Adult lactose intolerance (ALI) significantly alters calcium intake and absorption, and thus may promote osteoporosis. ALI is a recessive condition with a geographical north–south gradient characterised by decreased levels of intestinal lactase. PCR-based genotyping of lactase (LCT) gene polymorphisms is a safe and easy way to diagnose ALI and may complement diagnostic procedures to identify individuals at risk for reduced calcium intake and subsequently osteoporosis due to lactose malabsorption. Therefore, we investigated the frequency of ALI and its influence on calcium intake, markers of bone metabolism and bone mineral density (BMD) in a cohort of Turkish immigrants living in Germany.
Materials and methods
We investigated single nucleotide polymorphisms of the LCT gene, calcium intake, markers of bone metabolism and BMD in 183 Turkish immigrants.
ALI was diagnosed in 154 out of 183 (81%) probands. ALI was significantly associated with self-reported lactose intolerance (p < 0.001) and dislike for dairy products (p < 0.01). Osteopenia was diagnosed in 59 out of 183 (32%) and osteoporosis in 15 out of 183 (8%) probands. Probands with reduced BMD had ALI in 86%. All probands had a decreased calcium intake [mg/week]. There was no significant association between ALI, calcium intake, markers of bone metabolism or BMD.
Turkish immigrants mostly have ALI and overall show a reduced calcium intake per week. However, ALI did not significantly influence calcium intake, markers of bone metabolism or BMD in this cohort. Therefore, ALI in Turkish immigrants does not seem to be a risk factor for osteoporosis.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Sahi T, Isokoski M, Jussila J, Launiala K, Pyörälä K (1973) Recessive inheritance of adult-type lactose malabsorption. Lancet 302:823–826. https://doi.org/10.1016/S0140-6736(73)90862-3
Tamm A (1994) Management of lactose intolerance. Scand J Gastroenterol Suppl 202:55–63
Obermayer-Pietsch BM, Gugatschka M, Reitter S, Plank W, Strele A, Walter D, Bonelli C, Goessler W, Dobnig H Högenauer C, Renner W, Fahrleitner-Pammer A (2007) Adult-type hypolactasia and calcium availability: Decreased calcium intake or impaired calcium absorption? Osteoporos Int 18:445–451. https://doi.org/10.1007/s00198-006-0251-6
Obermayer-Pietsch BM, Bonelli CM, Walter DE, Kuhn RJ, Fahrleitner-Pammer A, Berghold A, Goessler W, Stepan V, Dobnig H, Leb G, Renner W (2004) Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res 19:42–47. https://doi.org/10.1359/JBMR.0301207
Finkenstedt G, Skrabal F, Gasser RW, Braunsteiner H (1986) Lactose absorption, milk consumption, and fasting blood glucose concentrations in women with idiopathic osteoporosis. Br Med J (Clin Res Ed) 292:161–162. https://doi.org/10.1136/bmj.292.6514.161
Enattah N, Pekkarinen T, Välimäki MJ, Löyttyniemi E, Järvelä I (2005) Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in Finnish postmenopausal women. Eur J Clin Nutr 59:1105–1111. https://doi.org/10.1038/sj.ejcn.1602219
Corazza GR, Benati G, Sario A, Tarozzi C, Strocchi A, Passeri M, Gasbarrini G (1995) Lactose intolerance and bone mass in postmenopausal Italian women. Br J Nutr 73:479–487. https://doi.org/10.1079/bjn19950050
Hammer HF, Petritsch W, Pristautz H, Krejs GJ (1996) Assessment of the influence of hydrogen nonexcretion on the usefulness of the hydrogen breath test and lactose tolerance test. Wien Klin Wochenschr 108:137–141
Högenauer C, Hammer HF, Mellitzer K, Renner W, Krejs GJ, Toplak H (2005) Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 17:371–376
Kerber M, Oberkanins C, Kriegshäuser G, Kollerits B, Dossenbach-Glaninger A, Fuchs D, Ledochowski M (2007) Hydrogen breath testing versus LCT genotyping for the diagnosis of lactose intolerance: a matter of age? Clin Chim Acta 383:91–96. https://doi.org/10.1016/j.cca.2007.04.028
Enattah NS, Sahi T, Savilahti E, Terwilliger JD, Peltonen L, Järvelä I (2002) Identification of a variant associated with adult-type hypolactasia. Nat Genet 30:233–237. https://doi.org/10.1038/ng826
Kuokkanen M, Enattah NS, Oksanen A, Savilahti E, Orpana A, Järvelä I (2003) Transcriptional regulation of the lactase-phlorizin hydrolase gene by polymorphisms associated with adult-type hypolactasia. Gut 52:647–652. https://doi.org/10.1136/gut.52.5.647
Tastan Y, Kann PH, Tinneberg HR, Hadji P, Müller-Ladner U, Lange U (2016) Low bone mineral density and vitamin d deficiency correlated with genetics and other bone markers in female Turkish immigrants in Germany. Clin Rheumatol 35:2789–2795. https://doi.org/10.1007/s10067-016-3237-6
Erkal MZ, Wilde J, Bilgin Y, Akinci A, Demir E, Bödeker RH, Mann M, Bretzel R, Stracke H, Holick MF (2006) High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int 17:1133–1140. https://doi.org/10.1007/s00198-006-0069-2
Tarner IH, Erkal MZ, Obermayer-Pietsch BM, Hofbauer LC, Bergmann S, Goettsch C, Madlener K, Müller-Ladner U, Lange U (2012) Osteometabolic and osteogenetic pattern of Turkish immigrants in Germany. Exp Clin Endocrinol Diabetes 120:517–523. https://doi.org/10.1055/s-0032-1321808
Ross AC, Taylor CL, Yaktine AL, Valle HB Del (2011) Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press, Washington, DC
Black RE, Williams SM, Jones LE, Goulding A (2002) Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health. Am J Clin Nutr 76:675–680. https://doi.org/10.1093/ajcn/76.3.675
Gugatschka M, Dobnig H, Fahrleitner-Pammer A, Pietschmann P, Kudlacek S, Strele A, Obermayer-Pietsch BM (2005) Molecularly-defined lactose malabsorption, milk consumption and anthropometric differences in adult males. QJM - Mon J Assoc Physicians 98:857–863. https://doi.org/10.1093/qjmed/hci140
Gugatschka M, Hoeller A, Fahrleitner-Pammer A, Dobnig H, Pietschmann P, Kudlacek S, Obermayer-Pietsch BM (2007) Calcium supply, bone mineral density and genetically defined lactose maldigestion in a cohort of elderly men. J Endocrinol Invest 30:46–51. https://doi.org/10.1007/BF03347395
Ross AC, Taylor CL, Yaktine AL, Valle HB (2012) Dietary reference intakes for calcium and vitamin D. Pediatrics 130:e1424–e1424. https://doi.org/10.1542/peds.2012-2590
The authors are grateful to the sub-investigators, patients and hospital staff who participated in this study. We acknowledge the statistical support of MoReData GmbH, Kerkrader Strasse 11, 35394, Giessen, Germany.
There was no financial support.
Conflict of interest
The authors declare no conflict of interest.
All the authors approved the entirety of the submitted material and contributed actively to the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Klemm, P., Dischereit, G. & Lange, U. Adult lactose intolerance, calcium intake, bone metabolism and bone density in German-Turkish immigrants. J Bone Miner Metab 38, 378–384 (2020). https://doi.org/10.1007/s00774-019-01070-4
- Turkish immigrants
- Lactase polymorphism
- Calcium intake
- Bone mineral density