcium intake: 789.6 ± 213.5 mg (control), 860.8 ± 230.7 mg (CaD dairy group) 831.7 ± 362.6 mg (CaDK1 dairy group), 849.7 ± 250.9 mg (CaDK2 dairy group). Baseline protein intake: NR Baseline serum 25OHD: NR	Baseline: 115 Final: 115	ΔBMD (g/cm^2)	Control	CaD dairy group	CaDK1 dairy group	CaDK2 dairy group	p-value (treatment x time)
				Lumbar spine L2–L4 (derived from DXA)	−0.032 (−0.046 to −0.011)	−0.008 (−0.011 to 0.030)	0.016 (−0.005 to 0.036)*	0.006 (−0.018 to 0.026)*	0.001
				Total body (derived from DXA)	−0.001 (−0.008 to 0.005)	0.024 (0.016 to 0.032)*	0.013 (0.006 to 0.021)*	0.013 (0.005 to 0.021)*	0.001
				Derived from QUS, eBMD Note: measures derived from DXA and QUS.	−0.011 (−0.026 to 0.004)	−0.016 (−0.035 to 0.002)	−0.008 (−0.026 to 0.010)	−0.003 (−0.021 to 0.016)	0.762 * p < 0.05 compared to control
Prince et al. (2009)	RCT to investigate the effects of increased dietary calcium and exercise on BMD in women at least 10 years after menopause Intervention: Milk powder Comparator: placebo Duration: 2 years	Sex: women Age: 50–70 years (at least 10 years postmenopausal) Race: assumed white Location: Australia Baseline dairy intake: NR Baseline calcium intake: 787 ± 312 mg (placebo group), 778 ± 335 mg (milk powder group) Baseline protein intake: 77 ± 15 g (placebo group), 76 ± 15 g (milk powder group) Baseline serum 25OHD: 85 ± 43 nmol/L (placebo) and 77 ± 35 nmol/L (milk powder group)	Baseline: 84 Final: 84	Change in BMD per Year (5)	Milk Powder	Placebo
				Trochanter Intertrochanter Femoral neck Ultradistal ankle	0.24 ± 0.26* 0.07 ± 0.26* −0.18 ± 0.24 −1.51 ± 0.22*	−0.58 ± 0.33 −0.81 ± 0.26 −0.67 ± 0.21 −2.47 ± 0.24	*p < 0.05
Storm et al. (1998)	RCT to investigate the effects of increased dietary calcium and exercise on BMD in women at least 10 years after menopause Intervention: Milk Comparator: placebo Duration: 2 years	Sex: women Age: 71 years (mean) Race: assumed white Location: USA Baseline dairy intake: NR Baseline calcium intake: 644 ± 50 mg (milk group) and 699 ± 64 mg (placebo) Baseline protein intake: NR Baseline serum 25OHD: 25.4 ± 3.2 ng/mL (milk group) and 23.9 ± 2.7 ng/mL (placebo)	Baseline: 60 Final: 53	Change in BMD (g/cm^2)	Milk Group vs. Placebo
				Trochanter Femoral neck Lumbar spine	After 2 years, no significant changes were noted in greater trochanter, femoral neck, or lumbar spine BMD in the milk group vs. placebo (p > 0.05) Raw data not available. See Figure 2 within the original manuscript.
Ting et al. (2007) Chee et al. (2003) (original study)	RCT to determine whether the results of the Chee et al. (2003) study were sustained after study conclusion Intervention: high-calcium milk: 50 g high-calcium skimmed milk powder (calcium 1200 mg and vitamin 10 µg) Comparator: control Duration: 24-months with an additional 21-months follow-up Note: *Baseline data also reported in Chee et al. (2003)	Sex: women, postmenopausal Age: 55–70 years Race: Asian Location: Malaysia Baseline dairy intake: NR Baseline calcium intake: 477 ± 233 mg (control group) and 474 ± 193 mg (high calcium milk group) Baseline protein intake: 66 ± 18 g (control group) and 66 ± 15 g (milk group) Baseline serum 25OHD: NR	Baseline: 139 Final: 139	BMD (%Δ)	Baseline to end of treatment (24 months)			Baseline to follow-up (45 months)
					Control	High-calcium milk	p-value	Control	High-calcium milk	p-value
				Total body	−0.76 ± 0.23	0.06 ± 0.21	<0.005	−1.07 ± 0.28	−0.42 ± 0.25	<0.005
				Spine L2–L4	−1.35 ± 0.45	−0.10 ± 0.38	<0.005	−3.29 ± 0.73	−2.01 ± 0.62	<0.005
				Femoral neck	−0.95 ± 0.54	0.76 ± 0.50	<0.005	−1.49 ± 0.56	0.44 ± 0.58	<0.05
				Total hip	−1.67 ± 0.66	−0.21 ± 0.53	<0.005	−0.89 ± 0.57	−0.21 ± 0.53	<0.05
Tu et al. (2015)	RCT to investigate the effects of a Kefir-fermented milk supplemented with calcium carbonate on bone metabolism Intervention: Kefir-fermented milk (1600 mg) supplemented with calcium bicarbonate (CaC0^3, 1500 mg) Comparator: control Duration: 6-months	Sex: both, osteoporosis diagnosis Age: 67 -ears (women); 64-years (men) Race: Asian Location: Taiwan Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: 21.203 ± 11.375 ng/mL (control) and 25.245 ± 13.039 ng/mL (kefir fermented milk group)	Baseline: 69 Final: 40	BMD (g/cm^2)	Control	Kefir-fermented milk	p-value
				Spine, baseline	0.842 ± 0.215	0.843 ± 0.193	0.872
				Spin, 6-months	0.852 ± 0.204	0.849 ± 0.201	0.909
				Femoral neck, baseline	0.629 ± 0.143	0.560 ± 0.139	0.439	Note: femoral neck BMD was significantly different from baseline to 6-months in Kefir-fermented milk group only (p < 0.05)
				Femoral neck, 6-months	0.635 ± 0.126	0.591 ± 0.148	0.501
				Total hip, baseline	0.742 ± 0.161	0.677 ± 0.173	0.596
				Total hip, 6-months	0.753 ± 0.153	0.689 ± 0.182	0.52
Prospective and retrospective cohort studies
Aslam et al. (2019)		Prospective cohort study to examine the association between milk and total dairy consumption on major osteoporotic fractures. Cohort name: Geelong Osteoporosis Study Exposure: Milk and total dairy consumption. Diet assessment method: Self-reported 35 questionnaire on 35 foods at baseline and 6-years; FFQ at 10 years. Follow-up: 10 years	Sex: Women Age: ≥50 years Race: Assumed white Location: Australia Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	833		Milk Consumption
						No milk	<250 mL per day	250–500 mL per day	>500 mL per day
					Fractures, N Person years Rate (n/1000) Multivariable adjusted HR (95% CI)	24 1040.0 23.09 1.54 (0.98–2.44)	82 5001.0 16.40 1.00 (ref)	71 4092.0 17.35 1.0 (0.73–1.37)	29 1373.4 21.12 1.23 (0.80–1.96)
						Total Dairy Consumption
						<200 g per day	200–399 g per day	400–799 g per day	≥800 g per day
					Fractures, N Person years Rate (n/1000) Multivariable adjusted HR (95% CI)	61 31.25.0 19.52 1.40 (0.98–1.97)	66 4362.1 15.13 1.00 (ref)	62 3492.1 17.75 1.35 (0.95–1.91)	17 528.1 32.19 1.70 (0.99–2.93) *p < 0.05
Benetou et al. (2011)	Prospective cohort study to examine the association between diet and hip fracture incidence in elderly Europeans Cohort name: European Prospective Investigation into Cancer. Exposure: Intake of dairy products. Diet assessment method: FFQ Follow-up: 8 years	Sex: Both Age: 60–86 years Race: Assumed white Location: Italy, the Netherlands, Greece, Germany and Sweden. Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	29,122		Dairy product intake	p-value
				Hazard ratio and 95% CI per sex and country-specific quintile (trend test) for incident hip fracture.	1.02 (0.93–1.12)	0.62
Biver et al. (2018)	A prospective cohort study to investigate whether fermented dairy products, milk, or ripened cheese consumption influences age-related changed in BMD and microstructure Cohort name: Geneva Retirees Cohort Exposure: various dairy products Dietary assessment method: FFQ Follow-up: 3 years	Sex: women, postmenopausal Age: ≥65 years (mean) Race: white Location: Switzerland Baseline dairy intake: 1.5 ± 1.3 servings (<1 serving/wk), 2.2 ± 1 serving (1–6 serving/wk), 3.4 ± 1 serving (≥1 serving/d) Baseline calcium intake: 942 ± 394 mg (<1 serving/wk), 1122 ± 317 mg (1–6 serving/wk), 1502 ± 322 mg (≥1 serving/d) Dietary protein intake: 0.97 ± 0.33 g (<1 serving/wk), 1.08 ± 0.32 g (1–6 serving/wk), 1.27 ± 0.34 mg (≥1 serving/d) Baseline serum 25OHD: 65.7 ± 26.3 nmol/L (<1 serving/wk), 67.3 ± 27.6 nmol/L (1–6 serving/wk), 69.2 ± 28.2 nmol/L (≥1 serving/d)	482		Distal radius
					<1 serving/week	1–6 servings/week	≥1 serving/day	p-value (three-group comparison)	p-value (≥1 serving/day versus <1 serving/week)
				Total area (mm^2)	245 ± 35	263 ± 45	268 ± 45	0.024	0.009
				Cortical perimeter (mm)	66 ± 5	69 ± 6	69 ± 6	0.041	0.014
				Total vBMD (mg HA/cm^3)	304 ± 83	296 ± 65	298 ± 58	0.957	0.977
				Cortical vBMD (mg HA/cm^3)	848 ± 83	861 ± 66	863 ± 58	0.727	0.424
				Cortical area (mm^2)	46.6 ± 14.4	48.7 ± 10.6	49.1 ± 9.9	0.469	0.23
				Cortical thickness (mm)	0.71 ± 0.24	0.71 ± 0.17	0.71 ± 0.16	0.835	0.551
				Cortical porosity (%)	0.028 ± 0.013	0.026 ± 0.013	0.025 ± 0.013	0.325	0.316
				Trabecular vBMD (mg HA/cm^3)	145 ± 36	140 ± 38	146 ± 35	0.393	0.545
				Trabecular area (mm^2)	192 ± 40	208 ± 45	213 ± 45	0.066	0.027
				Trabecular number (mm^−1)	1.83 ± 0.33	1.81 ± 0.3	1.85 ± 0.3	0.282	0.542
				Trabecular thickness (mm)	0.066 ± 0.009	0.064 ± 0.011	0.065 ± 0.01	0.407	0.357
				Trabecular spacing (mm)	0.5 ± 0.13	0.51 ± 0.12	0.49 ± 0.14	0.296	0.553
				Trabecular spacing SD (mm)	0.25 ± 0.13	0.24 ± 0.11	0.24 ± 0.18	0.34	0.93
				Estimated failure load (N)	2522 ± 475	2619 ± 461	2679 ± 416	0.192	0.176
					Distal tibia
					<1 serving/week	1–6 servings/week	≥1 serving/day	p-value (a)	p-value (b)
				Total area (mm^2)	653 ± 79	706 ± 115	715 ± 101	0.014	0.005
				Cortical perimeter (mm)	100 ± 6	104 ± 8	105 ± 8	0.025	0.008
				Total vBMD (mg HA/cm^3)	260 ± 49	257 ± 50	259 ± 50	0.923	0.908
				Cortical vBMD (mg HA/cm^3)	809 ± 56	816 ± 66	828 ± 58	0.232	0.317
				Cortical area (mm^2)	93.6 ± 22.7	97 ± 21	99.2 ± 20.8	0.295	0.155
				Cortical thickness (mm)	0.94 ± 0.24	0.94 ± 0.24	0.95 ± 0.23	0.847	0.616
				Cortical porosity (%)	0.091 ± 0.036	0.084 ± 0.032	0.079 ± 0.031	0.189	0.281
				Trabecular vBMD (mg HA/cm^3)	153 ± 29	151 ± 35	154 ± 36	0.814	0.749
				Trabecular area (mm^2)	550 ± 84	600 ± 121	607 ± 107	0.037	0.013
				Trabecular number (mm^−1)	1.68 ± 0.32	1.71 ± 0.31	1.75 ± 0.27	0.272	0.327
				Trabecular thickness (mm)	0.077 ± 0.012	0.074 ± 0.014	0.074 ± 0.014	0.449	0.221
				Trabecular spacing (mm)	0.54 ± 0.11	0.53 ± 0.12	0.51 ± 0.09	0.343	0.419
				Trabecular spacing SD (mm)	0.27 ± 0.1	0.26 ± 0.12	0.24 ± 0.07	0.154	0.189
				Estimated failure load (N)	6130 ± 899	6359 ± 875	6467 ± 950	0.141	0.057
Cumming et al. (1997)	A prospective cohort study to investigate the relation between calcium intake and risk of fractures. Cohort name: Study of Osteoporotic Fractures Exposure: milk Dietary assessment method: FFQ Follow-up: 6.6 years	Sex: women, Age: ≥65 years Race: white Location: USA Baseline dairy intake: NR Baseline calcium intake: 714 ± 425 mg Baseline protein intake: NR Baseline serum 25OHD: NR	9,704		Current milk intake (glasses)
