There is consistent evidence supporting the role of milk and milk products as part of a healthy diet for the development of strong and healthy bones in children and adolescents. Osteoporosis is characterized by low bone mass and can lead to increased risk of fracture. Attaining peak bone mass in early life is key to preventing osteoporosis and related fractures later in life.

What role do dairy products and their nutrients play in bone health? NutriNews® is designed for health professionals and will not only help you stay up-to-date on the latest research and scientific data related to milk products, it will be your source for upcoming events, such as webinars and symposiums.

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Article How Does Milk Product Consumption Influence Fracture Risk? Learning about the foods that are rich in calcium, vitamin D and other nutrients that are important for your bone health and overall health will help you make healthier food choices every day.

Use the chart below for examples of the different types of food you should be eating every day. If you eat and drink three to four servings of milk, cheese, yogurt, or calcium added orange juice and plant milks, you may be getting all the calcium you need in a day.

When choosing a supplement, you should assess the amount of calcium you get from your diet and how much you might need to add. Good-for-Your-Bones Foods Food Nutrient Dairy products such as low-fat and non-fat milk, yogurt and cheese Calcium. Some dairy products are fortified with Vitamin D. Fish Canned sardines and salmon with bones Calcium Fatty varieties such as salmon, mackerel, tuna and sardines Vitamin D Fruits and vegetables Collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens and broccoli.

Calcium Spinach, beet greens, okra, tomato products, artichokes, plantains, potatoes, sweet potatoes, collard greens, prunes and raisins. Magnesium Tomato products, prunes, raisins, potatoes, spinach, sweet potatoes, papaya, oranges, orange juice, bananas and plantains.

Potassium Red peppers, green peppers, oranges, grapefruits, broccoli, strawberries, brussels sprouts, papaya and pineapples. Vitamin C Prunes. Dark green leafy vegetables such as kale, collard greens, spinach, mustard greens, turnip greens and brussel sprouts.

Vitamin K Fortified Foods Calcium and vitamin D are sometimes added to certain brands of juices, breakfast foods, soy milk, rice milk, cereals, snacks and breads. Calcium, Vitamin D Leafy greens and other nutrient-rich foods are good for your bones.

More Examples of Bone Healthy Food Recent research suggests that olive oil, soy beans, blueberries and foods rich in omega-3s, like fish oil and flaxseed oil may also have bone boosting benefits. But the many overall health benefits of these foods make them excellent choices to add to your diet.

While beans contain calcium, magnesium, fiber and other nutrients, they are also high in substances called phytates. You can reduce the phytate level by soaking beans in water for several hours and then cooking them in fresh water. However, special high protein diets that contain multiple servings of meat and protein with each meal can also cause the body to lose calcium.

For example dairy products, although high in protein, also contain calcium that is important for healthy bones. The best food sources of calcium are milk, yogurt, cheese, fortified cereals and dark green leafy vegetables.

The Academy of Nutrition and Dietetics recommends three servings of calcium-rich foods every day for children ages nine and older to maintain bone health.

Bones need vitamin D to help absorb calcium. Most people get vitamin D from three sources:. One cup of milk provides a quarter or more of the daily requirement of vitamin D. Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, In addition to a diet that includes calcium and vitamin D, weight-bearing activities like walking, running, hiking, climbing, dancing and lifting weights help to prevent fractures and maintain healthy bones.

Aim for 30 minutes each day, most days of the week. Please click on any of the texts below to preview your preferred resource s. Bone Health. Risk Factors for Osteoporosis.

But there's good news: You can play a significant role in your bone health. This may mean that you either slow down or prevent osteoporosis a disease characterized by brittle and breaking bones.

Learn more about how you can strengthen your bones and what can help, including the foods you'll want to add to your diet. Exercise and physical activity can keep bones healthy from childhood through adulthood. Kids and teens should aim for an hour of physical activity daily, while adults need about two hours and 30 minutes each week.

Ideally, you would mix in exercises that are:. You may also like yoga, pilates, or tai chi to improve flexibility, core strength, and balance. Additionally, a diet full of calcium and vitamin D can help if you develop osteoporosis.

Getting plenty of calcium and vitamin D may slow the disease and prevent fractures. Calcium is a mineral that supports your bone and teeth structure and hardness.

The rest of your body sort of uses your bones as a calcium bank. Vitamin D is found naturally in a few foods, including fish and mushrooms, but it's mainly found in fortified foods. Your body also produces it when your skin is in the sun.

Vitamin D improves calcium absorption and bone growth and helps your muscles, nerves, and immune system. You want to make sure that you get enough of each nutrient to maintain healthy bones.

