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Association between Dairy Product intake and Risk of Osteoporotic Fractures in Postmenopausal Japanese Women: Secondary Analysis of 15-Year Follow-Up data from the Japanese Population-Based Osteoporosis (JPOS) Cohort Study

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Few prospective cohort studies have evaluated the relationship between dairy product intake frequency and risk of osteoporotic fractures in Asians. This study aimed to investigate the association between habitual dairy product intake and risk of osteoporotic fractures.

Design

Secondary analysis of prospective cohort study.

Setting

Five municipalities of Japan.

Participants

This study included 1,429 postmenopausal Japanese women (age ≥45 years at baseline).

Measurements

Baseline milk-intake frequency was obtained using nurse-administered questionnaires. Intakes of yogurt and cheese, and estimated calcium intake, were assessed using a validated food frequency questionnaire. Osteoporotic fracture was defined as a clinical fracture diagnosed using radiography. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

Results

Over a median follow-up period of 15.1 years (interquartile range [IQR], 10.1–15.4 years; total, 18,118 person-years), 172 women sustained at least one osteoporotic fracture. The proportions of participants with milk intakes <1, 1, and ≥2 cups/d were 34.4%, 48.0%, and 17.6%, respectively. After adjustment for age, frequency of yogurt intake, frequency of cheese intake, body mass index, history of osteoporotic fractures, and frequency of natto intake, the HRs compared with that for milk intake <1 cup/d were 0.71 (95% CI: 0.51–0.98) and 0.57 (95% CI: 0.35–0.92) for 1 cup/d and ≥2 cups/d, respectively. After adjustment for bone mineral density, HR significance for milk intakes ≥2 cups/d remained significant. Yogurt and cheese intakes were not related to the risk of osteoporotic fractures.

Conclusion

High habitual milk intake, but not a habitual yogurt or cheese intake is associated with a decreased risk of osteoporotic fractures, independent of bone mineral density, in postmenopausal Japanese women.

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Abbreviations

BMD:

bone mineral density

BMI:

body mass index

CI:

confidence interval

FFQ:

food frequency questionnaire

JPOS study:

Japanese Population-based Osteoporosis study

HR:

hazard ratio

HR-pQCT:

high-resolution peripheral quantitative computed tomography

AOM:

anti-osteoporotic medication

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Acknowledgments

This study represents a part of the research conducted by the Japanese Population-based Osteoporosis Study Group (chairman: Masayuki Iki, MD, PhD, Department of Public Health, Kindai University, Faculty of Medicine). The authors would like to thank all the JPOS members, including Hideo Yoneshima (former chairman, Shuwa General Hospital), Fumiaki Marumo (former chairman, Professor Emeritus, Tokyo Medical and Dental University), Toshihisa Matsuzaki (former co-chairman, Professor Emeritus, University of the Ryukyus), Yoshiko Kagawa (Kagawa Nutrition University), Takashi Akiba (Tokyo Women’s Medical University), Harumi Nishino (Toyama Pharmaceutical Association), Tomoharu Matsukura (Toyama Prefectural Government), Toshio Matsumoto (University of Tokushima Graduate School of Medical Sciences), and Takashi Yamagami (Hokuriku Health Service Association). The authors would also like to thank the staff at the health departments of Miyakojima, Sanuki, Joetsu, Nishi-aizu, and Memuro for their unfailing support. The authors are particularly grateful to Toyo Medic Co. (Osaka, Japan) and Toyukai Medical Corporation (Tokyo, Japan) for their technical assistance.

Funding

Funding: Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. Follow-up surveys were supported by Grants-in-Aid for Scientific Research (B #10470114, 1998–2000; B #14370147, 2002–2003; B #18390201, 2006–2008; C#18590619, 2006-9; B# 23390180, 2011-13; and C#23590824, 2011-13) from the Japanese Society for the Promotion of Science, a grant (2000–2002) from the Research Society for Metabolic Bone Diseases, Japan, and a Grant-in-Aid to study Milk Nutrition (2006) from the Japan Dairy Association.

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Authors and Affiliations

  1. Department of Health and Nutrition, Kyoto College of Nutritional and Medical Sciences, Kyoto, Kyoto, Japan

    A. Kojima

  2. Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan

    K. Kamiya & Junko Tamaki

  3. Faculty of Nursing, Chukyo Gakuin University, Mizunami, Gifu, Japan

    E. Kajita & T. Tachiki

  4. Department of Human Life, Jin-ai University, Echizen, Fukui, Japan

    Y. Sato

  5. Department of Hygiene and Public Health, Kansai Medical University, Hirakata, Osaka, Japan

    K. Kouda

  6. Laboratory of Physiological Nutrition, Kagawa Nutrition University, Chiyoda, Sakado, Saitama, Japan

    K. Uenishi

  7. University of Toyama, Toyama, Toyama, Japan

    S. Kagamimori

  8. Department of Public Health, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan

    M. Iki

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Contributions

Authors’ Contributions: JT and MI conceived the study, designed and developed the research plan and were in charge of study oversight. AK performed data analysis, created all tables and figures, and prepared and edited the first and final drafts of the manuscript. Kamiya K reviewed the first draft of the manuscript, tables, and figures. EK conducted interviews on incident events, history of fractures, medical history, and lifestyle habits. TT and Koda K participated in the cohort study and reviewed the manuscript. YS conducted the interviews on food and estimation of daily calcium intakes. JT and MI directed the cohort study and reviewed/edited the first and final drafts of the manuscripts, tables, and figures. KU and SK reviewed/edited the final draft of the manuscripts, tables, and figures. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Junko Tamaki.

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Conflict of interest: All authors declare no conflicts of interest.

Ethical Standards: The study protocol was approved by the Ethics Committee of Kindai University Faculty of Medicine, and the study complied with the Helsinki Declaration and the current laws of Japan.

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Kojima, A., Kamiya, K., Kajita, E. et al. Association between Dairy Product intake and Risk of Osteoporotic Fractures in Postmenopausal Japanese Women: Secondary Analysis of 15-Year Follow-Up data from the Japanese Population-Based Osteoporosis (JPOS) Cohort Study. J Nutr Health Aging 27, 228–237 (2023). https://doi.org/10.1007/s12603-023-1898-1

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