However, there are other factors that intervene with the effect of calcium on bone quality and hip fractures, in particular vitamin D, which plays a crucial role in calcium absorption [51]. It has been shown that there was not much difference between calcium supplementation alone (almost the DRI) or calcium CDK inhibitor combined with vitamin D on reducing osteoporotic fractures [50, 53]. This is in line with
the conditions of use as determined by the European Food Safety Authority that indicate 1,200 mg of calcium per day, or 1,200 mg of calcium and 20 μg of vitamin D per day for women aged 50 years and older (http://www.efsa.europa.eu/). However, if dietary calcium is a threshold nutrient, then that threshold for optimal calcium absorption may be achieved at a lower calcium intake when vitamin D levels are adequate [51]. In this respect, it should be mentioned that the occurrence of dairy selleck food fortification with vitamin D might have been of some influence on the results of our model. However, accurate information on the consumption of such products was not readily available. Besides such a fortification, dairy products themselves contain additional nutrients that are beneficial to bone health, e.g. high protein content
[54]. Unfortunately, the literature does not provide valid risk-estimates for osteoporotic fractures given the additional elements in dairy foods. In this selleck chemicals llc regard, the results of this study might give an underestimation about the effect size of dairy calcium. Moreover, other factors mediate the effect of
calcium on bone health, and concomitantly on osteoporotic fractures. These factors include exposure to sunlight, level of exercise, and genetic predisposition [55]. Considering the foregoing, it may be expected that there are differences in the relative risk of hip fractures between the populations of different countries. Cyclooxygenase (COX) Our analysis concentrated on the effects of dairy calcium on hip fractures. Two observations need to be made about this. First, we did not include osteoporotic fractures other than hip fractures, due to the unavailability of sufficient data. As a result, our model may have underestimated the beneficial effects of dairy calcium. On the other hand, a side effect of consuming more dairy products might be the intake of more saturated fat, considered a risk factor for vascular diseases. Although dairy products make a contribution to total fat consumption, this contribution is likely to be relatively small. Moreover, a review by Elwood et al. [5] showed that there was no convincing evidence of any increased risk of ischaemic heart disease or ischaemic stroke in subjects who have the highest milk consumption. For all countries in this study, the loss in quality of life following a hip fracture was based on data from a Swedish study [38] because country-specific data were not available.