Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women

Am J Clin Nutr. 2003 Feb;77(2):504-11. doi: 10.1093/ajcn/77.2.504.


Background: Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets. Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures.

Objective: We assessed relations between postmenopausal hip fracture risk and calcium, vitamin D, and milk consumption.

Design: In an 18-y prospective analysis in 72 337 postmenopausal women, dietary intake and nutritional supplement use were assessed at baseline in 1980 and updated several times during follow-up. We identified 603 incident hip fractures resulting from low or moderate trauma. Relative risks (RRs) from proportional hazards models were controlled for other dietary and nondietary factors.

Results: Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37% lower risk of hip fracture (RR = 0.63; 95% CI: 0.42, 0.94) than did women consuming < 3.5 microg/d. Total calcium intake was not associated with hip fracture risk (RR = 0.96; 95% CI: 0.68, 1.34 for > or = 1200 compared with < 600 mg/d). Milk consumption was also not associated with a lower risk of hip fracture (P for trend = 0.21).

Conclusions: An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women. Neither milk nor a high-calcium diet appears to reduce risk. Because women commonly consume less than the recommended intake of vitamin D, supplement use or dark fish consumption may be prudent.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Bone Density / drug effects*
  • Calcium, Dietary / administration & dosage*
  • Cohort Studies
  • Diet
  • Dietary Supplements
  • Female
  • Hip Fractures / epidemiology*
  • Hip Fractures / prevention & control
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Milk* / chemistry
  • Osteoporosis, Postmenopausal / epidemiology
  • Osteoporosis, Postmenopausal / prevention & control
  • Postmenopause
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Vitamin D / administration & dosage*


  • Calcium, Dietary
  • Vitamin D