Nutr Res Pract.  2013 Oct;7(5):409-417. 10.4162/nrp.2013.7.5.409.

Effects of calcium intake, milk and dairy product intake, and blood vitamin D level on osteoporosis risk in Korean adults: analysis of the 2008 and 2009 Korea National Health and Nutrition Examination Survey

  • 1Department of Medical Science, School of Medicine Konkuk University, Seoul 143-701, Korea.
  • 2National Academy of Agricultural Science, Rural Development Administration, Suwon, Gyeonggi 441-707, Korea.
  • 3FANSA (Food and nutrition statistical analysis), 793, Geumha-ro, Geumcheon-gu, Seoul 153-764, Korea.


This study was performed to determine the effects of dietary calcium (Ca) intake, milk and dairy product intake, and serum vitamin D level on bone mineral density. The survey data from the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES) for adults (3,819 males, 5,625 females) aged > 20 years were examined; osteoporosis was defined according to the standards for Asian populations (T-score < -2.5). The risk for osteoporosis significantly decreased as Ca intake increased; this effect persisted (quartile 4 vs. quartile 1 of Ca intake: odds ratio [OR] 0.66; 95% confidence interval [CI]: 0.50-0.87) even after adjustment for gender, age, and other factors (body mass index, serum vitamin D, menstruation, female hormone intake, menopausal status, and the number of days per week of muscular strength exercise). Additionally, the risk for osteoporosis significantly decreased as the Ca/P ratio increased (quartile 4 vs. quartile 1: OR 0.76; 95% CI: 0.58-0.98). The degree of risk was 0.96 (0.66-1.38) in those who consumed < 1 portion of milk or dairy products daily, and 0.71 (0.53-0.96) in those who consumed > 1 portion per day, compared with those who had zero intake. The risk for osteoporosis significantly decreased as the serum 25(OH) vitamin D level increased. From these results, we advocate an increase in Ca, milk, and dairy product intake, and that serum 25(OH) vitamin D levels be maintained within the normal range, for the maintenance of bone health and the prevention of osteoporosis in adults.


Calcium; milk and dairy products; serum vitamin D level; osteoporosis; bone mineral density

MeSH Terms

Asian Continental Ancestry Group
Bone Density
Calcium, Dietary
Dairy Products
Nutrition Surveys
Odds Ratio
Reference Values
Vitamin D
Calcium, Dietary
Vitamin D