				HR (95% CI)	Rarely/Never	<1 per day	1–2.5 per day	≥3 per day	p-value (trend)
				Any nonvertebral fracture Hip fractures Ankle fractures Proximal humeral fractures Wrist fractures Vertebral fractures	1.0 (ref) 1.0 (ref) 1.0 (ref) 1.0 (ref) 1.0 (ref) 1.0 (ref)	1.0 (0.9–1.1) 0.9 (0.7–1.3) 0.7 (0.5–1.1) 1.2 (0.9–1.7) 1.0 (0.8–1.4) 1.1 (0.8–1.5)	1.0 (0.9–1.1) 0.9 (0.7–1.3) 0.7 (0.5–1.1) 1.0 (0.7–1.5) 1.1 (0.9–1.4) 1.3 (0.9–1.7)	1.0 (0.8–1.2) 0.9 (0.5–1.7) 0.4 (0.2–0.9) 1.2 (0.6–2.4) 0.8 (0.5–1.4) 1.4 (0.8–2.3)	0.65 0.76 0.03 0.87 0.89 0.13
Feart et al. (2013)	Prospective cohort study to examine the association of the Mediterranean Diet with fractures. Cohort name: Three City Prospective Cohort Study France Exposure: Intake of dairy products. Diet assessment method: FFQ + 24-hour recall Follow-up: 8 years	Sex: Both Age: 67.4–94.9 years Race: Assumed white Location: France Baseline dairy intake: 18.0 ± 7.8 servings per week (men) and 18.6 ± 7.8 servings per week (women) Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	1,482		Low yogurt			Low milk		Low cheese
					P	HR (95% CI)	P		HR (95% CI)	P	HR (95% CI)	P
				Hip fracture	0.92	1.06 (0.61–1.87)	0.82		1.23 (0.72–2.10)	0.45	1.44 (0.84–2.49)	0.19
				Vertebral fracture	0.09	0.87 (0.45–1.70)	0.68		1.26 (0.68–2.36)	0.46	1.49 (0.80–2.78)	0.21
				Wrist fracture	0.008	1.58 (1.13–2.20)	0.01		0.99 (0.62–1.58)	0.95	1.08 (0.67–1.76)	0.75
				Fracture at any site	0.007	1.25 (0.90–1.75)	0.18		1.16 (0.84–1.60)	0.38	1.23 (0.88–1.71)	0.23
					Low yogurt		Low milk			Low cheese
					P	HR (95% CI)	P		HR (95% CI)	P	HR (95% CI)	P
				Hip fracture	0.86	1.11 (0.62–1.99)	0.72		1.16 (0.67–2.02)	0.60	1.28 (0.72–2.28)	0.40
				Vertebral fracture	0.21	0.85 (0.42–1.70)	0.64		1.15 (0.60–2.20)	0.68	1.55 (0.80–2.99)	0.19
				Wrist fracture	0.007	1.98 (1.22–3.21)	0.005		0.96 (0.59–1.56)	0.88	0.98 (0.59–1.62)	0.93
				Fracture at any site	0.02	1.29 (0.92–1.81)	0.15		1.10 (0.79–1.53)	0.57	1.14 (0.81–1.61)	0.46
Feskanich et al. (2014)	Prospective cohort study to examine whether higher teenage milk consumption is associated with hip fractures in older adults. Cohort name: Nurses’ Health Study and Health Professionals Follow-up Study Exposure: intake of milk Dietary assessment method: FFQ Follow-up: >22 years	Sex: both Age: men: 42–77 years; women: 40–65 years Race: mixed Location: USA Baseline dairy intake: Mean intake of milk was 3.2 and 3.3 glasses per week (< 2 glasses per week in teenage years), 4.7 and 5.7 glasses per week (1 glass per day in teenage years), and 9.6 and 10.4 glasses per week (≥4 glasses per day in teenage years) Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	96,927		Teenage milk consumption
					<2/week	2–6/week	1/day	2–3/day	≥4/day	Per 1/day
				Men
				Hip fracture cases (N)	39	68	87	224	72	490
				Person-years	53,364	80,094	92,630	263,168	86,914	576,171
				RR (95% CI)
				Basic model	0.82 (0.55–1.20)	0.99 (0.71–1.37)	1.00 (ref)	1.04 (0.81–1.35)	1.19 (0.86–1.64)	1.06 (0.99–1.14)
				Adult milk intake added	0.75 (0.51–1.12)	0.97 (0.70–1.34)	1.00 (ref)	1.06 (0.82–1.38)	1.21 (0.87–1.69)	1.08 (1.01–1.16)
				Multivariable model	0.75 (0.50–1.12)	0.97 (0.69–1.35)	1.00 (ref)	1.07 (0.84–1.39)	1.21 (0.86–1.69)	1.09 (1.01–1.17)
				Women
				Hip fracture cases (N)	225	197	250	474	80	1226
				Person-years	176,056	190,898	197,054	414,803	66,013	1,044,824
				RR (95% CI)
				Basic model	1.03 (0.86–1.24)	0.86 (0.72–1.04)	1.00 (ref)	0.96 (0.82–1.12)	1.01 (0.78–1.30)	1.00 (0.96–1.05)
				Adult milk intake added	1.00 (0.83–1.20)	0.87 (0.72–1.05)	1.00 (ref)	0.97 (0.83–1.13)	1.02 (0.79–1.32)	1.01 (0.97–1.06)
				Multivariable model	1.03 (0.85–1.24)	0.89 (0.73–1.07)	1.00 (ref)	0.95 (0.81–1.12)	1.01 (0.78–1.31)	1.00 (0.95–1.05)
Feskanich et al. (2018)	Prospective cohort study to examine whether higher milk and dairy food consumption are associated with risk of hip fracture in older adults Cohort name: Nurses’ Health Study and Health Professionals Follow-up Study Exposure: intake of milk and other calcium-rich foods Dietary assessment method: FFQ Follow-up: 32 years	Sex: both Age: >50 years Race: mixed Location: USA Baseline dairy intake: Total dairy food intake was 7.4 and 6.8 servings per week (< 1 servings per week milk group), 8.7 and 8.0 servings per week (1 servings per week milk group), 10.9 and 10.2 servings per week (2–4 servings per week milk group), 13.7 and 12.8 servings per week (5–6 servings per week milk group), 15.4 and 14.6 servings per week (1 serving per day milk group), and 25.9 and 26.3 servings per week (≥ 2 servings per day milk group) for men and women, respectively Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 23OHD: NR	123,906		Milk consumption, servings
					˂1/week	1/week	2–4/week	5–6/week	1/day		≥2/day	Per 1/day
				Hip fracture risk
				Women age ˂75 years	1.00 (ref)	0.93 (0.73–1.19)	0.99 (0.82–1.19)	0.97 (0.78–1.20)	0.92 (0.75–1.11)		0.78 (0.61–1.00)	0.90 (0.83–0.98)
				Women age ≥75 years	1.00 (ref)	0.81 (0.59–1.10)	0.85 (0.67–1.08)	0.80 (0.61–1.05)	0.80 (0.62–1.03)		0.74 (0.54–1.02)	0.94 (0.84–1.05)
				Men age ˂75 years	1.00 (ref)	0.88 (0.53–1.46)	0.95 (0.65–1.37)	0.97 (0.64–1.49)	0.63 (0.41–0.97)		0.64 (0.41–1.04)	0.82 (0.69–0.98)
				Men age ≥75 years	1.00 (ref)	1.08 (0.71–1.66)	0.75 (0.53–1.06)	0.70 (0.48–1.04)	0.80 (0.55–1.15)		0.87 (0.57–1.32)	0.98 (0.85–1.13)*
				Hip fracture risk	Cumulative average consumption (Women)			Cumulative average consumption (Men)
				Milk	Cases	Person years	OR (95% CI)	Cases		Person years			OR (95% CI)
				<1/week	285	249	1.00 (ref)	109		134			1.00 (ref)
				1/week	173	140	0.89 (0.73–1.08)	66		64			1.00 (0.72–1.36)
				2–4/week	578	422	0.94 (0.81–1.09)	179		198			0.81 (0.63–1.04)
				5–6/week	331	240	0.90 (0.76–1.07)	107		109			0.79 (0.59–0.96)
				1/day	550	420	0.88 (0.75–1.03)	142		155			0.73 (0.58–0.96)
				≥2/day	221	207	0.77 (0.64–0.94)	91		99			0.77 (0.58–1.05)
				Per 1 a day	2138	1678	0.92 (0.86–0.98)	694		759			0.91 (0.82–1.02)
				Cheese
				<1/week	126	112	1.00 (ref)	90		93			1.00 (ref)
				1/week	323	251	1.09 (0.88–1.35)	123		144			0.89 (0.67–1.19)
				2–4/week	1017	740	1.03 (0.85–1.24)	333		343			0.96 (0.75–1.24)
				5–6/week	393	314	1.00 (0.81–1.24)	70		101			0.72 (0.51–1.01)
				1/day	279	261	0.94 (0.75–1.17)	78		78			1.08 (0.77–1.51)
				Per 1 a day	2138	1678	0.91 (0.81–1.02)	694		759			1.04 (0.85–1.28)
				Yogurt
				Never	668	560	1.00 (ref)	303		372			1.00 (ref)
				<1/week	814	567	0.97 (0.87–1.08)	244		235			1.12 (0.93–1.34)
				1/week	327	255	0.97 (0.84–1.12)	90		76			1.29 (1.00–1.66)
				2–4/week	297	247	1.08 (0.93–1.26)	57		76			0.92 (0.67–1.25)
				≥5/week	32	49	0.77 (0.53–1.12)	--		--			--
				Per 1 a week	2138	1678	1.00 (0.97–1.04)	694		759			1.04 (0.97–1.11)
				Total dairy foods
				<1/day	306	252	1.00 (ref)	139		158			1.00 (ref)
				1/day	873	653	0.98 (0.86–1.13)	257		301			0.82 (0.66–1.03)
				2/day	611	461	0.90 (0.78–1.05)	166		166			0.79 (0.61–1.02)
				3/day	284	234	0.88 (0.73–1.05)	80		90			0.68 (0.49–0.98)
				≥4/day	64	78	0.76 (0.57–1.02)	62		44			1.17 (0.80–1.70)
				Per 1 a day	2138	1678	0.93 (0.86–0.96)	694		759			0.96 (0.88–1.02)
Fujiwara et al. (1997)	Prospective cohort study to examine risk factors associated with hip fracture in a Japanese cohort. Cohort name: Adult Health Study Exposure: milk intake Dietary assessment method: standardized questionaire Follow-up: 14 years	Sex: both Age: 58.5 years (mean) Race: Asian Location: Japan Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 23OHD: NR	4,573		Milk Consumption (Times per Week)
				Hip fracture, RR (95% CI)	≤1 per Week	2–4 per Week	≥5 per Week
				Men and Women Women	1.00 (ref) 1.00 (ref)	1.09 (0.48–2.30) 0.80 (0.29–1.87)	0.54 (0.25–1.07) 0.58 (0.27–1.18)
Holvik et al. (2019)	Prospective cohort study to examine associations of milk intake and hip fracture in two Norwegian cohorts. Cohort name: Norwegian Counties Study 1985–1988 and Five Counties Study 2000–2002. Exposure: milk intake Dietary assessment method: FFQ Follow-up: varied	Sex: both Age: 46–53 years and 60–75 years. Race: White Location: Norway Baseline dairy intake: 2.6 ± 1.5 glasses of milk (men) and 1.7 ± 1.1 glasses of milk (women) Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	35,114 and 23,259		Norwegian Counties Study 1985–1988
					N	N hip fractures	Person-years of follow-up	HR (95% CI)	p-value
				All
				<1 glass/day	2,155	137	37,872	1.19 (0.99–1.43)	0.07
				1 glass/day	11,308	627	200,668	1.00 (ref)	--
				2 glasses/day	9,529	545	166,487	1.04 (0.93–1.17)	0.46
				3 glasses/day	6,175	297	106,366	1.01 (0.87–1.17)	0.89
				4+ glasses/day	5,947	259	101,624	1.07 (0.91–1.26)	0.40
				Per glass	35,114	1,865	613,018	0.99 (0.96–1.04)	0.78
				Men
				<1 glass/day	745	34	12,504	1.33 (0.91–1.93)	0.14
				1 glass/day	3,953	140	67,384	1.00 (ref)	--
				2 glasses/day	4,184	165	70,869	1.12 (0.89–1.40)	0.34
				3 glasses/day	3,645	113	61,578	0.94 (0.73–1.20)	0.61
				4+ glasses/day	4,648	151	79,000	1.03 (0.81–1.32)	0.80
				Per glass	17,175	603	291,335	0.97 (0.92–1.03)	0.39
				Women
				<1 glass/day	1,410	103	25,368	1.14 (0.92–1.42)	0.22
				1 glass/day	7,355	487	133,284	1.00 (ref)	--
				2 glasses/day	5,345	380	95,618	1.01 (0.88–1.16)	0.88
				3 glasses/day	2,530	184	44,788	1.05 (0.88–1.26)	0.56
				4+ glasses/day	1,299	108	22,624	1.15 (0.92–1.43)	0.21
				Per glass	17,939	1,262	321,683	1.02 (0.96–1.07)	0.58
					Five Counties Study 2000–2002
					N	N hip fractures	Person-years of follow-up	HR (95% CI)	p-value
				All
				<1 glass/day	7,924	432	87,385	0.94 (0.83–1.06)	0.32
				1–<2 glasses/day	7,986	564	86,803	1.00 (ref)	--
				2–<3 glasses/day	4,949	309	52,965	0.96 (0.84–1.11)	0.61
				3–<4 glasses/day	1,521	105	16,569	1.02 (0.83–1.26)	0.85
				4+ glasses/day	879	56	9,272	1.06 (0.80–1.39)	0.70
				Per glass	23,259	1,466	252,996	1.02 (0.97–1.06)	0.51
