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. 2025 Aug;36(8):1447-1458.
doi: 10.1007/s00198-025-07577-z. Epub 2025 Jun 23.

Joint association of milk intake and blood 25(OH)D levels with fracture risk in postmenopausal women: 20-year follow-up data from the Japanese Population-Based Osteoporosis cohort study

Kuniyasu Kamiya  1 , Akane Kojima  2 , Takahiro Tachiki  3 , Nami Imai  4 , Katsuyasu Kouda  5 , Masami Hamada  6 , Asako Kudo  7 , Kouji Tsuda  7 , Akiko Hata  7   8 , Kumiko Ohara  9 , Naoyuki Takashima  9 , Yuho Sato  10 , Miho Tanaka  7 , Jun Kitagawa  11 , Kazuhiro Uenishi  12 , Junko Tamaki  7 , Etsuko Kajita  13 , Sadanobu Kagamimori  14 , Toshio Matsumoto  15 , Masayuki Iki  16
Affiliations

Joint association of milk intake and blood 25(OH)D levels with fracture risk in postmenopausal women: 20-year follow-up data from the Japanese Population-Based Osteoporosis cohort study

Kuniyasu Kamiya et al. Osteoporos Int. 2025 Aug.

Abstract

The associations between milk intake frequency and fracture risk in groups categorized by 25(OH)D levels were investigated using 20-year follow-up data. A significant association was observed only among women with 25(OH)D levels < 15 ng/mL. The measurement of blood 25(OH)D levels should be prioritized for individuals with low milk intake.

Purpose: To investigate the association between milk intake frequency and fracture risk in groups based on blood 25(OH)D levels.

Methods: This secondary analysis of a prospective cohort study included data from 1209 postmenopausal Japanese women aged ≥ 50 years. Baseline milk intake frequency was obtained using a questionnaire. Blood 25(OH)D levels were measured using a competitive protein-binding assay. Information on fracture events was obtained from face-to-face interviews through follow-up or supplemental mail surveys.

Results: Over a median follow-up period of 16.1 years (total: 17,427 person-years), 358 and 238 women sustained at least one clinical and osteoporotic fracture, respectively. The proportions of participants with milk intake < 1 glass/day and those with 25(OH)D levels < 15 ng/mL were 31.9% and 21.6%, respectively. In univariate Cox proportional hazard analyses, a 25(OH)D level < 15 ng/mL and a milk intake of < 1 glass/day were associated with an increased risk of clinical and osteoporotic fractures. Among participants with 25(OH)D levels < 15 ng/mL, the adjusted hazard ratios for milk intake < 1 glass/day compared to ≥ 1 glass/day were 1.99 (95% confidence interval: 1.32-2.99) and 2.11 (1.28-3.47) for clinical and osteoporotic fractures, respectively. In contrast, the HRs were not significant among those with 25(OH)D levels ≥ 15 ng/mL.

Conclusion: A clear positive association was identified between milk intake frequency and fracture risk among Japanese women after menopause with low 25(OH)D levels. Therefore, correcting vitamin D insufficiency would likely lower fracture risk. In addition, encouraging habitual milk intake may help prevent fractures, particularly among individuals with low 25(OH)D levels.

Keywords: 25(OH)D; Bone mineral density; Fracture; Milk intake; Postmenopausal women; Vitamin D.

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Conflict of interest statement

Declarations. Ethical Approval: The study protocol was approved by the Ethics Committee of the Kindai University Faculty of Medicine. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards [46]. Informed Consent: Informed consent was obtained from all individual participants included in the study. Human Rights: This study was conducted in accordance with the Declaration of Helsinki. Conflicts of interest: Toshio Matsumoto serves as an advisor/consultant for Amgen and Teijin Pharma. Kuniyasu Kamiya, Akane Kojima, Takahiro Tachiki, Nami Imai, Katsuyasu Kouda, Masami Hamada, Asako Kudo, Kouji Tsuda, Akiko Hata, Kumiko Ohara, Naoyuki Takashima, Yuho Sato, Miho Tanaka, Jun Kitagawa, Kazuhiro Uenishi, Junko Tamaki, Etsuko Kajita, Sadanobu Kagamimori, and Masayuki Iki declare that they have no conflict of interest.

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