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1. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. 2009 Korea National Health and Nutrition Examination Survey. Cheongwon: Korea Centers for Disease Control and Prevention;2010.
2. Health Insurance Review & Assessment Service Report Data. Seoul: Health Insurance Review & Assessment Service;2013.
3. Weinsier RL, Krumdieck CL. Dairy foods and bone health: examination of the evidence. Am J Clin Nutr. 2000; 72:681–689.
4. Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr. 2000; 19:83S–99S.
5. Ruiz JC, Mandel C, Garabedian M. Influence of spontaneous calcium intake and physical exercise on the vertebral and femoral bone mineral density of children and adolescents. J Bone Miner Res. 1995; 10:675–682.
6. Sentipal JM, Wardlaw GM, Mahan J, Matkovic V. Influence of calcium intake and growth indexes on vertebral bone mineral density in young females. Am J Clin Nutr. 1991; 54:425–428.
7. Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr. 2003; 77:504–511.
8. Lanou AJ, Berkow SE, Barnard ND. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics. 2005; 115:736–743.
9. Murphy S, Khaw KT, May H, Compston JE. Milk consumption and bone mineral density in middle aged and elderly women. BMJ. 1994; 308:939–941.
10. Choi MJ, Park EJ, Jo HJ. Relationship of nutrient intakes and bone mineral density of elderly women in Daegu, Korea. Nutr Res Pract. 2007; 1:328–334.
11. Yoon EH, Noh H, Lee HM, Hwang HS, Park HK, Park YS. Bone mineral density and food-frequency in Korean adults: The 2008 and 2009 Korea National Health and Nutrition Examination Survey. Korean J Fam Med. 2012; 33:287–295.
12. NIH Consensus conference. Optimal calcium intake. Optimal calcium intake. NIH Consensus Development Panel on Optimal Calcium Intake. JAMA. 1994; 272:1942–1948.
13. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board. Institute of Medicine. Dri Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, D.C.: National Academy Press;1997.
14. Abelow BJ, Holford TR, Insogna KL. Cross-cultural association between dietary animal protein and hip fracture: a hypothesis. Calcif Tissue Int. 1992; 50:14–18.
15. Hegsted DM. Fractures, calcium, and the modern diet. Am J Clin Nutr. 2001; 74:571–573.
16. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, Dietrich T, Willett WC. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among US adults. J Bone Miner Res. 2009; 24:935–942.
17. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004; 116:634–639.
18. Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, Ragi-Eis S, Chandler J. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006; 260:245–254.
19. Melhus H, Snellman G, Gedeborg R, Byberg L, Berglund L, Mallmin H, Hellman P, Blomhoff R, Hagström E, Arnlöv J, Michaëlsson K. Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab. 2010; 95:2637–2645.
20. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994; 9:1137–1141.
21. Włodarek D, Głąbska D, Kołota A, Adamczyk P, Czekajło A, Grzeszczak W, Drozdzowska B, Pluskiewicz W. Calcium intake and osteoporosis: the influence of calcium intake from dairy products on hip bone mineral density and fracture incidence - a population-based study in women over 55 years of age. Public Health Nutr. 2012. p. 1–7.
22. Kardinaal AF, Ando S, Charles P, Charzewska J, Rotily M, Väänänen K, Van Erp-Baart AM, Heikkinen J, Thomsen J, Maggiolini M, Deloraine A, Chabros E, Juvin R, Schaafsma G. Dietary calcium and bone density in adolescent girls and young women in Europe. J Bone Miner Res. 1999; 14:583–592.
23. Jones G, Riley MD, Whiting S. Association between urinary potassium, urinary sodium, current diet, and bone density in prepubertal children. Am J Clin Nutr. 2001; 73:839–844.
24. Moro M, van der Meulen MC, Kiratli BJ, Marcus R, Bachrach LK, Carter DR. Body mass is the primary determinant of midfemoral bone acquisition during adolescent growth. Bone. 1996; 19:519–526.
25. Uusi-Rasi K, Haapasalo H, Kannus P, Pasanen M, Sievänen H, Oja P, Vuori I. Determinants of bone mineralization in 8 to 20 year old Finnish females. Eur J Clin Nutr. 1997; 51:54–59.
26. Higashiguchi M, Onoda T, Turin TC, Sakata K. NIPPON DATA 80/90 Research Group. Calcium intake and associated factors in a general Japanese population: baseline data of NIPPON DATA 80/90 and the National Nutrition Survey. J Epidemiol. 2010; 20:Suppl 3. S549–S556.
27. Yu CH, Lee JS, Lee L, Kim SH, Lee SS, Kang SA. Nutritional factors related to bone mineral density in the different age groups of Korean men. Korean J Nutr. 2004; 37:132–142.
28. Yu CH, Lee JS, Lee L, Kim SH, Lee SS, Jung IK. Nutritional factors related to bone mineral density in the different age groups of Korean women. Korean J Nutr. 2002; 35:779–790.
29. Lee JS, Yu CH, Chung CE. Relation between milk consumption and bone mineral density of female college students in Korea. Korean J Nutr. 2006; 39:451–459.
30. Sahni S, Tucker KL, Kiel DP, Quach L, Casey VA, Hannan MT. Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study. Arch Osteoporos. 2013; 8:119.
31. Jakobsen A, Laurberg P, Vestergaard P, Andersen S. Clinical risk factors for osteoporosis are common among elderly people in Nuuk, Greenland. Int J Circumpolar Health. 2013; 72:19596.
32. Warensjö E, Byberg L, Melhus H, Gedeborg R, Mallmin H, Wolk A, Michaëlsson K. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ. 2011; 342:d1473.
33. Kruger MC, Ha PC, Todd JM, Kuhn-Sherlock B, Schollum LM, Ma J, Qin G, Lau E. High-calcium, vitamin D fortified milk is effective in improving bone turnover markers and vitamin D status in healthy postmenopausal Chinese women. Eur J Clin Nutr. 2012; 66:856–861.
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