Adults should aim to get the following recommended amounts of calcium and vitamin D:. Not getting enough calcium and vitamin D can lead to muscle strain, joint pain, and an increased risk of bone disorders, like osteoporosis.

If you are experiencing pain or are concerned about your symptoms, find personalized tips on how to prioritize your bone health by taking the quiz below. Quiz medically reviewed by Soma Mandal, MD. Dairy products —like milk, yogurt, and cheese—can be excellent sources of calcium to help strengthen your bones.

Milk has several nutrients—18 out of the 22 that are most important for human health, including calcium. It is also considered one of the richest sources of naturally occurring calcium. According to the Dietary Guidelines for Americans, different types of milk contain various amounts of calcium.

Some examples include:. Another good source of naturally occurring calcium is yogurt. Specifically, 8 ounces of low or nonfat plain yogurt has milligrams of calcium, while 8 ounces of non- or low-fat plain Greek yogurt has milligrams of calcium.

Yogurt also contains other nutrients, such as:. You may be happy to know cheese can be a calcium source that provides other minerals, vitamins, and protein.

Each kind of cheese packs a different punch so let's break it down. The estimated calcium contents for the following cheeses are:. As much as you may want to eat cheese for its calcium, it's a good idea to eat it in moderation.

Cheese can be high in salt and saturated fats—two things that can raise blood pressure and LDL cholesterol aka the bad cholesterol.

Maybe you don't eat or drink dairy products. You may be lactose intolerant or choose not to consume animal products. Don't fret. You can still find many ways to get calcium and vitamin D. Some plant-based alternatives to dairy milk that provide nutrients for making bones stronger include:.

Check the food labels on packages to determine the calcium and vitamin D content for these or other products you plan to purchase. How much of the nutrients dairy alternatives have can vary between foods or drinks. These three types of fish can load you up with calcium and vitamin D and lots of protein to help you maintain healthy bones.

Sardines sometimes get a bad reputation, but just 3. You can enjoy sardines straight from the can, on a pizza, or mixed in a pasta or salad dish.

You can also try them on crackers with mustard. Salmon often gets coined a "superfood" because it boasts numerous health benefits , one of which is keeping your bones healthy. A 3-ounce serving of cooked salmon has about 13 milligrams of calcium but a whopping IU of vitamin D.

Salmon is also famous for its omega-3 fatty acids. Omega-3 fatty acids are essential for heart, eye, and brain health, as well as maintaining your energy level.

Tuna dishes are inexpensive dinner staples tuna melt or casserole, anyone? One can of tuna provides 26 milligrams of calcium and 67 international units of vitamin D.

Although lower in vitamin D than sardines and salmon, tuna is still a healthy source of vitamin D to include in your diet. Egg yolks can help your bone health too. Just one large egg yolk provides 22 milligrams of calcium and 37 international units of vitamin D.

Plus, if you eat the egg white, you'll get about 6 grams of protein from each large egg. If you're vegan or just love tofu it's delicious, after all , you can find tofu prepared with calcium sulfate.

Tofu with calcium sulfate can have as much as milligrams of calcium in a 1-cup serving. Calcium amounts in tofu can vary depending on the brand, so it's a good idea to check your food label. Soybeans, also known as edamame, make a great snack or appetizer with the bonus of helping your bones.

The USDA reports just one cup of cooked soybeans has milligrams of calcium. Adding edamame to your soups and salads is a great way to boost the calcium and protein you get. Some people don't realize that dark leafy vegetables—kale, mustard and collard greens, spinach , and bok choy —can be loaded with calcium to support bone health.

The study included more than 2, people, including about 1, men with an average age of The researchers asked about the people's dairy intake and measured their bone density with CT scans. They found that higher dairy food intake correlated with higher bone density in men, but not women.

On average, the men consumed 11 servings of low-fat milk, yogurt, and cheese per week, or 1. The researchers noted that if the men met the higher daily amount, their spinal bone density in particular would have been higher. While calcium is an important bone-building nutrient, dairy foods contain other vital ones, like vitamin D in fortified dairy foods , protein, magnesium, and potassium.

Therefore, the benefit is likely from a combination of these nutrients, according to the researchers. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

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It is well-known that milk has more beneficial effects on bone health when compared to other food products. Milk is made up phosphoproteins such as growth factors, immunoglobulins, bovine serum albumin BSA , alpha-lactalbumin and beta-lactoglobulin and a large quantity of caseins Milk proteins are made up of bioactive peptides which are inactive or latent until released and activated by the process of enzymatic proteolysis during food processing, gastrointestinal digestion, fermentation of milk with proteolytic starter cultures or hydrolysis by proteolytic enzymes Enzymatic proteolysis, for example, the actions of proteinases and peptidases from lactic acid bacteria are important for the release and activation of the milk-protein derived bioactive peptides known to be inactive within the sequence of the parent protein Casein is the major source of amino acids in the milk-peptide sequence.

