Consuming more dairy in liquid form appears to reduce the risk of osteoporotic and other fractures, while cheese is specifically linked to a reduced risk of hip fractures in older women, researchers in Finland have found.
Their findings were published in the European Journal of Nutrition. Women skipping liquid dairy entirely had the highest fracture risk, but moving to even moderate intake (up to 4 dl/day) offered the biggest drop in protection against broken bones, they found.
Fractures represent a major global public health concern, especially among older adults, because of their association with pain, disability and early death. Over the past 30 years, fracture rates have risen globally by more than 33%, primarily due to population ageing.
News-Medical.net reports that osteoporotic fractures, commonly affecting the wrist, hip, and spine, are the most frequent complication of osteoporosis, with about 9m cases annually worldwide. Preventive strategies have therefore focused on modifiable risk factors, including diet.
Dairy products are widely consumed and contain key bone-supporting nutrients such as bioactive compounds, protein and calcium. However, existing research on their role in preventing fractures has produced mixed results.
While some cohort studies report a protective effect of dairy, particularly milk, on fracture risk, others have found no association or even an increased risk with high milk consumption. A Swedish cohort study notably linked high milk intake to higher fracture risk, further deepening the uncertainty.
One reason for this inconsistency may be the lack of long-term studies with repeated assessments of dairy intake and verified fracture data.
Daily intake
The aim of this study, led by the University of Eastern Finland, was to determine whether the consumption of liquid dairy products and cheese was associated with a reduced risk of fractures over a 25-year period in a large cohort of ageing Finnish women.
Started in 1989, the study included 14 220 participants, born between 1932 and 1941. Respondents reported their dairy intake based on the daily amounts they consumed of liquid dairy items such as yoghurt, sour milk, and milk in decilitres, and cheese in slices per day.
They reported any fractures they experienced, including the location and timing; these were then validated through medical records.
To focus on the protective role of dairy, the researchers excluded pathological and high-energy fractures, including those resulting from traffic accidents and falls from heights above one metre. Fractures in the shoulder, wrist, spine, or hip were considered osteoporotic injuries.
Researchers also considered other explanatory factors that could influence fracture risk, including physical activity, vitamin D and calcium supplementation, alcohol consumption, medication use affecting the bones, and body mass index (BMI).
The statistical model calculated the time to survival until the end of the study, the last response, death, or the first fracture. Hazard ratios (HRs) were estimated for hip, osteoporotic, and any fractures through proportional hazard models that included time-dependent covariates.
Key findings
This long-term cohort study followed the women for an average of 17.6 years, resulting in data from 245 005 person-years to investigate the link between dairy consumption and fracture risk.
During the follow-up, 4 358 women reported experiencing any fracture, while 2 326 had osteoporotic fractures and 427 had hip fractures.
At baseline, women with higher liquid dairy intake tended to have a higher BMI and lower supplement use. Inversely, higher cheese consumption was associated with lower liquid dairy intake and a lower BMI.
Women who consumed moderate or high amounts of liquid dairy had a significantly reduced risk of any fracture by 23% and 26%, respectively, and osteoporotic fracture by 31% and 36%, respectively, compared with non-consumers.
This protective effect remained significant in time-dependent models and when dairy intake was treated as a continuous variable. However, liquid dairy intake was not associated with an increased risk of hip fractures.
Cheese showed a J-shaped relationship with hip fractures, they said. While high intake reduced risk by 38%, moderate intake (≤3 slices/day) showed no significant protection versus non-consumers.
While cheese did not have an impact on the risk of osteoporotic fractures; high intake was associated with a significantly reduced risk of hip fractures by 47% in adjusted models.
The authors note, however, that the relatively low number of hip fracture events may have limited the statistical power for this analysis. These findings suggest that liquid dairy may protect against general and osteoporotic fractures, while cheese may offer specific protection against hip fractures.
Conclusions
The study showed that a higher intake of liquid dairy products was associated with a reduced risk of osteoporotic and other fractures, but not hip fractures. In contrast, cheese intake showed no association with overall fracture risk but was linked to a reduced risk of hip fractures.
These results align with some cohort and trial data, though previous meta-analyses have yielded inconsistent findings. Biological differences in bone types may partly explain the site-specific effects, as dairy’s impact can vary between the trabecular bone, which is common in the spine, and the cortical bone that makes up most of the hip.
Factors such as the protein-to-calcium ratio and sodium content in various dairy products may also play a role.
A major strength of the study is its long follow-up and the use of repeated dietary measurements, which allow for time-dependent analyses. However, limitations include a lack of detailed dietary data to distinguish between different types of cheese, potential recall bias from self-reported intake, and the use of binary categorisation for supplement use.
Additionally, the homogenous population may limit generalisability.
In conclusion, promoting the consumption of liquid dairy products may help lower the risk of fractures in ageing populations. The study also suggests a potential threshold effect, where the most significant benefit is achieved when moving from no intake to moderate consumption, with diminishing returns thereafter. However, further research is needed, especially regarding specific cheese types and their impact on bone health.
The Swedish milk paradox got a theory: researchers proposed that country-specific milk fortification with vitamin A (linked to fracture risk) might explain prior conflicting findings about milk’s effects.
Study details
Long-term consumption of liquid dairy products predicts lower fracture risk in aging women: a 25-year follow-up.
Aleghehband, FR, Lyytinen, AT, Isanejad, M, Kopra, J, Heikki Kröger, Rikkonen, T.
Published in European Journal of Nutrition on 9 June 2025
Abstract
Purpose
The study aimed to investigate whether high dairy products consumption is associated with reduced fracture risk in ageing women, contributing to understanding this health issue.
Method
Data were obtained from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, a large cohort of 14 220 older Finnish women (mean baseline age 52.3 years) with 25 years of follow-up. Participants completed questionnaires every five years, providing information on health status, lifestyle habits, dairy products consumption (milk, sour milk, yoghurt, cheese), and fracture history. Cox proportional hazard models with time-dependent covariates were used to estimate hazard ratios for any fracture, hip fracture, or osteoporotic fracture based on dairy products consumption. The models were adjusted for time-updated BMI (kg/m²), alcohol use (portions/day), physical activity (hours/month), age (years), use of calcium and/or vitamin D supplements (yes/no), and use of bone-affecting medications (yes/no).
Results
Higher liquid dairy products consumption (milk, sour milk, yoghurt) was associated with decreased risk for any fracture (β = 0.98, SE = 0.01, P = 0.008) and osteoporotic fracture (β = 0.97, SE = 0.01, P = 0.011). In contrast, cheese consumption was not associated with the overall risk of any fracture or osteoporotic fracture. In a separate analysis, higher cheese consumption was linked to a reduced hip fracture risk (β = 0.91, SE = 0.05, P = 0.043) while no association was found between liquid dairy products consumption and hip fracture risk.
Conclusion
A long-term consumption of liquid dairy products may lower fracture risk. Encouraging the consumption of these products through public health initiatives may help reduce fractures and ease the economic burden on the healthcare system.
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