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Are milk and alternatives and fruit and vegetable intakes during adolescence associated with cortical and trabecular bone structure, density, and strength in adulthood?



We investigated the impact of food group intake during adolescence on bone structure and strength during adulthood. In females, we found a beneficial effect of adolescent milk and alternatives and fruit and vegetable intake on adult radius shaft and distal tibia bone structure, respectively. No association was observed in males.


The purpose of this study was to investigate whether adolescents with high intake of milk and alternatives (M&A) or fruit and vegetables (F&V) had better adult bone structure and strength compared to those with low intake levels.


We analyzed data from 47 males and 69 females enrolled in the Pediatric Bone Mineral Accrual Study (PBMAS 1991–2011), who had one peripheral quantitative computed tomography scan at age 29 ± 2 years. We measured radius and tibia shaft total area (ToA), cortical area (CoA), cortical content (CoC), cortical density, bone strength (SSIp), and muscle area, as well as distal radius and tibia ToA, total density, trabecular area, trabecular content, trabecular density, and bone strength (BSIc). Sequential 24-h recalls were used to assess M&A and F&V intake; participants were grouped for their mean intake during adolescence (low = bottom quartile, moderate = middle quartiles, high = top quartile) and were compared using multivariate analysis of covariance while adjusting for adult height, muscle area, physical activity, energy and calcium intake and adolescent energy intake, and physical activity.


Females with high M&A intake compared to low M&A intake group (mean 3.8 vs. 1.3 servings/day, respectively) had greater adult ToA (14 %, p < 0.05), CoA (15 %, p < 0.01), and CoC (16 %, p < 0.01) at radius shaft. Females with moderate F&V intake compared to low F&V intake group (mean 3.7 vs. 2.1 servings/day, respectively) had greater adult ToA (8.5 %, p < 0.05) at distal tibia.


Higher intake of M&A or F&V during adolescence had a long-term beneficial effect on bone structure in females, an association not observed in males.

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Analysis of variance


Bone strength index in compression


Cortical area


Cortical content


Cortical density


Dual-energy X-ray absorptiometry


Fruit and vegetables


Milk and alternatives


Multivariate analysis of covariance


Physical activity


Physical activity questionnaire


Pediatric Bone Mineral Accrual Study


Peak height velocity


Peripheral quantitative computed tomography


Standard errors


Bone strength in torsion


Total area


Total density


Trabecular area


Trabecular content


Trabecular density


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All authors contributed to the final manuscript. The project was funded by the Canadian Institutes of Health Research (CIHR, MOP 98002; MOP57671). Dairy Farmers of Canada (DFC-417283) provided funding for the PhD student support. The authors (Movassagh, Kontulainen, Baxter-Jones, Whiting, Szafron, Papadimitropoulos, Vatanparast) have no conflict of interest to disclose.

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Corresponding author

Correspondence to H. Vatanparast.

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Ethical approval

Ethics approval was obtained from the University of Saskatchewan and Royal Hospital advisory boards on ethics in human experimentation [21], and all procedures were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants (or their parents) included in the study.

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Z. Movassagh, E., Kontulainen, S., Baxter-Jones, A.D.G. et al. Are milk and alternatives and fruit and vegetable intakes during adolescence associated with cortical and trabecular bone structure, density, and strength in adulthood?. Osteoporos Int 28, 609–619 (2017).

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  • Adolescence
  • Bone strength
  • Cortical bone
  • Fruit and vegetables
  • Milk and alternatives
  • Trabecular bone