The active sequence size which may vary from 2 to 20 amino acid residues and many peptides are also known for its multi-functional properties Digestive enzymes in the human gastrointestinal tract GIT contribute to the further breakdown of long casein-derived oligopeptides which may lead to the release of bioactive peptides.

Casein phosphopeptides CPP prepared from cow's milk beta-casein is known to enhance the absorption of calcium by increasing the soluble calcium concentration in the small intestinal lumen On liberation, these bioactive peptides may produce hormone-like activity acting as regulatory compounds Milk whey protein, in particular the milk basic protein MBP fractions have also been shown to promote bone formation and increase bone mineral density in both in vivo and in vitro studies 36 , Caseinoglycomacropeptide CGMP is an acidic protein from milk released from kappa-casein during coagulation in the making of cheese.

The milk acidic protein has also been reported to reduce bone loss in ovariectomised rats 38 , Lactic acid bacteria produce lactic acid whey by the process of fermentation in the making of cheese. However, the lactic acid whey and mineral acid whey do not contain CGMP Lactoferrin is known as an iron-binding glycoprotein found in milk which is capable of stimulating bone formation cells, osteoblasts while inhibiting the osteoclasts, bone resorption cells Studies conducted in vitro 41 and in vivo 42 have shown a positive association and effects on bone mass in ovariectomized rats and mice.

Osteopontin is another highly glycosylated and phosphorylated protein typically found in milk. It is a non-collagenous protein in bone which protects the exposed bone surface. Osteopontin is known to be important for bone cells and cell-matrix interactions Milk products such as yogurt and kefir contain probiotics, however milk and dairy products may also be considered a good carrier of probiotics and prebiotics which are important for calcium absorption.

Calcium bioavailability depends on various factors such as the source of calcium, age, transit time, the amount of calcium ingested, intestinal content, and type of diet. All of these factors play a role in the rate of calcium absorption. Calcium is a divalent cation which occurs as salt in food.

Calcium gets absorbed in soluble form and must be in an ionized form Prebiotics for example, improve mineral balance and bone properties by lowering cecal pH which can increase calcium solubility and absorption, increase in cecal wall thickness and content weight as well as increases in bifidobacterial Probiotics are known to contain living microorganism that tends to exert beneficial effects onto the GIT microbial population.

The most commonly defined probiotic microbes are member of the genera Lactobacillus, Bifidobacterium as well as lactic acid and non-lactic acid bacteria Probiotics has numerous advantages and functions in the human organism with the main advantage being the ability to maintain appropriate balance between pathogens and bacteria necessary for normal function.

This positive effect is also used to restore the natural microbiota in the gut after antibiotic therapy Another role of the probiotics is in the counteraction of the activities of pathogenic intestinal bacteria which were caused by contaminated food and environment.

Probiotic microbes have been reported to increase the immune system efficiency, enhance vitamin, and mineral absorption as well as generate organic acids and amino acids Some probiotics may produce enzymes such as lipase and esterase and co-enzymes A, Q, NAD and NADP.

All these have been shown to exhibit antibiotic acidophiline, bacitracin and lactacin, a bacteriocin 47 , anti-cancerogenic 48 , and immunosuppressive properties Bone health depends on the bone remodeling cycle and the balance of the bone formation by osteoblasts and bone resorption process by osteoclasts.

These processes is regulated by hormones, immune cells, and the gastrointestinal system while the healthy intestine is known for mineral calcium, phosphorus absorption and subsequent bone mineralization In addition, the intestine also produces endocrine factors such as incretins and serotonins that signal crosstalk to bone cells.

A randomized control trial have shown that Lactobacillus reuteri reduced bone loss in elderly women aged 75—80 years with low bone mineral density in Sweden Similarly, a multispecies probiotic supplement Gerilact capsule slowed down the rate of bone turnover in postmenopausal women aged 50—72 years in Iran Furthermore, when the probiotic is combined with bioavailable isoflavones, it improved estrogen metabolism and bone health status in postmenopausal women Prebiotics are also known as functional food components that have a great potential of modulating the gut microbiota as well as the gut environment and pH.

These non-digestible oligosaccharides containing prebiotic activities occur naturally in human milk and plants. Prebiotics either occur naturally in plant-based foods or by enzymatic conversion of sugars from synthetic production of carbohydrate structures or soluble dietary fibers Some prebiotics are artificially produced, they include lactulose, galactooligosaccharides GOS , fructooligosaccharides FOS , maltooligosaccharides MOS , cyclodextrins, and lactosaccharose.