				Men
				<1 glass/day	3,311	127	35,491	0.88 (0.70–1.12)	0.30
				1–<2 glasses/day	3,409	173	36,005	1.00 (ref)	--
				2–<3 glasses/day	2,660	110	28,181	0.85 (0.67–1.08)	0.19
				3–<4 glasses/day	842	41	9,103	0.98 (0.69–1.38)	0.90
				4+ glasses/day	580	22	6,093	0.81 (0.52–1.26)	0.35
				Per glass	10,802	473	114,876	0.99 (0.92–1.07)	0.80
				Women
				<1 glass/day	4,613	305	51,893	0.96 (0.83–1.12)	0.62
				1-<2 glasses/day	4,577	391	50,797	1.00(ref)	--
				2-<3 glasses/day	2,289	199	24,784	1.01 (0.85–1.20)	0.87
				3-<4 glasses/day	679	64	7,466	1.03 (0.79–1.35)	0.82
				4+ glasses/day	299	34	3,178	1.23 (0.86–1.75)	0.25
				Per glass	12,457	993	138,120	1.02 (0.97–1.08)	0.39
					Categories of daily milk intake
Michaelsson et al. (2014)†	Prospective investigation into 2 cohorts to determine the association between milk consumption and time to fracture Cohort name: Swedish Mammography Cohort and Cohort of Swedish Men Exposure: milk intake Dietary assessment method: FFQ Follow-up: 20.1 years; 11.2 years	Sex: both Age: men: 39–74 years; women: 45–79 years Race: white Location: Sweden Baseline dairy intake: 240 g women) and 290 g (men) Baseline calcium intake: 733 ± 159 mg (women; <1 glass/d), 859 ± 140 mg (women; 1–2 glasses/d), 973 ± 144 mg (women; 2–3 glasses/d), and 1101 ± 175 mg (women; ≥3 glasses/d), 1239 ± 390 mg (men; <1 glass/d), 2043 ± 280 mg (men; 1–2 glasses/d), 2174 ± 295 mg (men; 2–3 glasses/d), and 2378 ± 355 mg (men; ≥3 glasses/d) Baseline protein intake: 62.2 ± 9.2 g (women; <1 glass/d), 66.4 ± 8.0 g (women; 1–2 glasses/d), 69.9 ± 8.2 g (women; 2–3 glasses/d), and 73.1 ± 8.8 g (women; ≥3 glasses/d), 98.3 ± 14.8 g (men; <1 glass/d), 101.5 ± 14.0 g (men; 1–2 glasses/d), 104.9 ± 14.1 g (men; 2–3 glasses/d), and 110.9 ± 15.3 g (men; ≥3 glasses/d) Baseline serum 25OHD: NR	106,772		<1 glass (200 g/day)	1–2 glasses (200–399 g/day)	2–3 glasses (400–599 g/day)	≥3 glasses (≥600 g/day)	Continuous (per 200 g)
				Any fracture, women	1.00 (ref)	1.07 (1.04–1.11)	1.16 (1.11–1.21)	1.16 (1.08–1.25)	1.02 (1.00–1.04)
				Hip fracture, women	1.00 (ref)	1.19 (1.11–1.28)	1.55 (1.41–1.69)	1.60 (1.39–1.84)	1.09 (1.05–1.13)
				Any fracture, men	1.00 (ref)	1.02 (0.396–1.10)	1.01 (0.93–1.08)	1.03 (0.94–1.11)	1.01 (0.99–1.03)
				Hip fracture, men	1.00 (ref)	0.95 (0.82–1.11)	1.13 (0.97–1.31)	1.01 (0.85–1.20)	1.03 (0.99–1.07)
					Categories of daily cheese intake
				OR (95% CI)	<20 g per day	20–39 g per day	40–59 g per day	≥60 g per day	Continuous (per 20 g)
				Any fracture, women	1.00 (ref)	0.87 (0.84–0.91)	0.94 (0.90–0.99)	0.89 (0.83–0.94)	0.97 (0.95–0.98)
				Hip fracture, women	1.00 (ref)	0.72 (0.67–0.78)	0.88 (0.80–0.97)	0.64 (0.55–0.74)	0.89 (0.85–0.92)
				Any fracture, men	1.00 (ref)	0.96 (0.87–1.06)	0.97 (0.88–1.06)	0.89 (0.80–0.98)	0.99 (0.97–1.01)
				Hip fracture, men	1.00 (ref)	0.76 (0.62–0.93)	0.88 (0.74–1.05)	0.75 (0.62–0.92)	0.98 (0.94–1.02)
					Categories of daily soured milk and yogurt intake
				OR (95% CI)	<20 g per day	20–39 g per day	40–59 g per day	≥60 g per day	Continuous (per 20 g)
				Any fracture, women	1.00 (ref)	0.89 (0.85–0.92)	0.94 (0.89–0.98)	0.93 (0.84–1.03)	0.98 (0.96–1.01)
				Hip fracture, women	1.00 (ref)	0.73 (0.68–0.79)	0.84 (0.76–0.93)	0.70 (0.57–0.86)	0.92 (0.87–0.98)
				Any fracture, men	1.00 (ref)	0.93 (0.87–1.00)	0.92 (0.86–0.99)	0.95 (0.87–1.03)	0.95 (0.87–1.03)
				Hip fracture, men	1.00 (ref)	0.78 (0.67–0.90)	0.75 (0.65–0.87)	0.75 (0.63–0.90)	0.97 (0.91–1.04)
Michaelsson et al. (2018)	Prospective cohort study to determine how milk and fermented milk combined with F&V consumption is associated with hip fractures Cohort name: Swedish Mammography Cohort Exposure: milk products fermented milk products Dietary assessment method: FFQ Follow-up: 22 years	Sex: women Age: 39–74 years Race: white Location: Sweden Baseline dairy intake: 17.3 ± 37.3 mL (women; <1 serving milk per day), 676.8 ± 151.9 mL (women; ≥3 servings milk per day) Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	38,071	F&V servings per day	Glasses of milk per day
					<1	≥1 or <2	≥2 or <3	≥3
				<2
				Age-adjusted hip fracture rate/1000 person-years	5.0 (4.6–5.5)	5.1 (4.6–5.7)	5.2 (4.5–5.9)	6.1 (4.7–7.7)
				≥2 to <3
				Age-adjusted hip fracture rate/1000 person-years	4.2 (3.9–4.4)	4.2 (4.0–4.5)	4.7 (4.3–5.2)	4.2 (3.5–5.1)
				≥5
				Age-adjusted hip fracture rate/1000 person-years	3.4 (3.2–3.6)	3.5 (3.2–3.9)	4.8 (4.1–5.5)	5.7 (4.5–7.2)
					Servings of fermented milk (yogurt and soured milk) per day
				F&V servings per day	0	<1	≥1 to <2	≥2
				<2
				Age-adjusted hip fracture rate/1000 person-years	6.1 (5.6–6.7)	4.6 (4.1–5.1)	4.7 (4.0–5.4)	4.4 (3.2–6.0)
				≥2 to <3
				Age-adjusted hip fracture rate/1000 person-years	5.0 (4.7–5.4)	4.0 (3.7–4.2)	4.0 (3.7–4.3)	4.0 (3.4–4.6)
				≥5
				Age-adjusted hip fracture rate/1000 person-years	3.9 (3.5–4.4)	3.5 (3.2–3.8)	3.7(3.4–4.0)	3.1(2.7–3.6)
Nevitt et al. (2005)	Retrospective cohort study to examine risk factors for first vertebral fracture. Cohort name: Study of Osteoporotic Fractures Exposure: milk intake Dietary assessment method: Interviewed FFQ Follow-up: 3.7 years	Sex: women Age: 65–99 years Race: mixed Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	7,238		Odds ratios (95% CI)
					Age-adjusted	Base multivariate model	Add radius BMD
				Milk when pregnant (<1 glass/day)	1.49 (1.09–2.04)	1.43 (1.05–1.96)	1.42 (1.04–1.94)
Owusu et al. (1997)	Prospective cohort study to examine the relation between calcium intake and risk of fractures. Cohort name: Health Professionals Follow-up Study Exposure: milk intake Dietary assessment method: FFQ Follow-up: 8 years	Sex: men Age: 40–75 years Race: mixed (96% Caucasian) Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: 90 ± 18 g (<512 mg per day calcium group), 91 ± 17 g (512–679 mg per day calcium group), 92 ± 16 g (680–871 mg per day calcium group), 93 ± 17 g (870–1227 mg per day calcium group), and 97 ± 16 g (>1227 mg per day calcium group) Baseline serum 25OHD: NR	43,063		Milk (glasses; 8-ounce)
					≤1 per week	2–6 per week	1 per day	>1–2.5 per day	>2.5 per day
				Forearm fracture Cases (N) Relative Risk (95% Confidence Interval) Hip fracture Cases (N) Relative Risk (95% Confidence Interval)	34 Reference 8 Reference	61 1.09 (0.72–1.67) 14 0.91 (0.38–2.09)	20 1.13 (0.65–1.96) 8 1.73 (0.65–4.64)	33 0.95 (0.60–1.51) 15 1.70 (0.72–4.01)	53 1.06 (0.69–1.62) 11 0.97 (0.39–2.42)
Roy et al. (2003)	Prospective cohort study to examine influence of lifestyle, anthropometric and reproductive factors on subsequent risk of incident vertebral fractures. Cohort name: European Vertebral Osteoporosis Study Exposure: milk intake Dietary assessment method: interviewer administered questionnaire. Follow-up: 3.8 years	Sex: both Age: 50–79 years Race: assumed mixed Location: 36 European centers Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	6,575	Milk intake	Risk of incident vertebral fractures
					Men		Women
					Morphometric definition HR (95% CI)	Qualitative definition HR (95% CI)	Morphometric definition HR (95% CI)	Qualitative definition HR (95% CI)
				At age < 25 years
				<1 glass/day	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
				≥1 glass/day	0.92 (0.54–1.57)	1.02 (0.63–1.64)	1.18 (0.79–1.75)	1.02 (0.71–1.46)
				At age 26–49 years
				<1 glass/day	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
				≥1 glass/day	1.08 (0.63–1.84)	1.01 (0.62–1.64)	0.94 (0.63–1.40)	0.89 (0.61–1.30)
				At age >50 years
				<1 glass/day	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
				≥1 glass/day	1.03 (0.60–1.78)	0.74 (0.44–1.26)	0.99 (0.67–1.47)	1.04 (0.71–1.50)
Sahni et al. (2013)	Prospective cohort study to evaluate the association of milk, yogurt, cheese, cream, most dairy (total dairy without cream), and milk + yogurt intakes with bone density and incident hip fracture Cohort name: Framingham Offspring Cohort Exposure: dairy intake Dietary assessment method: FFQ Follow-up: 12 years	Sex: both Age: 55 (mean) 26–85 years (range) Race: mixed Location: USA Baseline dairy intake: 9.5 ± 7.5 servings per week Baseline calcium intake: 829 ± 436 mg Baseline protein intake: 77 ± 27 g Baseline serum 23OHD: NR	3212		Milk
				BMD, mean ± SD	Quartile 1 (Lowest)	Quartile 2	Quartile 3	Quartile 4 (Highest)	p-value
				Femoral neck	0.9136 ± 0.005	0.9044 ± 0.005	0.9179 ± 0.005	0.216 ± 0.005	0.08
				Trochanter	0.7853 ± 0.005	0.7790 ± 0.005	0.7966 ± 0.005	0.7935 ± 0.005	0.05
				Lumbar spine	1.2234 ± 0.008	1.2149 ± 0.008	1.2349 ± 0.008	1.2287 ± 0.008	0.29
					Yogurt
				BMD, mean ± SD	No Intake	Medium Intake	High Intake	p-value (trend)
				Femoral neck	0.9142 ± 0.003	0.9133 ± 0.004	0.9327 ± 0.009	0.32
				Trochanter	0.7870 ± 0.003	0.7921 ± 0.004	0.8089 ± 0.009	0.05
				Lumbar spine	1.2246 ± 0.005	1.2305 ± 0.006	1.2415 ± 0.016	0.27
					Cheese
				BMD, mean ± SD	<2 Servings/Week	2–4 Servings/Week	>4 Servings/Week	p-value (trend)
				Femoral neck	0.9138 ± 0.004	0.9150 ± 0.004	0.9184 ± 0.006	0.54
				Trochanter	0.7901 ± 0.004	0.7869 ± 0.004	0.7977 ± 0.006	0.48
				Lumbar spine	1.2257 ± 0.006	1.2253 ± 0.007	1.2402 ± 0.009	0.29
					Cream Intake
				BMD, mean ± SD	Quartile 1 (Lowest)	Quartile 2	Quartile 3	Quartile 4 (Highest)	p-value
				Femoral neck	0.9130 ± 0.005	0.9180 ± 0.005	0.9121 ± 0.005	0.9090 ± 0.005	0.39
				Trochanter	0.7850 ± 0.005	0.7971 ± 0.005	0.7816 ± 0.005	0.7867 ± 0.005	0.59
				Lumbar spine	1.2282 ± 0.008	1.2286 ± 0.008	1.2223 ± 0.008	1.2211 ± 0.008	0.42
					Most Dairy (without Cream)
				BMD, mean ± SD	Quartile 1 (Lowest)	Quartile 2	Quartile 3	Quartile 4 (Highest)	p-value
				Femoral neck	0.9064 ± 0.005	0.9048 ± 0.005	0.9211 ± 0.005	0.9247 ± 0.005	0.001
				Trochanter	0.7793 ± 0.005	0.7813 ± 0.005	0.7924 ± 0.005	0.7987 ± 0.005	0.02
				Lumbar spine	1.2105 ± 0.008	1.2251 ± 0.008	1.2316 ± 0.008	1.2354 ± 0.008	0.02
					Milk + Yogurt
				BMD, mean ± SD	Quartile 1 (Lowest)	Quartile 2	Quartile 3	Quartile 4 (Highest)	p-value
