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Meta-Analysis
. 2022 Aug 1;13(4):1186-1199.
doi: 10.1093/advances/nmab136.

The Effects of Milk Supplementation on Bone Health Indices in Adults: A Meta-Analysis of Randomized Controlled Trials

Khemayanto Hidayat  1 , Jing-Si Chen  1 , Tian-Ci Wang  1 , Yu-Jie Liu  1 , Yu-Jie Shi  2 , Hong-Wen Su  2 , Biao Liu  2 , Li-Qiang Qin  1
Affiliations
Meta-Analysis

The Effects of Milk Supplementation on Bone Health Indices in Adults: A Meta-Analysis of Randomized Controlled Trials

Khemayanto Hidayat et al. Adv Nutr. .

Abstract

Milk contains a number of bone-beneficial nutrients. However, milk, due to the D-galactose content, might have unfavorable effects on bone health. A meta-analysis of randomized controlled trials (RCTs) was performed to clarify the effects of milk supplementation on bone mineral density (BMD), bone turnover markers [N-terminal telopeptide of type I collagen (NTx), C-terminal telopeptide of type 1 collagen (CTx), osteocalcin, bone alkaline phosphatase (BALP), and procollagen type 1 N-propeptide (P1NP)], and hormonal indices related to bone metabolism [parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], and insulin-like growth factor 1 (IGF-1)] in adults. The PubMed and Web of Science databases were searched. A random-effects model was used to estimate the pooled effect sizes. A total of 20 RCTs were included. The trial duration ranged from 1 mo to 36 mo. Milk supplementation resulted in a small but significant increase in BMD at the hip (+0.004 g/cm2; n = 9 RCTs) and lumbar spine (+0.025 g/cm2; n = 7), but did not significantly affect whole-body BMD (n = 3) and femoral neck BMD (n = 7). Milk supplementation reduced the concentrations of P1NP (-5.20 ng/mL; n = 9), CTx (-0.16 ng/mL; n = 9), and NTx (-8.66 nmol bone collagen equivalents/mmol creatinine; n = 3). The concentrations of osteocalcin (n = 9) and BALP (n = 3) were not affected by milk supplementation. Reduced parathyroid hormone PTH (-1.01 pg/mL; n = 13) concentrations and increased IGF-1 (+1.79 nmol/l; n = 4) concentrations were observed with milk supplementation. 25(OH)D (+3.73 ng/mL; n = 11) concentrations were increased with vitamin-D fortified milk supplementation. The addition of milk to the diet may potentially increase the likelihood of preventing bone loss by restoring bone homeostasis through the modulation of the calcium-vitamin D-PTH axis, bone remodeling rate, and growth hormone/IGF-1 axis.

Keywords: bone mass; bone mineral density; bone remodeling; bone turnover; calcium; milk.

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Figures

FIGURE 1
FIGURE 1
Forest plot of the change in bone mineral density (BMD) after milk supplementation in adults. Weighted mean difference: 0.005 (95% CI: –0.005 to 0.016) g/cm2 for whole-body BMD, 0.004 (95% CI: 0.002 to 0.007) g/cm2 for hip BMD, 0.002 (95% CI: –0.003 to 0.007) g/cm2 for femoral neck BMD, and 0.025 (95% CI: 0.005 to 0.045) g/cm2 for lumbar spine BMD. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 2
FIGURE 2
Forest plot of the change in the concentrations of serum osteocalcin and BALP after milk supplementation in adults. Weighted mean difference: –0.11 (95% CI: –1.23 to 1.00) ng/mL for osteocalcin and 0.25 (95% CI: –0.39 to 0.89) μg/L for BALP. Weights are from random-effects meta-analysis. BALP, bone alkaline phosphatase; WMD, weighted mean difference.
FIGURE 3
FIGURE 3
Forest plot of the change in serum procollagen type 1 N-propeptide (P1NP) concentrations after milk supplementation in adults. Weighted mean difference: –5.20 (95% CI: –9.07 to –1.33) ng/mL. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 4
FIGURE 4
Forest plot of the change in serum C-terminal telopeptide of type 1 collagen concentrations after milk supplementation in adults. Weighted mean difference: –0.16 (95% CI: –0.23 to –0.10) ng/mL. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 5
FIGURE 5
Forest plot of the change in urine N-terminal telopeptide of type 1 collagen concentrations after milk supplementation in adults. Weighted mean difference: –8.66 (95% CI: –13.57 to –3.75) nmol bone collagen equivalents/mmol creatinine. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 6
FIGURE 6
Forest plot of the change in the concentrations of serum parathyroid hormone and insulin-like growth factor-1 (IGF-1) after milk supplementation in adults. Weighted mean difference: –1.01 (95% CI: –1.42 to –0.60) pg/mL for parathyroid hormone and 1.79 (95% CI: 1.03 to 2.56) nmol/L for IGF-1. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 7
FIGURE 7
Forest plot of the change in serum 25-hydroxyvitamin D concentrations after vitamin D-fortified milk supplementation in adults. Weighted mean difference: 3.73 (95% CI: 1.36 to 6.11) ng/mL. Weights are from random-effects meta-analysis. WMD, weighted mean difference.
FIGURE 8
FIGURE 8
The potential mechanisms by which milk may improve bone health in adults. IGF-1, insulin-like growth factor-1; PTH, parathyroid hormone.
See this image and copyright information in PMC

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