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The Association Between Osteoporosis and Hypertension: The Role of A Low Dairy Intake


Hypertension and related cardiovascular diseases are reported to be associated with osteoporosis. A nutritional pathway related to dairy intake has been postulated for both diseases. The aim of this study was to assess calcium intake from dairy sources as a possible pathogenic link between osteoporosis and hypertension. This was a cross-sectional observational study performed on 3,301 postmenopausal women referred for a densitometry screening. Osteoporosis was diagnosed by lumbar dual-energy X-ray absorptiometry and hypertension was defined by blood pressure data and/or the use of antihypertensive medication. Dairy food consumption was evaluated using a weekly food-frequency questionnaire. The odds of being affected by osteoporosis, hypertension, or both diseases were calculated for quartiles of dairy intake by logistic regression analyses. Women with hypertension were affected more frequently by osteoporosis (33.2 vs. 23.3 %; p = 0.000), and there was a higher prevalence of hypertension among women with osteoporosis (32.2 vs. 22.5 %; p = 0.000). The proportion of women with hypertension, osteoporosis, and both diseases significantly increased across decreasing quartiles of dairy intake. A dairy intake in the lowest quartile was a significant predictor of osteoporosis [OR (95 % CI): 1.43 (1.12, 1.82)] and hypertension [OR (95 % CI): 1.46 (1.15, 1.85)] when compared to the highest quartile. Similarly, a low dairy intake was associated with increased odds to have both the diseases [OR (95 % CI): 1.60 (1.10, 2.34)]. From these results we conclude that osteoporosis and hypertension are associated in postmenopausal women, and a low dairy intake may increase the risk of both diseases, acting as a possible pathogenic link.

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  1. 1.

    Cooper C, Campion G, Melton LJ III (1992) Hip fracture in the elderly: a world-wide projection. Osteoporos Int 2:285–289

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365:217–223

    PubMed  Google Scholar 

  3. 3.

    McFarlane SI, Muniyappa R, Shin JJ, Bahtiyar G, Sowers JR (2004) Osteoporosis and cardiovascular disease: brittle bones and boned arteries, Is there a link? Endocrine 23:1–10

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Browner WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR (1993) Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke 24:940–946

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Farhat GN, Strotmeyer ES, Newman AB, Sutton-Tyrrell K, Bauer DC, Harris T et al (2006) Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 79:102–111

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Cappuccio FP, Meilahn E, Zmuda JM, Cauley JA (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Wiklund P, Nordström A, Jansson JH, Weinehall L, Nordström P (2012) Low bone mineral density is associated with increased risk for myocardial infarction in men and women. Osteoporos Int 23:963–970

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Shen C, Deng J, Zhou R, Chen J, Fan S, Li Z et al (2012) Relation between bone mineral density, bone loss and the risk of cardiovascular disease in a Chinese cohort. Am J Cardiol 110:1138–1142

    PubMed  Article  Google Scholar 

  10. 10.

    Makovey J, Macara M, Chen JS, Hayward CS, March L, Sambrook PN (2013) High osteoporotic fracture risk and CVD risk co-exist in postmenopausal women. Bone 52:120–125

    PubMed  Article  Google Scholar 

  11. 11.

    Nieves JW, Barrett-Connor E, Siris ES, Zion M, Barlas S, Chen YT (2008) Calcium and vitamin D intake influence bone mass, but not short-term fracture risk, in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study. Osteoporos Int 19:673–679

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Warensjö E, Byberg L, Melhus H, Gedeborg R, Mallmin H, Wolk A et al (2011) Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ 342:d1473

    PubMed  Article  Google Scholar 

  13. 13.

    Wang L, Manson JE, Buring JE, Lee IM, Sesso HD (2008) Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension 51:1073–1079

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Engberink MF, Hendriksen MA, Schouten EG, van Rooij FJ, Hofman A, Witteman JC et al (2009) Inverse association between dairy intake and hypertension: the Rotterdam Study. Am J Clin Nutr 89:1877–1883

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Ralston RA, Lee JH, Truby H, Palermo CE, Walker KZ (2012) A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods. J Hum Hypertens 26:3–13

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Soedamah-Muthu SS, Verberne LD, Ding EL, Engberink MF, Geleijnse JM (2012) Dairy consumption and incidence of hypertension: a dose-response meta-analysis of prospective cohort studies. Hypertension 60:1131–1137

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Varenna M, Binelli L, Casari S, Zucchi F, Sinigaglia L (2007) Effects of dietary calcium intake on body weight and prevalence of osteoporosis in early postmenopausal women. Am J Clin Nutr 86:639–644

    PubMed  CAS  Google Scholar 

  18. 18.

    Carnovale E, Marletta L (1997) Food composition tables. Italian National Institute of Nutrition, Rome

    Google Scholar 

  19. 19.