				Femoral neck	0.9097 ± 0.005	0.9054 ± 0.005	0.9205 ± 0.005	0.9240 ± 0.005	0.006
				Trochanter	0.7864 ± 0.005	0.7797 ± 0.005	0.7974 ± 0.005	0.7973 ± 0.005	0.02
				Lumbar spine	1.2254 ± 0.008	1.2175 ± 0.008	1.1230 ± 0.008	1.2371 ± 0.008	0.15
				Hip fractures	No significant associations between dairy intake and hip fractures were shown (p > 0.05).
Sahni et al. (2014)	Prospective cohort study to evaluate the association of milk, yogurt, cheese, cream, and milk + yogurt intakes with incident hip fracture Cohort name: Framingham Original Cohort Exposure: dairy intake Dietary assessment method: FFQ Follow-up: 11.6 years	Sex: both Age: 68–96 years Race: white Location: USA Baseline dairy intake: 6.0 ± 6.4 servings per week (total milk), 2.6 ± 3.1 servings per week (total cheese), 3.4 ± 5.5 servings per week (yogurt), and 6.4 ± 6.7 servings per week (milk + yogurt) Baseline calcium intake: 726 ± 350 mg Baseline protein intake: NR Baseline serum 23OHD: NR	764		Milk
					Low intake		Medium intake		High intake
					HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
				Incident hip fracture	1.00 (ref)	—	0.61 (0.36–1.08)	0.071	0.58 (0.31–1.06)	0.078
					Yogurt
					No intake		Yes intake
					HR (95% CI)	p-value	HR (95% CI)	p-value
				Incident hip fracture	1.00 (ref)	—	1.09 (0.65–1.81)	0.746
					Cheese
					Minimal intake		Some intake
					HR (95% CI)	p-value	HR (95% CI)	p-value
				Incident hip fracture	1.00 (ref)	—	0.72 (0.48–1.08)	0.117
					Cream
					Low intake		Medium intake		High intake
					HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
				Incident hip fracture	1.00 (ref)	—	0.86 (0.47–1.58)	0.626	1.04 (0.59–1.86)	0.881
					Milk + yogurt
					Low intake		Medium intake		High intake
					HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
				Incident hip fracture	1.00 (ref)	—	0.65 (0.37–1.14)	0.136	0.63 (0.34–1.15)	0.133
					Total milk intake (medium-high vs. refence) adjusted RR of hip fractures, HR 0.64 (95% CI, 0.38–1.08) (p < 0.05)
Sahni et al. (2017)	Prospective cohort study to evaluate the association of dairy products with BMD in vitamin D supplement users and nonusers Cohort name: Framingham Original Cohort and Framingham Osteoporosis Study Exposure: dairy intake Dietary assessment method: FFQ Follow-up: 3.9 years	Sex: both Age: 67–93 years Race: white Location: USA Baseline dairy intake: 8.6 ± 7.0 servings per week milk + yogurt + cheese (vitamin D supplement nonusers) and 9.7 ± 8.0 servings per week milk + yogurt + cheese (vitamin D supplement users) Baseline calcium intake: 745 ± 368 mg (vitamin D supplement nonusers) and 966 ± 527 mg (vitamin D supplement users) Baseline protein intake: 67 ± 23 g (vitamin D supplement nonusers) and 71 ± 25 g (vitamin D supplement users) Baseline serum 25OHD: NR	628		Vitamin D supplement nonusers		Vitamin D supplement users
					β ± SE	p-value	β ± SE	p-value
				%Δ in femoral neck BMD
				Milk	−0.0270 ± 0.0566	0.63	0.1056 ± 0.0873	0.22
				Yogurt	0.1639 ± 0.276	0.55	−0.5967 ± 0.3919	0.13
				Cheese	−0.0487 ± 0.121	0.69	0.1690 ± 0.198	0.39
				Cream	−0.0397 ± 0.059	0.50	−0.2623 ± 0.168	0.12
				Fluid dairy	−0.0208 ± 0.053	0.70	0.0709 ± 0.083	0.40
				Milk + yogurt + cheese	−0.0276 ± 0.053	0.60	0.0836 ± 0.077	0.28
				%Δ in trochanter BMD
				Milk	−0.0590 ± 0.074	0.42	0.2084 ± 0.101	0.040
				Yogurt	−0.4501 ± 0.361	0.21	0.4229 ± 0.469	0.37
				Cheese	−0.2361 ± 0.159	0.13	0.3817 ± 0.230	0.09
				Cream	0.0413 ± 0.077	0.59	−0.1922 ± 0.199	0.33
				Fluid dairy	−0.0843 ± 0.073	0.25	0.2127 ± 0.097	0.030
				Milk + yogurt + cheese	0.1163 ± 0.070	0.09	0.2352 ± 0.089	0.009
				%Δ in lumbar spine BMD
				Milk	0.1226 ± 0.071	0.09	−0.0560 ± 0.152	0.71
				Yogurt	−0.0966 ± 0.359	0.79	−0.9177 ± 0.779	0.24
				Cheese	−0.2860 ± 0.158	0.07	0.4567 ± 0.271	0.09
				Cream	−0.0441 ± 0.074	0.55	0.2268 ± 0.202	0.26
				Fluid dairy	0.1145 ± 0.070	0.10	−0.0692 ± 0.148	0.63
				Milk + yogurt + cheese	0.0547 ± 0.069	0.42	0.0358 ± 0.128	0.78
Cross-sectional studies
Chan et al. (2020)		Cross-sectional study to assess the association between risk factors and bone health status.	Sex: Both Age: ≥40 years (average 57.16 years) Race: Mixed Asian (Indian, Malay, Chinese) Location: Malaysia Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	786	Hip fracture risk, OR (95% CI)	Dairy products
						Drinker	Non-drinker	p-value
					Both sexes Males Females	1.038 (0.733–1.471) 0.830 (0.483–1.427) 1.261 (0.759–2.095)	1.00 (ref) 1.00 (ref) 1.00 (ref)	0.833 0.501 0.371
Eysteinsdottir et al. (2014)	Cross-sectional study to assess the association between milk consumption in adolescence, midlife, and current old age on current hip BMD and BMC in old age.	Sex: both Age: 66–96 years Race: assumed white Location: Iceland Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	4797		Milk intake
				Δ Z-score (95% CI)	1 serving/week	1–6 servings/week	≥1 serving/day	p-value
				Trochanter
				Male BMD
				Adolescence	1.00 (ref)	0.09 (−0.23–0.41)	0.13 (−0.17–0.44)	0.28
				Midlife	1.00 (ref)	0.16 (−0.02–0.34)	0.21 (0.05–0.39)	0.02
				Current	1.00 (ref)	−0.02 (−0.14–0.10)	0.09 (−0.01–0.20)	0.04
				Male BMC
				Adolescence	1.00 (ref)	0.03 (−0.28–0.34)	0.1 (−0.21–0.40)	0.18
				Midlife	1.00 (ref)	0.12 (−0.06–0.29)	0.18 (0.01–0.35)	0.03
				Current	1.00 (ref)	0.00 (−0.12–0.12)	0.07 (−0.04–0.17)	0.15
				Male bone volume
				Adolescence	1.00 (ref)	−0.10 (−0.43–0.22)	−0.06 (−0.37–0.25)	0.65
				Midlife	1.00 (ref)	−0.07 (−0.25–0.12)	−0.05 (−0.23–0.12)	0.79
				Current	1.00 (ref)	0.02 (−0.15–0.10)	−0.04 (−0.15–0.07)	0.47
				Female BMD
				Adolescence	1.00 (ref)	0.11 (−0.08–0.30)	0.12 (−0.06–0.30)	0.29
				Midlife	1.00 (ref)	0.14 (0.00–0.27)	0.2 (0.07–0.33)	0.002
				Current	1.00 (ref)	0.06 (−0.03–0.16)	0.07 (−0.01–0.16)	0.12
				Female BMC
				Adolescence	1.00 (ref)	0.04 (−0.15–0.23)	0.1 (−0.08–0.28)	0.11
				Midlife	1.00 (ref)	0.12 (−0.01–0.25)	0.15 (0.02–0.28)	0.04
				Current	1.00 (ref)	0.1 (0.01–0.21)	0.03 (−0.05–0.12)	0.69
				Female bone volume
				Adolescence	1.00 (ref)	−0.08 (−0.28–0.13)	−0.01 (−0.20–0.18)	0.36
				Midlife	1.00 (ref)	−0.01 (−0.15–0.14)	−0.03 (−0.17–0.11)	0.54
				Current	1.00 (ref)	0.08 (−0.03–0.18)	−0.02 (−0.11–0.07)	0.45
				Femoral neck
				Male BMD
				Adolescence	1.00 (ref)	0.09 (−0.23–0.41)	0.13 (−0.17–0.44)	0.10
				Midlife	1.00 (ref)	0.16 (−0.02–0.34)	0.21 (0.05–0.39)	0.02
				Current	1.00 (ref)	−0.02 (−0.14–0.10)	0.09 (−0.01–0.20)	0.04
				Male BMC
				Adolescence	1.00 (ref)	0.03 (−0.28–0.34)	0.10 (−0.21–0.40)	0.18
				Midlife	1.00 (ref)	0.12 (−0.06–0.29)	0.18 (0.01–0.35)	0.03
				Current	1.00 (ref)	0.00 (−0.12–0.12)	0.07 (−0.04–0.16)	0.15
				Male bone volume
				Adolescence	1.00 (ref)	−0.10 (−0.43–0.22)	−0.06 (−0.37–0.25)	0.65
				Midlife	1.00 (ref)	−0.07 (−0.25–0.12)	−0.05 (−0.23–0.12)	0.79
				Current	1.00 (ref)	0.02 (−0.15–0.10)	−0.04 (−0.15–0.07)	0.47
				Female BMD
				Adolescence	1.00 (ref)	0.11 (−0.08–0.30)	0.12 (−0.06–0.30)	0.29
				Midlife	1.00 (ref)	0.14 (0.00–0.27)	0.20 (0.07–0.33)	0.002
				Current	1.00 (ref)	0.06 (−0.03 to 0.16)	0.07 (−0.01–0.16)	0.12
				Female BMC
				Adolescence	1.00 (ref)	0.04 (−0.15–0.23)	0.10 (−0.08–0.28)	0.11
				Midlife	1.00 (ref)	0.12 (−0.01–0.25)	0.15 (0.02–0.28)	0.04
				Current	1.00 (ref)	0.10 (0.01–0.21)	0.03 (−0.05–0.12)	0.69
				Female bone volume
				Adolescence	1.00 (ref)	−0.08 (−0.28–−0.13)	−0.01 (−0.20–0.18)	0.36
				Midlife	1.00 (ref)	−0.01 (−0.15–0.14)	−0.03 (−0.17–0.11)	0.54
				Current Note: measures assessed by QCT.	1.00 (ref)	0.10 (0.01–0.21)	0.03 (−0.05–0.12)	0.45
Lanyan et al. (2020)	Cross-sectional study to evaluate associations between nutrients, dietary patterns or compliance to dietary guidelines for bone health.	Sex: women Age: 64.3 ± 7.5 years Race: assumed white Location: Switzerland Baseline dairy intake: 215 ± 5 g (no osteoporosis group) and 175 ± 12 g (osteoporosis group) Baseline calcium intake: 1010 ± 12 (no osteoporosis group) and 928 ± 30 (osteoporosis group) Baseline protein intake: 62.4 ± 0.4 g (no osteoporosis group) and 61.3 ± 1.0 g (osteoporosis group) Baseline serum 25OHD: NR	1,215		Osteoporosis status by T-score
					No Osteoporosis	Osteoporosis	p-value
				Dairy, g per day Dairy (≥3 servings per day), OR (95% CI)	215 ± 5 1.00 (ref)	175 ± 12 0.44 (0.22–0.86)	0.003 0.017
Lunt et al. (2001)	Cross-sectional study to determine the effects of selected environmental factors on BMD in the European Vertebral Osteoporosis Study (EVOS) cohort and to explore the role of bone density as an explanatory intermediary variable in the determination of vertebral deformity occurrence	Sex: both Age: 50–80 years Race: white Location: Europe Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	4000	Risk factor	Hard cheese	Soft cheese	Yogurt	Milk	Other milk products	Cumulative milk drinking
				Spine BMD (g/cm^2)
				Men	0.0046 (0.0000–0.0091)*	0.0003 (−0.0046–0.0052)	0.0016 (−0.0029–0.0060)	0.0035 (−0.0004–0.0075)	0.0028 (−0.0042–0.0097)	0.0009 (0.0139–70.0120)
				Women	0.0017 (−0.0022–0.0056)	0.0037 (−0.0003–0.0078)	0.0034 (0.0000–0.0069)*	0.0026 (−0.0008–0.0060)	−0.0004 (−0.0063–0.0054)	0.0052 (0.0161–70.0056)
				Femoral neck BMD (g/cm^2)
				Men	0.0044 (0.0011–0.0077)*	0.0009 (−0.0029–0.0048)	0.0032 (−0.0002–0.0066)	0.0014 (−0.0017–0.0045)	0.0007 (−0.0042–0.0057)	0.0007 (0.0108–70.0095)
				Women	0.0006 (−0.0022–0.0033)	0.002 (−0.0009–0.0050)	0.0026 (0.0001–0.0051)*	0.0061 (0.0035–0.0087)*	−0.0006 (−0.0046–0.0035)	0.0133 (0.0215–0.0051)*
				Trochanter BMD (g/cm^2)
				Men	0.0047 (0.0016–0.0077)*	0.001 (−0.0026–0.0045)	0.003 (−0.0002–0.0062)	0.002 (−0.0009–0.0049)	0.0002 (−0.0044–0.0048)	0.0035 (0.0130–70.0059)
				Women	0.0023 (−0.0002–0.0047)	0.0034 (0.0008–0.0060)*	0.0019 (−0.0003–0.0042)	0.0044 (0.0021–0.0067)*	−0.0001 (−0.0037–0.0035)	0.0144 (0.0218–0.0070)*	*p < 0.05