Fructans, such as inulin and oligofructose, are believed to be the most used and effective in relation to many species of probiotics Prebiotics in the colon are fermented by beneficial bacteria.

There are two mechanisms by which dietary fiber increases the fecal bulk: incompletely fermented types of fiber binding to water throughout the GIT, whereas the readily fermented types of fiber tend to increase the microbial mass Human studies have shown FOS 58 , GOS 59 and xylooligosaccharide XOS 60 are compounds that are able to increase the proportion of Bifidobacterium in the GIT whereas the number of Bacteroidaceae and Clostridium perfringens are decreased.

Bacteria are known to produce genes in response to changes in their environment. These genes are responsible for encoding enzymes that produce metabolites such as short chain fatty acids i. These metabolic products are however dependent on the availability of substrate produced in part by prebiotics and the intestinal microbiota Furthermore, prebiotics causes the lowering of intestinal pH and is also important for maintaining the osmotic retention of water in the bowel These synbiotics are also known to stimulate and result in enlarged absorption surface area by the proliferation enterocytes mediated by bacterial fermentation Part of the activities of these microbes includes absorption and release of essential nutrients from the diet mainly calcium and phosphate , regulation of the immune system, support of intestinal integrity and function as well as the ability to repress pathogenic invasion of harmful bacteria or colony It also responsible for promoting the expression of calcium-binding proteins and degradation of mineral complexing molecules such as oxalates and phytic acid.

The commensal bacteria have recently been also thought to affect the bone physiology through production of small molecules such as serotonin or estrogen-like molecules beneficial for osteogenesis. A study conducted in healthy postmenopausal women showed that synbiotic fermented milk was capable of enhancing the oral bioavailability and plasma concentrations of isoflavones Isoflavones are known to be able to alleviate the risk of osteoporosis.

In this review of the literature, we have evaluated the benefits of milk components, probiotics, prebiotics and synbiotics in calcium absorption and bone health. Dairy products especially milk is known to provide phosphorus intake simultaneously with calcium intake unlike supplementation.

Milk contains substantially high levels of vitamin D, riboflavin, vitamin C and vitamin B12 necessary for bone health maintenance. The consumption of milk is also known to influence hormones such as IGF-1 and the bone cytokines. According to Goulding 66 , CPPs increase calcium absorption by reducing the production of insoluble calcium phosphate complexes through signaling and biomodulatory effects in the GIT.

In a systematic review of literature by Kouvelioti et al. Furthermore, a review by Heuvel and Steijns 68 revealed a strong evidence for the positive impact of calcium from dairy products with or without vitamin D on bone mineralization. Studies have also shown that calcium absorption may be mediated by the gut microbiota specifically by Bifidobacteria and Lactobacillus , and probably fermented milk products To our best knowledge, two human studies have investigated the role of gut microbiota in bone health.

The two studies used 16S ribosomal RNA rRNA gene sequencing to characterize the microbiota composition profile. Wang et al. This study was conducted with a small sample size of mainly female patients recruited from a Chinese hospital with mean age between 64 and 70 years.

Das et al. This study involved female and males aged between 55 and 75 years care referrals. The women were classified according to the World Health Organization WHO T -score cut-offs for diagnosing osteoporosis. The findings also showed a higher proportion of Bacteroidetes Bacteroides among the OP group compared to the H group.

The result of the finding also indicated higher microbial diversity among the H group than the OP group. healthy controls. Limited published epidemiological evidence supports the relationship between the gut microbiota and bone mineral density and robust human studies are required to evaluate this relationship.

Our results provide a basis for a longitudinal intervention assessment of the role of intestinal microbiota composition and function in osteoporosis to yield preventive and therapeutic interventions. In addition, further investigations using probiotic, prebiotic, or synbiotic foods in intervention studies may be able to provide more insight into the role of these foods in bone health maintenance.

Milk and milk components have been shown to significantly affect growth and bone mineralization in children. Studies in older women using regular or fortified milk have reported significant changes in bone biomarkers and some changes in bone mineral density, though not reduction in fracture risk.

Milk and dairy products also contain several other bioactives that can affect bone formation or resorption. Combining the inherent bioactives in milk with additional pre- or probiotics can enhance the beneficial effects of milk on bone health via improvement of the intestinal absorption of minerals especially calcium and magnesium.

The observed differences in diversity of microbiota between healthy and osteoporotic women open new avenues for modulating the gut profile and thereby preventing bone loss or maintaining healthy bone density.

MK was responsible for the conceptualization, writing the abstract, introduction and conclusion while BI-O wrote the body of the article. Both authors read, reviewed, and approved the final draft. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults.

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