    Krogh V, Freudenheim JL, D’Amicis A (1993) Food sources of nutrients of the diet of elderly Italians: II. Micronutrients. Int J Epidemiol 22:869–877

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    WHO Study Group (1994) Osteoporosis. In: assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series 843. World Health Organization, Geneva

  21. 21.

    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Varenna M, Binelli L, Zucchi F, Ghiringhelli D, Gallazzi M, Sinigaglia L (1999) Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int 9:236–241

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Chen YC, Wu JC, Liu L, Huang WC, Cheng H, Chen TJ et al (2013) Hospitalized osteoporotic vertebral fracture increases the risk of stroke: A population-based cohort study. J Bone Miner Res 28(3):516–523

    PubMed  Article  Google Scholar 

  24. 24.

    Vestergaard P, Rejnmark L, Mosekilde L (2009) Hypertension is a risk factor for fractures. Calcif Tissue Int 84:103–111

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A et al (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Gerber Y, Melton LJ 3rd, Weston SA, Roger VL (2011) Association between myocardial infarction and fractures: an emerging phenomenon. Circulation 124:297–303

    PubMed  Article  Google Scholar 

  27. 27.

    Heaney RP (2000) Calcium, dairy products and osteoporosis. J Am Coll Nutr 19:83S–99S

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li R, Spiegelman D et al (2007) Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr 86:1780–1790

    PubMed  CAS  Google Scholar 

  29. 29.

    Matkovic V, Heaney RP (1990) Calcium balance during human growth: evidence for threshold behavior. Am J Clin Nutr 55:992–996

    Google Scholar 

  30. 30.

    Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ (1999) The influence of dietary and nondietary calcium supplementation on blood pressure: an updated meta-analysis of randomized controlled trials. Am J Hypertens 12:84–92

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Li K, Kaaks R, Linseisen J, Rohrmann S (2012) Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart 98:920–925

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336:1117–1124

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Pereira MA, Jacobs DR, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS (2002) Dairy consumption, obesity, and the insulin resistance syndrome in young adults. The CARDIA study. JAMA 287:2081–2089

    PubMed  Article  Google Scholar 

  34. 34.

    Resnick LM (1999) The role of dietary calcium in hypertension. A hierarchal overview. Am J Hyperten 12:99–112

    Article  CAS  Google Scholar 

  35. 35.

    Teucher B, Dainty JR, Spinks CA, Majsak-Newman G, Berry DJ, Hoogewerff JA et al (2008) Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women. J Bone Miner Res 23:1477–1485

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Jorde R, Sundsfjord J, Haug E, Bonaa KH (2000) Relation between low calcium intake, parathyroid hormone, and blood pressure. Hypertension 35:1154–1159

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Wang D, An SJ, Wang WH, McGiff JC, Ferreri NR (2001) CaR-mediated COX-2 expression in primary cultured mTAL cells. Am J Physiol Renal Physiol 281:F658–F664

    PubMed  CAS  Google Scholar 

  38. 38.

    Guan XX, Zhou Y, Li JY (2011) Reciprocal roles of angiotensin II and angiotensin II receptors blockade (ARB) in regulating Cbfa1/RANKL via cAMP signaling pathway: possible mechanism for hypertension-related osteoporosis and antagonistic effect of ARB on hypertension-related osteoporosis. Int J Mol Sci 12:4206–4213

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D et al (1997) Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 277:1624–1632

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Mizushima S, Cappuccio FP, Nichols R, Elliott P (1998) Dietary magnesium intake and blood pressure: a qualitative overview of the observational studies. J Hum Hypertens 12:447–453

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    FitzGerald RJ, Murray BA, Walsh DJ (2004) Hypotensive peptides from milk proteins. J Nutr 134:980S–988S

    PubMed  CAS  Google Scholar 

  42. 42.

    Townsend RR, McFadden CB, Ford V, Cadée JA (2004) A randomized, double-blind, placebo-controlled trial of casein protein hydrolysate (C12 peptide) in human essential hypertension. Am J Hypertens 17:1056–1058

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Rejnmark L, Vestergaard P, Heickendorff L, Andreasen F, Mosekilde L (2006) Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide. J Bone Miner Res 21:163–170

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Bolland MJ, Ames RW, Horne AM, Orr-Walker BJ, Gamble GD, Reid IR (2007) The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women. Osteoporos Int 18:479–486

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Burgaz A, Orsini N, Larsson SC, Wolk A (2011) Blood 25-hydroxyvitamin D concentration and hypertension: a meta-analysis. J Hypertens 29:636–645

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Massimo Varenna.

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Varenna, M., Manara, M., Galli, L. et al. The Association Between Osteoporosis and Hypertension: The Role of A Low Dairy Intake. Calcif Tissue Int 93, 86–92 (2013).

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  • Osteoporosis
  • Hypertension
  • Dairy
  • Calcium