Mangano et al. (2019)		Cross-sectional study to examine associations of dairy intake with BMD among Puerto Rican adults.	Sex: both Age: 45–75 years Race: Hispanic Location: USA Baseline dairy intake: ∼1.5 servings per day Baseline calcium intake: 1005 ± 573 mg Baseline protein intake: NR Baseline serum 25OHD:14.3 ± 3.6 ng/mL (vitamin D-insufficient individuals) and 26.0 ± 5.5 in vitamin D-sufficient individuals)	904	BMD (g/cm^3) across tertiles of dairy food intake
							Tertile 1	Tertile 2	Tertile 3	p-value (trend)
						Femoral neck
						N	293	295	296
						Total dairy	0.933 ± 0.01	0.953 ± 0.01	0.952 ± 0.01	0.10
						Modified dairy	0.993 ± 0.01	0.954 ± 0.01	0.952 ± 0.01	0.09
						Fluid dairy	0.943 ± 0.01	0.954 ± 0.01	0.956 ± 0.01	0.11
						Cream + dessert dairy	0.947 ± 0.01	0.943 ± 0.01	0.946 ± 0.01	0.94
						Cheese	0.950 ± 0.01	0.948 ± 0.01	0.938 ± 0.01	0.30
						High-fat dairy	0.938 ± 0.01	0.946 ± 0.11	0.955 ± 0.01	0.13
						Low-fat dairy	0.935 ± 0.01	0.952 ± 0.01	0.949 ± 0.01	0.23
						Trochanter
						N	293	295	296
						Total dairy	0.837 ± 0.01	0.848 ± 0.01	0.850 ± 0.01	0.24
						Modified dairy	0.837 ± 0.01	0.847 ± 0.01	0.851 ± 0.01	0.23
						Fluid dairy	0.843 ± 0.01	0.848 ± 0.01	0.848 ± 0.01	0.41
						Cream + dessert dairy	0.845 ± 0.01	0.841 ± 0.01	0.847 ± 0.01	0.90
						Cheese	0.845 ± 0.01	0.852 ± 0.01	0.836 ± 0.01	0.42
						High-fat dairy	0.844 ± 0.01	0.839 ± 0.01	0.850 ± 0.01	0.58
						Low-fat dairy	0.839 ± 0.01	0.845 ± 0.01	0.850 ± 0.01	0.34
						Total femur
						N	290	292	293
						Total dairy	1.030 ± 0.01	1.043 ± 0.01	1.047 ± 0.01	0.16
						Modified dairy	1.030 ± 0.01	1.045 ± 0.01	1.045 ± 0.01	0.24
						Fluid dairy	1.038 ± 0.01	1.046 ± 0.01	1.046 ± 0.01	0.30
						Cream + dessert dairy	1.043 ± 0.01	1.037 ± 0.01	1.039 ± 0.01	0.78
						Cheese	1.042 ± 0.01	1.044 ± 0.01	1.032 ± 0.01	0.46
						High-fat dairy	1.039 ± 0.01	1.033 ± 0.01	1.048 ± 0.01	0.48
						Low-fat dairy	1.033 ± 0.01	1.042 ± 0.01	1.044 ± 0.01	0.38
						Lumbar spine
						N	285	291	289
						Total dairy	1.157 ± 0.01	1.167 ± 0.02	1.179 ± 0.02	0.16
						Modified dairy	1.157 ± 0.01	1.168 ± 0.02	1.179 ± 0.02	0.15
						Fluid dairy	1.163 ± 0.01	1.160 ± 0.02	1.183 ± 0.02	0.13
						Cream + dessert dairy	1.169 ± 0.02	1.168 ± 0.02	1.165 ± 0.02	0.96
						Cheese	1.172 ± 0.02	1.174 ± 0.02	1.155 ± 0.02	0.27
						High-fat dairy	1.164 ± 0.02	1.160 ± 0.02	1.178 ± 0.02	0.37
						Low-fat dairy	1.169 ± 0.02	1.171 ± 0.02	1.1681 ± 0.02	0.82
McCabe et al. (2004)	Cross-sectional study to examine the cross-sectional relation between calcium and other nutrients from dairy product consumption and BMD at hip in elderly black and white men and women	Sex: both Age: ≥60 years Race: black and white Location: USA Baseline dairy intake: NR Baseline calcium intake: 628 (311–1090) mg Baseline protein intake: 53 (32–82) g Baseline serum 25OHD: NR	745		Black and white men	p-value	Black and white women	p-value
				Total hip BMD
				Partial correlation of dairy servings (n/day)	0.19	<0.05	0.02	NS
				Partial correlation of % dairy calcium	0.17	<0.05	0	NS
				Femoral neck BMD
				Partial correlation of dairy servings (n/day)	0.18	<0.05	0.06	NS
				Partial correlation of % dairy calcium	0.14	<0.05	0.06	NS
Murphy et al. (1994)†	Cross-sectional study to relate historical milk consumption and BMD in the axial skeleton in a sample of community based middle-aged and elderly women	Sex: women Age: 44–74 years Race: assumed white Location: UK Baseline dairy intake: NR Baseline calcium intake: 758 ± 380 mg (<1 glass/wk), 908 ± 416 mg (<1 glass/d), 852 ± 249mg (≥1 glass/d) Baseline protein intake: NR Baseline serum 25OHD: NR	284	BMD (g/cm^2)	Historical milk intake up to age 25 years
					<1 glass/week	<1 glass/day	≥1 glass/day	p-value
				Spine (L2–L4)	0.96	0.97	1.00	0.216
				Total hip	0.84	0.86	0.89	0.039
				Femoral neck	0.7	0.72	0.75	0.048
				Trochanter	0.64	0.65	0.68	0.076
				Intertrochanter	0.99	1.01	1.04	0.06
				Ward's triangle	0.53	0.57	0.59	0.019
					Historical milk intake between age 25 to 44 years
				Spine (L2–L4)	0.95	0.98	0.97
				Total hip	0.85	0.87	0.88
				Femoral neck	0.71	0.73	0.75
				Trochanter	0.64	0.65	0.66
				Intertrochanter	0.53	0.56	0.59*
				Ward's triangle
					Milk intake between age 44 years to present
				Spine (L2–L4)	0.97	0.98	0.97
				Total hip	0.86	0.87	0.89
				Femoral neck	0.72	0.74	0.74
				Trochanter	0.66	0.66	0.67
				Ward's	0.55	0.58	0.59
				p < 0.05
Sato et al. (2015)	Cross-sectional study to examine whether milk intake is associated with levels of bone turnover markers, bone microarchitecture status, and aBMD in elderly Japanese men with lower calcium intake relative to Caucasians	Sex: men Age: ≥65 years Race: Asian Location: Japan Baseline dairy intake: NR Baseline calcium intake: 514 ± 187 mg Baseline protein intake: 71 ± 14 g Baseline serum 25OHD: NR	1479	aBMD (g/cm^2)	Habitual milk intake
					<1 glass/week	Several glasses/week	1 glass/day	≥2 glasses/day	p-value
				Lumbar spine	0.999 ± 0.010	1.014 ± 0.010	1.016 ± 0.007	1.022 ± 0.018	0.2417
				Total hip	0.875 ± 0.006	0.881 ± 0.006	0.890 ± 0.005	0.900 ± 0.011	0.0297
				Femoral neck	0.738 ± 0.006	0.742 ± 0.006	0.750 ± 0.004	0.751 ± 0.010	0.1082
				Trabecular bone score	1.187 ± 0.005	1.192 ± 0.005	1.198 ± 0.003	1.198 ± 0.008	0.0867
					Habitual dietary calcium intake (mg/Day)
					130–384 mg/day	385–497 mg/day	498–622 mg/day	623–1745 mg/day	p-value
				Lumbar spine	1.004 ± 0.010	1.019 ± 0.010	1.013 ± 0.010	1.011 ± 0.010	0.7654
				Total hip	0.870 ± 0.006	0.881 ± 0.006	0.886 ± 0.006	0.902 ± 0.006	0.0001
				Femoral neck	0.733 ± 0.006	0.738 ± 0.005	0.749 ± 0.005	0.761 ± 0.006	0.0002
				Trabecular bone score	1.185 ± 0.004	1.192 ± 0.004	1.198 ± 0.004	1.202 ± 0.004	0.0044
Zhu et al. (2018)	Cross-sectional study to explore risk factors associated with low-energy fracture since menopause in postmenopausal women.	Sex: women Age: ≤70 years Race: Asian Location: China Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	68,783		Milk Intake (servings/day)
				OR (95% CI)	Never	<1/Week	1–6/Week	≥1/Day
				Incident low-energy fracture since menopause	1.00 (ref)	0.94 (0.69–1.29)	1.25 (0.90–1.75)	1.79 (1.33–2.41)*	*p < 0.001
Case-controlled studies
Cumming and Klineberg (1994)	Case-controlled study to identify risk factors for hip fracture, particularly factors during young and middle adult life.	Sex: both Age: ≥65 years Race: assumed white Location: Australia Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	416		Dairy Product Intake (Quintiles)
				Hip fracture risk OR (95% CI)	1	2	3	4	5	p-value for trend
				Age 20 years Current Age	1.00 (ref) 1.00 (ref)	0.8 (0.2–3.2) 1.5 (0.5–4.7)	1.8 (0.5–6.3) 1.3 (0.4–3.8)	3.4 (1.0–12.1) 2.7 (0.8–8.5)	2.9 (0.8–9.9 1.7 (0.5–5.4)	0.013 0.23
Jha et al. (2010)	Case-controlled study to identify risk factors for hip fracture in an urban Indian population.	Sex: both Age: 62.5 years (mean) Race: Indian Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	200		Milk intake			Milk quantity
					Non-consumer	Consumer	p-value	≤1 glass per day	>1 glass per day	p-value
				Hip fracture, HR 95% CI	1.00 (ref)	0.67 (0.38–1.17)	0.16	1.00 (ref)	0.30 (0.13–0.72)	0.006
Jitapunkul, Yuktananandana, and Parkpian (2001)	Case-controlled study to identify risk factors of hip fracture.	Sex: women Age: ≥50 years Race: Asian Location: Thailand Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	120	OR (95% CI)	No Regular Intake of Milk
				Hip fracture	3.84 (1.31–11.23)
Johnell et al. (1995)	Case-controlled study to determine common international risk factors for hip fractures.	Sex: women Age: ≥50 years Race: assumed white Location: Portugal, Spain, France, Italy, Greece and Turkey Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	5,618	OR (95% CI)	Milk consumption (quartiles)	Milk intake
					1	2	3	4	Highest 90%
				Hip fracture	1.00 (ref)	0.75 (0.61–0.93)	0.65 (0.53–0.80)	0.77 (0.66–0.89)	0.71 (0.58–0.87)
Kanis et al. (1999)	Case-controlled study to identify risk factors for hip fracture.	Sex: men Age: ≥55 years Race: assumed white Location: Portugal, Spain, France, Italy, Greece and Turkey Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	1,862		Consumption (Quintiles)
				Hip fracture, OR (95% CI)	1	2	3	4	5
				Intake of milk Intake of cheese	1.00 (ref) 1.00 (ref)	0.82 (0.58–1.17) 0.50 (0.32–0.77)	0.72 (0.51–1.01) 0.32 (0.20–0.53)	0.75 (0.54–1.04) 0.54 (0.33–0.89)	0.94 (0.57–1.57) 0.40 (0.25–0.63)
Lan et al. (2010)	Case-controlled study to determine important characteristics of hip fracture in older adults.	Sex: both Age: ≥60 years Race: Asian Location: Taiwan Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	725		Milk intake (times per week)
					None or <1	1–5	≥6	p-value
				Hip fracture, HR 95% CI	1.00 (ref)	1.16 (0.66–2.03)	0.58 (0.37–0.91)	0.006
Nieves, Grisso, and Kelsey (1992)	Case-controlled study to examine possible risks associated with current dietary intake and with calcium intake and physical activity reported for the teen years on hip fractures	Sex: women Age: 50–103 years (range) Race: white Location: USA Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	161	Hip fracture, HR( 95%CI)	Milk intake (glasses per week in teenage years)
					None	1–6 Glasses	≥7 Glasses
					1.00 (ref)	1.71 (0.85–3.41)	1.10 (0.63–1.94_
					Milk intake (teenage years)
				Recreational activity (number of time per week in teenage years	< 1 Glass/Day	≥ 1 Glass/Day
				< 1	1.00 (ref)	1.00 (ref)
				1–2	0.82 (0.19–3.46)	0.22 (0.03–1.60)
				3–4	0.43 (0.10–1.85)	0.22 (0.03–1.31)
				5+	0.56 (0.13–2.25)	0.12 (0.02–0.57)
Tavani, Negri, and Vecchia (1995)	Case-controlled study to examine the relation between hip fracture and intake of calcium and dairy products	Sex: women Age: ≥45 years Race: assumed white Location: Italy Baseline dairy intake: NR Baseline calcium intake: NR Baseline protein intake: NR Baseline serum 25OHD: NR	960		Milk intake (drinks per week)			Cheese intake (portions per week)
					<7	7	>7	<4	4–6	>6
				Hip fracture, N Control, N OR 95% CI	101 303 Reference	101 278 1.2 (0.9–1.8)	39 138 1.0 (0.6–1.6)	85 252 Reference	63 176 1.2 (0.8–1.7)	93 291 1.0 (0.7–1.5)

