Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 24
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Jiao, Rui Chen, Jingnan Huang, Yu and Chen, Zhen-Yu 2016. Handbook of Functional Beverages and Human Health.

    Lani, Athina Kourkoumelis, Nikolaos Baliouskas, Gerasimos and Tzaphlidou, Margaret 2014. The effect of calcium and vitamin D supplementation on osteoporotic rabbit bones studied by vibrational spectroscopy. Journal of Biological Physics, Vol. 40, Issue. 4, p. 401.

    Lin, Xiaorong Chen, Zhongzheng Zhang, Yuanyuan Gao, Xiong Luo, Wei and Li, Bin 2014. Interactions among chemical components of Cocoa tea (Camellia ptilophylla Chang), a naturally low caffeine-containing tea species. Food & Function, Vol. 5, Issue. 6, p. 1175.

    Wee, James Sng, Bo Yang Jonathan Shen, Liang Lim, Chin Tat Singh, Gurpal and Das De, Shamal 2013. The relationship between body mass index and physical activity levels in relation to bone mineral density in premenopausal and postmenopausal women. Archives of Osteoporosis, Vol. 8, Issue. 1-2,

    Rouzi, Abdulrahim A. Al-Sibiani, Sharifa A. Al-Senani, Nawal S. Radaddi, Raja M. and Ardawi, Mohammed-Salleh M. 2012. Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: The CEOR Study. Bone, Vol. 50, Issue. 3, p. 713.

    Sáez-Ayala, Magalí Sánchez-del-Campo, Luis Montenegro, María F. Chazarra, Soledad Tárraga, Alberto Cabezas-Herrera, Juan and Rodríguez-López, José Neptuno 2011. Comparison of a Pair of Synthetic Tea-Catechin-Derived Epimers: Synthesis, Antifolate Activity, and Tyrosinase-Mediated Activation in Melanoma. ChemMedChem, Vol. 6, Issue. 3, p. 440.

    Ströhle, Alexander Waldmann, Annika Koschizke, Jochen Leitzmann, Claus and Hahn, Andreas 2011. Diet-Dependent Net Endogenous Acid Load of Vegan Diets in Relation to Food Groups and Bone Health-Related Nutrients: Results from the German Vegan Study. Annals of Nutrition and Metabolism, Vol. 59, Issue. 2-4, p. 117.

    Lee, Ren-Jye Lee, Viola S. Y. Tzen, Jason T. C. and Lee, Maw-Rong 2010. Study of the release of gallic acid from (-)-epigallocatechin gallate in old oolong tea by mass spectrometry. Rapid Communications in Mass Spectrometry, Vol. 24, Issue. 7, p. 851.

    Gotti, Roberto Furlanetto, Sandra Lanteri, Silvia Olmo, Stefano Ragaini, Alessandro and Cavrini, Vanni 2009. Differentiation of green tea samples by chiral CD-MEKC analysis of catechins content. ELECTROPHORESIS, Vol. 30, Issue. 16, p. 2922.

    Nieves, J. W. Barrett-Connor, E. Siris, E. S. Zion, M. Barlas, S. and Chen, Y. T. 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. Osteoporosis International, Vol. 19, Issue. 5, p. 673.

    Ramesh, E. Elanchezhian, R. Sakthivel, M. Jayakumar, T. Senthil Kumar, R.S. Geraldine, P. and Thomas, P.A. 2008. Epigallocatechin gallate improves serum lipid profile and erythrocyte and cardiac tissue antioxidant parameters in Wistar rats fed an atherogenic diet. Fundamental & Clinical Pharmacology, Vol. 22, Issue. 3, p. 275.

    Sticher, Otto 2008. Natural product isolation. Natural Product Reports, Vol. 25, Issue. 3, p. 517.

    Leontowicz, Maria Leontowicz, Hanna Jastrzebski, Zenon Jesion, Iwona Haruenkit, Ratiporn Poovarodom, Sumitra Katrich, Elena Tashma, Zev Drzewiecki, Jerzy Trakhtenberg, Simon and Gorinstein, Shela 2007. The nutritional and metabolic indices in rats fed cholesterol-containing diets supplemented with durian at different stages of ripening. BioFactors, Vol. 29, Issue. 2-3, p. 123.

    Miyabara, Yuko Onoe, Yoshiko Harada, Akiko Kuroda, Tatsuhiko Sasaki, Satoshi and Ohta, Hiroaki 2007. Effect of physical activity and nutrition on bone mineral density in young Japanese women. Journal of Bone and Mineral Metabolism, Vol. 25, Issue. 6, p. 414.

    Cashman, Kevin D. 2006. Milk minerals (including trace elements) and bone health. International Dairy Journal, Vol. 16, Issue. 11, p. 1389.

    Dennison, Elaine Medley, Judith and Cooper, Cyrus 2006. Who is at risk of osteoporosis?. Women's Health Medicine, Vol. 3, Issue. 4, p. 152.

    Friedman, Mendel Levin, Carol E. Choi, Suk-Hyun Kozukue, Etsuko and Kozukue, Nobuyuki 2006. HPLC Analysis of Catechins, Theaflavins, and Alkaloids in Commercial Teas and Green Tea Dietary Supplements: Comparison of Water and 80% Ethanol/Water Extracts. Journal of Food Science, Vol. 71, Issue. 6, p. C328.

    Khan, S. Mahaboob 2006. Protective effect of black tea extract on the levels of lipid peroxidation and antioxidant enzymes in liver of mice with pesticide-induced liver injury. Cell Biochemistry and Function, Vol. 24, Issue. 4, p. 327.