Abbreviations: aBMD, areal bone mineral density; BA, bone area; BMC, bone mineral content; BMD, bone mineral density; eBMD, estimated bone mineral density; F&V, fruits and vegetables; FFQ, food frequency questionnaire; FOS, fructooligosaccharide; HA, hydroxyapatite; HR, hazard ratio; NR, not reported; NS, not significant; QUS, quantitative ultrasound; RCT, randomized controlled trial; RR, relative risk; UHT, ultra-high temperature.

^†Age group spans into another life-stage; however, data are in this table.

Ganpule, A., C. S. Yajnik, C. H D. Fall, S. Rao, D. J. Fisher, A. Kanade, C. Cooper, S. Naik, N. Joshi, H. Lubree, et al. 2006. Bone mass in Indian children - relationships to maternal nutritional status and diet during pregnancy: The Pune Maternal Nutrition Study. The Journal of Clinical Endocrinology & Metabolism 91 (8):2994–3001. doi: https://doi.org/10.1210/jc.2005-2431.

 PubMed Web of Science ®Google Scholar

Specker, B. M., A. H. Beck, Kalkwarf, and M. Ho. 1997. Randomized trial of varying mineral intake on total body bone mineral accretion during the first year of life. Pediatrics 99 (6):E12. doi: https://doi.org/10.1542/peds.99.6.e12.

 PubMed Web of Science ®Google Scholar

Allison, R. M., C. S. Birken, G. Lebovic, A. W. Howard, M. R. L'Abbe, M.-E. Morency, and J. L. Maguire. 2020. Consumption of cow's milk in early childhood and fracture risk: A prospective cohort study. American Journal of Epidemiology 189 (2):146–55. doi: https://doi.org/10.1093/aje/kwz216.

 PubMed Web of Science ®Google Scholar

Andres, A., P. H. Casey, M. A. Cleves, and T. M. Badger. 2013. Body fat and bone mineral content of infants fed breast milk, cow's milk formula, or soy formula during the first year of life. The Journal of Pediatrics 163 (1):49–54. doi: https://doi.org/10.1016/j.jpeds.2012.12.067.

 PubMed Web of Science ®Google Scholar

Hillman, L. S., W. Chow, S. S. Salmons, E. Weaver, M. Erickson, and J. Hansen. 1988. Vitamin D metabolism, mineral homeostasis, and bone mineralization in term infants fed human milk, cow milk-based formula, or soy-based formula. The Journal of Pediatrics 112 (6):864–74. doi: https://doi.org/10.1016/s0022-3476(88)80206-3.

 PubMed Web of Science ®Google Scholar

Park, M. J., R. Namgung, D. H. Kim, and R. C. Tsang. 1998. Bone mineral content is not reduced despite low vitamin D status in breast milk-fed infants versus cow's milk based formula-fed infants. J. Pediatr 132 (4):641–5. doi:https://doi.org/10.1016/S0022-3476(98)70353-1.

 PubMed Web of Science ®Google Scholar

Gibbons, M. J., N. L. Gilchrist, C. Frampton, P. Maguire, P. H. Reilly, R. L. March, and C. R. Wall. 2004. The effects of a high calcium dairy food on bone health in pre-pubertal children in New Zealand. Asia Pacific Journal of Clinical Nutrition 13:341–7.

 PubMed Web of Science ®Google Scholar

Lau, E. M., H. Lynn, Y. H. Chan, W. Lau, and J. Woo. 2004. Benefits of milk powder supplementation on bone accretion in Chinese children. Osteoporosis International 15 (8):654–8. doi: https://doi.org/10.1007/s00198-004-1593-6.

 PubMed Web of Science ®Google Scholar

Goulding, A., J. E. Rockell, R. E. Black, A. M. Grant, I. E. Jones, and S. M. Williams. 2004. Children who avoid drinking cow's milk are at increased risk for prepubertal bone fractures. Journal of the American Dietetic Association 104 (2):250–3. doi: https://doi.org/10.1016/j.jada.2003.11.008.

 PubMedGoogle Scholar

van den Hooven, E. H., D. H. Heppe, J. C. Kiefte-de Jong, C. Medina-Gomez, H. A. Moll, A. Hofman, V. W. Jaddoe, F. Rivadeneira, and O. H. Franco. 2015. Infant dietary patterns and bone mass in childhood: The Generation R Study. Osteoporosis International 26 (5):1595–604. doi: https://doi.org/10.1007/s00198-015-3033-1.

 PubMed Web of Science ®Google Scholar

Black, R. E., S. M. Williams, I. E. Jones, and A. Goulding. 2002. Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health. The American Journal of Clinical Nutrition 76 (3):675–80. doi: https://doi.org/10.1093/ajcn/76.3.675.

 PubMed Web of Science ®Google Scholar

Cadogan, J., R. Eastell, N. Jones, and M. E. Barker. 1997. Milk intake and bone mineral acquisition in adolescent girls: Randomised, controlled intervention trial. BMJ (Clinical Research ed.) 315 (7118):1255–60. doi: https://doi.org/10.1136/bmj.315.7118.1255.

 PubMed Web of Science ®Google Scholar

Cheng, S., A. Lyytikainen, H. Kroger, C. Lamberg-Allardt, M. Alen, A. Koistinen, Q. J. Wang, M. Suuriniemi, H. Suominen, A. Mahonen, et al. 2005. Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: A 2-y randomized trial. The American Journal of Clinical Nutrition 82 (5):1115–26, quiz 47–8. doi: https://doi.org/10.1093/ajcn/82.5.1115.

 PubMed Web of Science ®Google Scholar

Du, X., K. Zhu, A. Trube, Q. Zhang, G. Ma, X. Hu, D. R. Fraser, and H. Greenfield. 2004. School-milk intervention trial enhances growth and bone mineral accretion in Chinese girls aged 10-12 years in Beijing. The British Journal of Nutrition 92 (1):159–68. doi: https://doi.org/10.1079/BJN20041118.

 PubMed Web of Science ®Google Scholar

Lu, J. X., H. Pan, X. Q. Hu, Z. W. Huang, and Q. Zhang. 2019. Effects of milk powder intervention on bone mineral density and indicators related to bone metabolism in Chinese adolescents. Osteoporosis International 30 (11):2231–9. doi: https://doi.org/10.1007/s00198-019-05105-4.

 PubMed Web of Science ®Google Scholar

Malpeli, A., M. Apezteguia, J. L. Mansur, A. Armanini, M. Macias Couret, R. Villalobos, M. Kuzminczuk, and H. F. Gonzalez. 2012. Calcium supplementation, bone mineral density and bone mineral content. Predictors of bone mass changes in adolescent mothers during the 6-month postpartum period. Archivos Latinoamericanos de Nutrición 62:30–6.

 PubMed Web of Science ®Google Scholar

Merrilees, M. J., E. J. Smart, N. L. Gilchrist, C. Frampton, J. G. Turner, E. Hooke, R. L. March, and P. Maguire. 2000. Effects of diary food supplements on bone mineral density in teenage girls. European Journal of Nutrition 39 (6):256–62. doi: https://doi.org/10.1007/s003940070004.

 PubMed Web of Science ®Google Scholar

Vogel, K. A., B. R. Martin, L. D. McCabe, M. Peacock, S. J. Warden, G. P. McCabe, and C. M. Weaver. 2017. The effect of dairy intake on bone mass and body composition in early pubertal girls and boys: A randomized controlled trial. The American Journal of Clinical Nutrition 105 (5):1214–29. doi: https://doi.org/10.3945/ajcn.116.140418.

 PubMed Web of Science ®Google Scholar

Volek, J. S., A. L. Gomez, T. P. Scheett, M. J. Sharman, D. N. French, M. R. Rubin, N. A. Ratamess, M. M. McGuigan, and W. J. Kraemer. 2003. Increasing fluid milk favorably affects bone mineral density responses to resistance training in adolescent boys. Journal of the American Dietetic Association 103 (10):1353–6. doi: https://doi.org/10.1016/S0002-8223(03)01073-3.

 PubMedGoogle Scholar

Zhu, K., Q. Zhang, L. H. Foo, A. Trube, G. Ma, X. Hu, X. Du, C. T. Cowell, D. R. Fraser, and H. Greenfield. 2006. Growth, bone mass, and vitamin D status of Chinese adolescent girls 3 y after withdrawal of milk supplementation. The American Journal of Clinical Nutrition 83 (3):714–21. doi: https://doi.org/10.1093/ajcn.83.3.714.

 PubMed Web of Science ®Google Scholar

Zhu, K., H. Greenfield, X. Du, Q. Zhang, G. Ma, X. Hu, C. T. Cowell, and D. R. Fraser. 2008. Effects of two years' milk supplementation on size-corrected bone mineral density of Chinese girls. Asia Pacific Journal of Clinical Nutrition 17 (Suppl 1):147–50.

 PubMedGoogle Scholar

Matkovic, V., J. D. Landoll, N. E. Badenhop-Stevens, E.-Y. Ha, Z. Crncevic-Orlic, B. Li, and P. Goel. 2004. Nutrition influences skeletal development from childhood to adulthood: A study of hip, spine, and forearm in adolescent females. The Journal of Nutrition 134 (3):701S–5S. doi: https://doi.org/10.1093/jn/134.3.701S.

 PubMed Web of Science ®Google Scholar

Moore, L. L., M. L. Bradlee, D. Gao, and M. R. Singer. 2008. Effects of average childhood dairy intake on adolescent bone health. The Journal of Pediatrics 153 (5):667–73. doi: https://doi.org/10.1016/j.jpeds.2008.05.016.

 PubMed Web of Science ®Google Scholar

Budek, A. Z., C. Hoppe, K. F. Michaelsen, and C. Molgaard. 2007. High intake of milk, but not meat, decreases bone turnover in prepubertal boys after 7 days. European Journal of Clinical Nutrition 61 (8):957–62. doi: https://doi.org/10.1038/sj.ejcn.1602605.

 PubMed Web of Science ®Google Scholar

Esterle, L., J. P. Sabatier, F. Guillon-Metz, O. Walrant-Debray, G. Guaydier-Souquieres, F. Jehan, and M. Garabedian. 2009. Milk, rather than other foods, is associated with vertebral bone mass and circulating IGF-1 in female adolescents. Osteoporosis International 20 (4):567–75. doi: https://doi.org/10.1007/s00198-008-0708-x.

 PubMed Web of Science ®Google Scholar

Konstantynowicz, J., T. V. Nguyen, M. Kaczmarski, J. Jamiolkowski, J. Piotrowska-Jastrzebska, and E. Seeman. 2007. Fractures during growth: Potential role of a milk-free diet. Osteoporosis International 18 (12):1601–7. doi: https://doi.org/10.1007/s00198-007-0397-x.

 PubMed Web of Science ®Google Scholar

Petridou, E., T. Karpathios, N. Dessypris, E. Simou, and D. Trichopoulos. 1997. The role of dairy products and non alcoholic beverages in bone fractures among schoolage children. Scandinavian Journal of Social Medicine 25 (2):119–25. doi: https://doi.org/10.1177/140349489702500209.

 PubMedGoogle Scholar

Lan, T.-Y., S.-M. Hou, C.-Y. Chen, W.-C. Chang, J. Lin, C.-C. Lin, W.-J. Liu, T.-F. Shih, and T.-Y. Tai. 2010. Risk factors for hip fracture in older adults: A case-control study in Taiwan. Osteoporosis International 21 (5):773–84. doi: https://doi.org/10.1007/s00198-009-1013-z.

 PubMed Web of Science ®Google Scholar

Ross, A. C., C. L. Taylor, A. L. Yaktine, and H. B. Del Valle. 2011. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press.

 Google Scholar

Fujiwara, S., F. Kasagi, M. Yamada, and K. Kodama. 1997. Risk factors for hip fracture in a Japanese cohort. Journal of Bone and Mineral Research 12 (7):998–1004. doi: https://doi.org/10.1359/jbmr.1997.12.7.998.

 PubMed Web of Science ®Google Scholar

Feskanich, D., W. C. Willett, M. J. Stampfer, and G. A. Colditz. 1997. Milk, dietary calcium, and bone fractures in women: A 12-year prospective study. American Journal of Public Health 87 (6):992–7. doi: https://doi.org/10.2105/ajph.87.6.992.

 PubMed Web of Science ®Google Scholar

Michaelsson, K., A. Wolk, S. Langenskiold, S. Basu, E. Warensjo Lemming, H. Melhus, and L. Byberg. 2014. Milk intake and risk of mortality and fractures in women and men: Cohort studies. BMJ (Clinical Research ed.) 349:g6015. doi: https://doi.org/10.1136/bmj.g6015.

 PubMed Web of Science ®Google Scholar

Obbagy, J. E, L. K. English, Y. P. Wong, N. F. Butte, K. G. Dewey, M. K. Fox, F. R. Greer, N. F. Krebs, K. S. Scanlon, and E. E. Stoody. 2019. Complementary feeding and bone health: A systematic review. The American Journal of Clinical Nutrition 109 (Suppl_7):872S–8S. doi: https://doi.org/10.1093/ajcn/nqy227.

 PubMedGoogle Scholar

Bahtiri, E., H. Islami, R. Hoxha, H. QorrajBytyqi, T. MalokuGjergji, S. Rexhepi, S. Krasniqi, V. Zhjeqi, E. Halimi, S. Thaci, et al. 2014. Calcium and dairy products consumption and association with total hip bone mineral density in women from Kosovo. Medical Archives (Sarajevo, Bosnia and Herzegovina) 68 (4):259–62. doi: https://doi.org/10.5455/medarh.2014.68.259-262.

 PubMedGoogle Scholar

Bierhals, I. O., J. dos Santos Vaz, A. M. Baptista Menezes, F. C. Wehrmeister, L. Pozza, and F. M. C. Assuncao. 2019. Milk consumption, dietary calcium intake and nutrient patterns from adolescence to early adulthood and its effect on bone mass: The 1993 Pelotas (Brazil) birth cohort. Cadernos de Saude Publica 35 (8):e00192418.

 PubMed Web of Science ®Google Scholar

Kalkwarf, H. J., B. S. Zemel, K. Yolton, and J. E. Heubi. 2013. Bone mineral content and density of the lumbar spine of infants and toddlers: Influence of age, sex, race, growth, and human milk feeding. Journal of Bone and Mineral Research 28 (1):206–12. doi: https://doi.org/10.1002/jbmr.1730.

 PubMed Web of Science ®Google Scholar

Murphy, S., K. T. Khaw, H. May, and J. E. Compston. 1994. Milk consumption and bone mineral density in middle aged and elderly women. BMJ 308 (6934):939–41. doi: https://doi.org/10.1136/bmj.308.6934.939.

 PubMedGoogle Scholar

Ott, S. M. 2018. Cortical or trabecular bone: What's the difference? American Journal of Nephrology 47 (6):373–5. doi: https://doi.org/10.1159/000489672.

 PubMed Web of Science ®Google Scholar

Sahni, S., K. M. Mangano, D. P. Kiel, K. L. Tucker, and M. T. Hannan. 2017. Dairy intake is protective against bone loss in older vitamin D supplement users: The Framingham Study. Journal of Nutrition 147:646–52.

 Web of Science ®Google Scholar

Wallace, T. C. 2019. Optimizing dietary protein for lifelong bone health: A paradox unraveled. Nutrition Today 54 (3):107–15. doi: https://doi.org/10.1097/NT.0000000000000340.

 Google Scholar

Chee, W. S., A. R. Suriah, S. P. Chan, Y. Zaitun, and Y. M. Chan. 2003. The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia. Osteoporosis International 14 (10):828–34. doi: https://doi.org/10.1007/s00198-003-1448-6.

 PubMed Web of Science ®Google Scholar

Chen, Y., Q. Zhang, Y. Wang, Y. Xiao, R. Fu, H. Bao, and M. Liu. 2015. Estimating the causal effect of milk powder supplementation on bone mineral density: A randomized controlled trial with both non-compliance and loss to follow-up. European Journal of Clinical Nutrition 69 (7):824–30. doi: https://doi.org/10.1038/ejcn.2015.3.

 PubMed Web of Science ®Google Scholar

Daly, R. M., N. Petrass, S. Bass, and C. A. Nowson. 2008. 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. The American Journal of Clinical Nutrition 87 (3):771–7. doi: https://doi.org/10.1093/ajcn/87.3.771.

 PubMed Web of Science ®Google Scholar

Jadad, A. R., R. A. Moore, D. Carroll, C. Jenkinson, D. J. M. Reynolds, D. J. Gavaghan, and H. J. McQuay. 1996. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials 17 (1):1–12. doi: https://doi.org/10.1016/0197-2456(95)00134-4.

 PubMedGoogle Scholar

Liu, Z., L. Qiu, Y. M. Chen, and Y. X. Su. 2011. Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: A randomized controlled trail. Archives of Gynecology and Obstetrics 283 (2):205–11. doi: https://doi.org/10.1007/s00404-009-1345-0.

 PubMed Web of Science ®Google Scholar

Lau, E. M., J. Woo, V. Lam, and A. Hong. 2001. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Journal of Bone and Mineral Research 16 (9):1704–9. doi: https://doi.org/10.1359/jbmr.2001.16.9.1704.

 PubMed Web of Science ®Google Scholar

Movassagh, E. Z., S. Kontulainen, A. D. G. Baxter-Jones, S. Whiting, M. Szafron, M. Papadimitropoulos, and H. Vatanparast. 2017. Are milk and alternatives and fruit and vegetable intakes during adolescence associated with cortical and trabecular bone structure, density, and strength in adulthood? Osteoporosis International 28 (2):609–19. doi: https://doi.org/10.1007/s00198-016-3775-4.

 PubMed Web of Science ®Google Scholar

Szulc, P., K. Naylor, N. R. Hoyle, R. Eastell, and E. T. Leary. 2017. Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability. Osteoporosis International 28 (9):2541–56. doi: https://doi.org/10.1007/s00198-017-4082-4.

 PubMed Web of Science ®Google Scholar

Torres-Costoso, A., P. Lopez-Munoz, A. Ferri-Morales, E. Bravo-Morales, V. Martinez-Vizcaino, and M. Garrido-Miguel. 2019. Body mass index, lean mass, and body fat percentage as mediators of the relationship between milk consumption and bone health in young adults. Nutrients 11 (10):2500. doi: https://doi.org/10.3390/nu11102500.

 Web of Science ®Google Scholar

van den Heuvel, E., and J. Steijns. 2018. Dairy products and bone health: How strong is the scientific evidence? Nutrition Research Reviews 31 (2):164–78. doi: https://doi.org/10.1017/S095442241800001X.

 PubMed Web of Science ®Google Scholar

Aslam, H., K. L. Holloway-Kew, M. Mohebbi, F. N. Jacka, and J. A. Pasco. 2019. Association between dairy intake and fracture in an Australian-based cohort of women: A prospective study. BMJ Open 9 (11):e031594. doi: https://doi.org/10.1136/bmjopen-2019-031594.

 PubMed Web of Science ®Google Scholar

Benetou, V., P. Orfanos, D. Zylis, S. Sieri, P. Contiero, R. Tumino, M. C. Giurdanella, P. H. M. Peeters, J. Linseisen, A. Nieters, et al. 2011. Diet and hip fractures among elderly Europeans in the EPIC cohort. European Journal of Clinical Nutrition 65 (1):132–9. doi: https://doi.org/10.1038/ejcn.2010.226.

 PubMed Web of Science ®Google Scholar

Biver, E., C. Durosier-Izart, F. Merminod, T. Chevalley, B. van Rietbergen, S. L. Ferrari, and R. Rizzoli. 2018. Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women. Osteoporosis International 29 (8):1771–82. doi: https://doi.org/10.1007/s00198-018-4535-4.

 PubMed Web of Science ®Google Scholar

Cumming, R. G., S. R. Cummings, M. C. Nevitt, J. Scott, K. E. Ensrud, T. M. Vogt, and K. Fox. 1997. Calcium intake and fracture risk: Results from the study of osteoporotic fractures. American Journal of Epidemiology 145 (10):926–34. doi: https://doi.org/10.1093/oxfordjournals.aje.a009052.

 PubMed Web of Science ®Google Scholar

Feart, C., S. Lorrain, V. Ginder Coupez, C. Samieri, L. Letenneur, D. Paineau, and P. Barberger-Gateau. 2013. Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporosis International 24 (12):3031–41. doi: https://doi.org/10.1007/s00198-013-2421-7.

 PubMed Web of Science ®Google Scholar

Feskanich, D., H. A. Bischoff-Ferrari, A. L. Frazier, and W. C. Willett. 2014. Milk consumption during teenage years and risk of hip fractures in older adults. JAMA Pediatrics 168 (1):54–60. doi: https://doi.org/10.1001/jamapediatrics.2013.3821.

 PubMed Web of Science ®Google Scholar

Feskanich, D., H. E. Meyer, T. T. Fung, H. A. Bischoff-Ferrari, and W. C. Willett. 2018. Milk and other dairy foods and risk of hip fracture in men and women. Osteoporosis International 29 (2):385–96. doi: https://doi.org/10.1007/s00198-017-4285-8.

 PubMed Web of Science ®Google Scholar

Huncharek, M., J. Muscat, and B. Kupelnick. 2008. Impact of dairy products and dietary calcium on bone-mineral content in children: Results of a meta-analysis. Bone 43 (2):312–21. doi: https://doi.org/10.1016/j.bone.2008.02.022.

 PubMed Web of Science ®Google Scholar

Michaelsson, K., A. Wolk, E. W. Lemming, H. Melhus, and L. Byberg. 2018. Intake of milk or fermented milk combined with fruit and vegetable consumption in relation to hip fracture rates: A cohort study of Swedish women. Journal of Bone and Mineral Research 33 (3):449–57. doi: https://doi.org/10.1002/jbmr.3324.

 PubMed Web of Science ®Google Scholar

Moher, D., A. Liberati, J. Tetzlaff, and D. G. Altman. 2009. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine 6 (7):e1000097. doi: https://doi.org/10.1371/journal.pmed.1000097.

 PubMed Web of Science ®Google Scholar

Nieves, J. W., J. A. Grisso, and J. L. A. Kelsey. 1992. A case-control study of hip fracture: Evaluation of selected dietary variables and teenage physical activity. Osteoporosis International 2 (3):122–7. doi: https://doi.org/10.1007/BF01623818.

 PubMed Web of Science ®Google Scholar

Rulu, P., M. Dhall, R. Tyagi, K. S. Devi, N. Feroz, S. Kapoor, M. G. Tungdim, and S. Thakur. 2019. Factors influencing bone mineral density among adults of Delhi: A gender differential. Journal of Health Management 21 (2):199–209. doi: https://doi.org/10.1177/0972063419835096.

 Web of Science ®Google Scholar

Sato, Y., M. Iki, Y. Fujita, J. Tamaki, K. Kouda, A. Yura, J. S. Moon, R. Winzenrieth, H. Iwaki, R. Ishizuka, et al. 2015. Greater milk intake is associated with lower bone turnover, higher bone density, and higher bone microarchitecture index in a population of elderly Japanese men with relatively low dietary calcium intake: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study. Osteoporosis International 26:1585–94.

 PubMed Web of Science ®Google Scholar

Sahni, S., K. L. Tucker, D. P. Kiel, L. Quach, V. A. Casey, and M. T. Hannan. 2013. Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: The Framingham Offspring Study. Archives of Osteoporosis 8:119. doi: https://doi.org/10.1007/s11657-013-0119-2.

 PubMed Web of Science ®Google Scholar

Sahni, S., K. M. Mangano, K. L. Tucker, D. P. Kiel, V. A. Casey, and M. T. Hannan. 2014. Protective association of milk intake on the risk of hip fracture: Results from the Framingham Original Cohort. Journal of Bone and Mineral Research 29 (8):1756–62. doi: https://doi.org/10.1002/jbmr.2219.

 PubMed Web of Science ®Google Scholar

Chan, C. Y., S. Subramaniam, N. Mohamed, S. Ima-Nirwana, N. Muhammad, A. Fairus, P. Y. Ng, N. A. Jamil, N. Abd Aziz, and K.-Y. Chin. 2020. Determinants of bone health status in a multi-ethnic population in Klang Valley. International Journal of Environmental Research and Public Health 17 (2):384. doi: https://doi.org/10.3390/ijerph17020384.

 Web of Science ®Google Scholar

Eysteinsdottir, T., T. I. Halldorsson, I. Thorsdottir, G. Sigurdsson, S. Sigurðsson, T. Harris, L. J. Launer, V. Gudnason, I. Gunnarsdottir, and L. Steingrimsdottir. 2014. Milk consumption throughout life and bone mineral content and density in elderly men and women. Osteoporosis International 25 (2):663–72. doi: https://doi.org/10.1007/s00198-013-2476-5.

 PubMed Web of Science ®Google Scholar

Lappe, J. M., P. Watson, V. Gilsanz, T. Hangartner, H. J. Kalkwarf, S. Oberfield, J. Shepherd, K. K. Winer, and B. Zemel. 2015. The longitudinal effects of physical activity and dietary calcium on bone mass accrual across stages of pubertal development. Journal of Bone and Mineral Research 30 (1):156–64. doi: https://doi.org/10.1002/jbmr.2319.

 PubMed Web of Science ®Google Scholar

Ma, D., and G. Jones. 2003. The association between bone mineral density, metacarpal morphometry, and upper limb fractures in children: A population-based case-control study. The Journal of Clinical Endocrinology & Metabolism 88 (4):1486–91. doi: https://doi.org/10.1210/jc.2002-021682.

 PubMed Web of Science ®Google Scholar

Mangano, K. M., S. E. Noel, S. Sahni, and K. L. Tucker. 2019. Higher dairy intakes are associated with higher bone mineral density among adults with sufficient vitamin D status: Results from the Boston Puerto Rican Osteoporosis Study. The Journal of Nutrition 149 (1):139–48. doi: https://doi.org/10.1093/jn/nxy234.

 PubMed Web of Science ®Google Scholar

Nevitt, M. C., S. R. Cummings, K. L. Stone, L. Palermo, D. M. Black, D. C. Bauer, H. K. Genant, M. C. Hochberg, K. E. Ensrud, T. A. Hillier, et al. 2005. Risk factors for a first-incident radiographic vertebral fracute in women ≥65 years of age: The Study of Osteoporotic Fractures. Journal of Bone and Mineral Research 20 (1):131–40. doi: https://doi.org/10.1359/jbmr.2005.20.1.131.

 PubMed Web of Science ®Google Scholar

Seeman, E. 2013. Age- and menopause-related bone loss compromise cortical and trabecular microstructure. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 68 (10):1218–25. doi: https://doi.org/10.1093/gerona/glt071.

 PubMed Web of Science ®Google Scholar

Zhu, Y., S. Liu, W. Chen, B. Liu, H. Lv, X. Zhang, and Y. Zhang. 2018. Epidemiology of low-energy fracture in Chinese postmenopausal women: Changing trend of incidence since menopause and associated risk factors, a national population-based survey. Menopause 26 (3):286–92. doi: https://doi.org/10.1097/GME.0000000000001211.

 Web of Science ®Google Scholar

Jitapunkul, S., P. Yuktananandana, and V. Parkpian. 2001. Risk factors of hip fracture among Thai female patients. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet 84 (11):1576–81.

 PubMedGoogle Scholar

Johnell, O., Gullberg, B. Kanis, J. Allander, A. E. Elffors, L. Dequeker, J. Dilsen, G. Gennari, C. Vaz, A. L. Lyritis, et al. 1995. Risk factors for hip fracture in European women: The MEDOS study. Journal of Bone and Mineral Research 10 (11):1802–15. doi: https://doi.org/10.1002/jbmr.5650101125.

 PubMed Web of Science ®Google Scholar

Jones, G., K. L. Hynes, and T. Dwyer. 2013. The association between breastfeeding, maternal smoking in utero, and birth weight with bone mass and fractures in adolescents: A 16-year longitudinal study. Osteoporosis International 24 (5):1605–11. doi: https://doi.org/10.1007/s00198-012-2207-3.

 PubMed Web of Science ®Google Scholar

Kerstetter, J. E., K. O. O’Brien, D. M. Caseria, D. E. Wall, and K. L. Insogna. 2005. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. The Journal of Clinical Endocrinology & Metabolism 90 (1):26–31. doi: https://doi.org/10.1210/jc.2004-0179.

 PubMed Web of Science ®Google Scholar

Lanyan, A., P. Marques-Vidal, E. Gonzalez-Rodriguez, D. Hans, and O. Lamy. 2020. Postmenopausal women with osteoporosis consume high amounts of vegetables but insuffient dairy products and calcium to benefit their virtues: The CoLaus/OsteoLaus cohort. Osteoporosis International 31 (5):875–86. doi: https://doi.org/10.1007/s00198-019-05225-x.

 PubMed Web of Science ®Google Scholar

Nieves, J. W., K. Melsop, M. Curtis, J. L. Kelsey, L. K. Bachrach, G. Greendale, M. F. Sowers, and K. L. Sainani. 2010. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. PM&R 2 (8):740–50, quiz 94. doi: https://doi.org/10.1016/j.pmrj.2010.04.020.

 Web of Science ®Google Scholar