    Kruger, M.C. Poulsen, R.C. Schollum, L. Haggarty, N. Ram, S. and Palmano, K. 2006. A comparison between acidic and basic protein fractions from whey or milk for reduction of bone loss in the ovariectomised rat. International Dairy Journal, Vol. 16, Issue. 10, p. 1149.

    Patel, Salil H. and Murphy, Kieran P. 2006. Fractures of the proximal femur: correlates of radiological evidence of osteoporosis. Skeletal Radiology, Vol. 35, Issue. 4, p. 202.


Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies

  • Liangzhi Xu (a1), Patrick McElduff (a1), Catherine D'Este (a1) and John Attia (a1)
  • DOI:
  • Published online: 01 March 2007

It is generally accepted that supplemental Ca and/or vitamin D is effective in reducing the incidence of bone fractures; this is supported by numerous randomised controlled trials and meta-analyses. However, a question that has received much less attention is whether dietary Ca, i.e. Ca in physiological doses in normal food intake, also affects bone fracture risk. The present study aims to review the effect of dietary Ca on bone fractures at the hip, spine and radius in women >35 years old, and to compare these results with previous meta-analyses. MEDLINE (1966–1999) and reference lists in papers were searched for observational dietary Ca studies. Data were extracted in duplicate and separately. Heterogeneity and publication bias were tested. Observational studies failed to show any association between dietary Ca intake and risk of hip fracture (risk ratio 1·01, 95% CI 0·96, 1·07 for each increment of 300mg dietary Ca intake/d). There is a suggestion that either extremely low Ca intake may increase fracture risk, or that East Asian women may respond differently to increasing Ca intake.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies
      Available formats
Corresponding author
*Corresponding author: Dr Liangzhi Xu, present address: Department of Obstetrics and Gynaecology, The Second West China Hospital, Sichuan University, Chengdu, China, fax +86 28 8555 9065, email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

M Angell (1989) Negative studies. New Engl J Med 321, 464466.

HH Chan , EM Lau , J Woo , F Lin , A Sham & PC Leung (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6, 228232.

E Chrischilles , T Shireman & R Wallace (1994) Costs and health effects of osteoporotic fractures. Bone 15, 377386.

C Cooper , DJ Barker & C Wickham (1988) Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. Br Med J 297, 14431446.

RG Cumming (1990) Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 47, 194201.

RG Cumming , SR Cummings , MC Nevitt , J Scott , KE Ensrud , TM Vogt & K Fox (1997) Calcium intake and fracture risk: results from the study of osteoporotic fractures. Am J Epidemiol 145, 926934.

RG Cumming & MC Nevitt (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 12, 13211329.

SR Cummings , MC Nevitt , WS Browner , K Stone , KM Fox , KE Ensrud , J Cauley , D Black & TM Vogt (1995) Risk factors for hip fracture in white women. New Engl J Med 332, 767773.

M Egger , G Davey Smith , M Schneider & C Minder (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315, 629634.

M Egger , S Ebrahim & GD Smith (2002) Where now for meta-analysis? Int J Epidemiol 31, 15.

T Fujita & M Fukase (1992) Comparison of osteoporosis and calcium intake between Japan and the United States. Proc Soc Exp Biol Med 200, 149152.

G Gregoire , F Derderian & J Le Lorier (1995) Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol 48, 159163.

O Johnell , B Gullberg , JA Kanis , (1995) Risk factors for hip fracture in European women: the MEDOS Study (Mediterranean Osteoporosis Study). J Bone Miner Res 10, 18021815.

N Kreiger , A Gross & G Hunter (1992) Dietary factors and fracture in postmenopausal women: a case–control study. Int J Epidemiol 21, 953958.

V Krogh , JL Freudenheim , A D'Amicis , C Scaccini , S Sette , A Ferro-Luzzi & M Trevisan (1993) Food sources of nutrients of the diet of elderly Italians: II. Micronutrients. Int J Epidemiol 22, 869877.

E Lau , S Donnan , DJ Barker & C Cooper (1988) Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. Br Med J 297, 14411443.

L McAuley , B Pham , P Tugwell & D Moher (2000) Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 356, 12281231.

HE Meyer , C Henriksen , JA Falch , JI Pedersen & A Tverdal (1995) Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 5, 239246.

HE Meyer , JI Pedersen , EB Loken & A Tverdal (1997) Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 145, 117123.

K Michaelsson , L Holmberg , H Mallmin , S Sorensen , A Wolk , R Bergstrom & S Ljunghall (1995) Diet and hip fracture risk: a case-control study. Int J Epidemiol 24, 771782.

D Moher , B Pham , T Klassen , KF Schulz , JA Berlin , AR Jadad & A Liverati (2000) What contributions do languages other than English make on the results of meta-analyses? J Clin Epidmiol 53, 964972.

JW Nieves , JA Grisso & JL Kelsey (1992) A case–control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporos Int 2, 122127.

A Paganini Hill , A Chao , RK Ross & BE Henderson (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2, 1625.

KF Schulz , I Chalmers , RJ Hayes & DG Altman (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. J Am Med Assoc 273, 408412.

ME Suarez-Almazor , E Belseck , J Homik , M Dorgan & C Ramos-Remus (2000) Identifying clinical trials in the medical literature with electronic databases: MEDLINE alone is not enough. Control Clin Trials 21, 476487.

A Tavani , E Negri & C La Vecchia (1995) Calcium, dairy products, and the risk of hip fracture in women in northern Italy. Epidemiology 6, 554557.

RP Young , EM Lau , Z Birjandi , J Critchley & J Woo (1996) Interethnic differences in hip fracture rate and the vitamin D receptor polymorphism. Lancet 348, 688689.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *