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References


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Building Bone Vitality can be obtained for FREE from the National Library of Medicine’s PubMed service (www.pubmed.gov):

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Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17

Chapter 1
COUNTRIES THAT CONSUME THE MOST MILK, DAIRY FOODS, AND CALCIUM SUPPLEMENTS SUFFER THE MOST FRACTURES

Table 1.1:
Melton J.L. “Epidemiology of Fractures,” in Osteoporosis: Etiology, Diagnosis, and Management, B.L. Riggs and L.J. Melton (eds.), Raven Press NY, 1988.

Table 1.2:
Abelow, B.J. et al. “Cross-Cultural Association Between Dietary Animal Protein and Hip Fracture: A Hypothesis,” Calcified Tissue International (1992) 50:14.

Table 1.3:
Frassetto, L.A. et al. “Worldwide Incidence of Hip Fracture in Elderly Women: Relation to Consumption of Animal and Vegetable Foods,” Journal of Gerontology: Medical Sciences (2000) 55:M585.

Table 1.4:
Moayyeri, A. et al. “Epidemiology of Hip Fracture in Iran: Results from Iranian Multicenter Study on Accidental Injuries,” Osteoporosis International (2006) 17:1252.

The study showing milk and dairy consumption around the world:
Speedy, A.W. “Global Production and Consumption of Animal Source Foods,” Journal of Nutrition (2003) 133:4048S.

Additional studies documenting geographic and ethnic fracture differences around the world:
Lau, E.M. et al. “The Incidence of Hip Fracture in Four Asian Countries: The Asian Osteoporosis Study,” Osteoporosis International (2001) 12:239.

Tsukahara, N. and I. Ezawa. “Calcium Intake and Osteoporosis in Many Countries,”
Clinical Calcium (2001) 11:173.

Schwartz, A.V. et al. “International Variation in the Incidence of Hip Fractures: Cross-National Project on Osteoporosis for the World Health Organization Program for Research on Aging,”
Osteoporosis International (1999) 9:242.

Bacon, W.E. et al. “International Comparison of Hip Fracture Rates in 1988-1989,”
Osteoporosis International (1996) 6:69.

Fang, J. et al. “Variations in Hip Fracture Hospitalization Rates Among Different Race/Ethnic Groups in New York City,” Ethnicity and Disease (2004) 14:280.

Lauderdale, D.S. et al. “Hip Fracture Incidence Among Elderly Asian-American Populations,” American Journal of Epidemiology (1997) 146:502.

Silverman, S.L. and R.E. Madision. “Decreased Incidence of Hip Fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data,”
American Journal of Public Health (1988) 78:1482.

The Staggering Toll of Osteoporosis:
Centers for Disease Control and Prevention (CDC). “Bone Health,” 2007, www.cdc.gov.

Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General. “Bone Health and Osteoporosis: What It Means to You,” (2004), pp. 1-2.

National Institutes of Health, Osteoporosis and Related Bone Diseases National Resource Center. “Osteoporosis in Men,” (2006). P. 1.

Liebman, B. “Breaking Up: Strong Bones Need More Than Calcium,”
Nutriton Action Healthletter, April 2005, p. 1.

Studies showing that osteoporosis is not just a women’s disease:

Agnusdei, D. et al. “Age-Related Decline of Bone Mass and Intestinal Calcium Absorption in Normal Males,”
Calcified Tissues International (1998) 63:197.

Center, J.R. et al. “Mortality After All Major Types of Osteoporotic Fracture in Men and Women: An Observational Study,”
Lancet (1999) 353(9156):878.

Lippuner, K. et al. “Epidemiology and Direct Medical Costs of Osteoporotic Fractures in Men and Women in Switzerland,”
Osteoporosis International (2005) 16(Suppl 2):S8.

Studies showing that unusually early menopause is associated with unusually early bone loss and fractures:

Gallagher, J.C. “Effect of Early Menopause on Bone Mineral Density and Fractures,”
Menopause (2007) 14(3 Pt 2):567.

Van der Voort, D.J. et al. “Early Menopause: Increased Fracture Risk at Older Age,”
Osteoporosis International (2003) 14:525.


Chapter 2:
WHY SOME OSTEOPOROSIS STUDIES SHOULD BE TAKEN
MORE SERIOUSLY THAN OTHERS

The report documenting the change in definition of osteoporosis from suffering a fracture to having low bone mineral density:

Cheung, A.M. and Detsky, A.S. “Osteoporosis and Fractures: Missing the Bridge?”
Journal of the American Medical Association (2008) 299:1468.



Chapter 3
MILK, DAIRY FOODS, AND CALCIUM SUPPLEMENTS
BY THEMSELVES OR IN ANY COMBINATION
DO NOT PREVENT FRACTURES


The twenty-four studies showing that milk and dairy foods reduce fracture risk:
1. Bischoff-Ferrari, H.A et al. “Effect of Calcium Supplementation on Fracture Risk: A Double-Blind Randomized Trial,” American Journal of Clinical Nutrition (2008) 87:1945.

2. Chan, H.H. et al. “Dietary Calcium Intake, Physical Activity, and the Risk of Vertebral Fracture in Chinese,”
Osteoporosis International (1996) 6:228.

3. Chevalley, T. et al. “Effects of Calcium Supplements on Femoral Bone Mineral Density and Vertebral Fracture Rate in Vitamin-D-Replete Elderly Patients,”
Osteoporosis International (1994) 4:245.

4. Chu, S.P. et al. “Risk Factors for Proximal Humerus Fracture,”
American Journal of Epidemiology (2004) 160:360. Stanford University researchers.

5. Clark, P. et al. “Risk Factors for Osteoporotic Hip Fractures in Mexicans,”
Archives of Medical Research (1998) 29:253.

6. Diez-Perez, A. et al. “Prediction of Absolute risk of Non-Spinal Fractures Using Clinical Risk Factors and Heel Quantitative Ultrasound,”
Osteoporosis International (2007) 18:629.

7. Fujiwara, S. et al. “Risk Factors for Hip Fracture in a Japanese Cohort,”
Journal of Bone and Mineral Research (1997) 12:998.

8. Holbrook, T.L. et al. “Dietary Calcium and Risk of Hip Fracture: 14-Year Prospective Population Study,”
Lancet (1988) 2(8619):1046.

9. Honkanen, R.J. et al. “Risk Factors for Perimenopausal Distal Forearm Fracture,”
Osteoporosis International (2000) 11:265.

10. Kalkwarf, H.J. et al. “Milk Intake During Childhood and Adolescence, Adult Bone Density, and Osteoporotic Fractures in U.S. Women,”
American Journal of Clinical Nutrition (2003) 77:257.

11. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study: Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

12. Kelsey, J.L et al. “Risk Factors for Stress Fracture Among Young Female Cross-Country Runners,”
Medicine and Science in Sports and Exercise (2007) 39:1457.

13. Kelsey, J.L. et al. “Reducing the Risk for Distal Forearm Fracture: Preserve Bone Mass, Slow Down, and Don’t Fall,”
Osteoporosis International (2005) 16:681.

14. Kung, A.W. et al. “Ten-Year Risk of Osteoporotic Fractures in Postmenopausal Chinese Women According to Clinical Risk Factors and BMD T-Scores: A Prospective Study,”
Journal of Bone and Mineral Research (2007) 22:1080.

15. Lau, E. et al. “Physical Activity and Calciu Intake in Fracture of the Proximal Femur in Hong Kong,”
BMJ [formerly British Medical Journal] (1988) 297(6661):1441.

16. Lumbers, M. et al. “Nutritional Status in Elderly Female Hip Fracture Patients: Comparison with and Age-Matched Home Living Group Attending Day Centers,” British Journal of Nutrition (2001) 85:733.

17. Michael, B.A. et al. “Physical Activity and Fractures Over the Age of Fifty Years,”
International Orthopedics (1992) 16:87.

18. Myburgh, K.H. et al. “Low Bone Density is an Etiological Factors for Stress Fractures in Athletes,”
Annals of Internal Medicine (1990) 113:754.

19. Nevitt, M.C. et al. “Risk Factors for a First-Incident Radiographic Vertebral Fracture in Women > or = 65 Years of Age: The Study of Osteoporotic Fractures,”
Journal of Bone and Mineral Research (2005) 20:131.

20. Perez-Cano, R. et al. “Risk Factors for Hip Fracture in Spanish and Turkish Women,”
Bone (1993) 14(Suppl 1):S69.

21. Pires, L.A. et al. “Bone Mineral Density, Milk Intake, and Physical Activity in Boys Who Suffer Forearm Fractures,”
Journal of Pediatrics (Rio de Janeiro) (2005) 81:332.

22. Reid, I.R. et al. “Long-Term Effects of Calcium Supplementation on Bone Loss and Fractures in Postmenopausal Women: A Randomized Controlled Trial,”
American Journal of Medicine (1995) 98:331.


23. Tuppurainen, M. et al. “Osteoporosis Risk Factors, Gynecological History, and Fractures in Perimenopausal Women: Results of the Baseline Postal Enquiry of the Kuopio Osteoporosis Risk Factor and Prevention Study,” Maturitas (1993) 17:89.

24. Wyshak, G. and R.E. Frisch. “Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosporus Ratio, and Bone Fractures in Girls and Boys,”
Journal of Adolescent Health (1994) 15:210.

The fifteen studies that are inconclusive:

1. Center, J.R. et al. “Risk of Subsequent Fracture After Low-Trauma Fracture in Men and Women,” Journal of the American Medical Association (2007) 297:387.

2. Cooper, C. et al. “Physical Activity, Muscle Strength, and Calcium Intake in Fracture of the Proximal Femur in Britain,”
BMJ [formerly British Medical Journal] (1988) 297(6661):1443.

3. Cumming, R.G. and M.C. Nevitt. “Calcium for Prevention of Osteoporotic Fractures in Postmenopausal Women,”
Journal of Bone and Mineral Research (1997) 12:1321.

4. Honkanen, R. et al. “Lactose Intolerance Associated with Fracture of Weight-Bearing Bones in Finnish Women Aged 38-57 Years,”
Bone (1997) 21:473.

5. Huang, Z. et al. “Nutrition and Subsequent Hip Fracture Risk Among a National Cohort of White Women,”
American Journal of Epidemiology (1996) 144:124.

6. Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: The MEDOS Study, Mediterranean Osteoporosis study,”
Journal of Bone and Mineral Research (1995) 10:1802.

7. Kreiger, N. et al. “Dietary Factors and Fracture in Postmenopausal Women: A Case-Control Study,”
International Journal of Epidemiology (1992) 21:953.

8. Kudlacek, S. et al. “Lactose Intolerance: A Risk Factor for Reduced Bone Mineral Density and Vertebral Fractures?”
Journal of Gastroenterology (2002) 37:1014.

9. Looker, A.C. et al. “Dietary Calcium and Hip Fracture Risk: the NHANES I Epidemiologic Follow-Up Study,”
Osteoporosis International (1993) 3:177.

10. Matkovic, V. et al. “Bone Status and Fracture Rates in Two Regions of Yugoslavia,”
American Journal of Clinical Nutrition (1979) 32:540.

11. Prince, R.L. et al. “Effects of Calcium Supplementation on Clinical Features and Bone Structure: Results of a Five-Year, Double-Blind, Placebo-Controlled trial in Elderly Women,”
Archives of Internal Medicine (2006) 166:869.

12. Recker, R.R. et al. “Correcting Calcium Nutritional Deficiency Prevents Spine Fractures in Elderly Women,”
Journal of Bone and Mineral Research (1996) 11:1961.

13. Reid, I.R. et al. “Randomized controlled trial of Calcium in Health Older Women,”
American Journal of Medicine (2006) 119:777.

14. Shea, B. et al. “Calcium Supplementation on Bone Loss in Postmenopausal Women,”
Cochrane Database System Review (2004) CD004526. This same meta-analysis was also published in Endocrinology Reviews (2002) 23:552.

15. Yaegashi, Y. et al. “Association of Hip Fracture Incidence and Intake of Calcium, Magnesium, Vitamin D, and Vitamin K,”
European Journal of Epidemiology (2008) 23:219.

The forty-seven studies showing that milk and dairy foods do not reduce risk of fractures:

1. Albrand, G et al. “Independent Predictors of All Osteoporosis-Related Fractures in Health Postmenopausal Women: the OFELY study,” Bone (2003) 32:78.

2. Almustafa, M. et al. “Effects of Treatments by Calcium and Sex Hormones on Vertebral Fracturing in Osteoporosis,”
QJM [Quarterly Journal of Medicine] (1992) 83:283.

3. Bischoff-Ferrari, H.A. et al. “Calcium Intake and Hip Fracture Risk in Men and Women: A Meta-Analysis of Prospective Cohort Studies and Randomized Controlled Trials,”
American Journal of Clinical Nutrition (2007) 86:1780.

4. Campbell, I.A. et al. “Five-Year Study of Etidronate and/or Calcium as Prevention and Treatment for Osteoporosis and Fractures in Patients with Asthma Receiving Longterm Oral and/or Inhaled Glucocorticoids,”
Thorax (2004) 59:761.

5. Cumming, R.G. et al. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

6. Cumming, R.G. et al. “Calcium Intake and Fracture Risk: Results from the Study of Osteoporotic Fractures,”
American Journal of Epidemiology (1997) 145:926.

7. Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women. Study of Osteoporotic Fractures Research Group,”
New England Journal of Medicine (1995) 332:767.

8. Farmer, M.E. et al. “Anthropometric Indicators and Hip Fracture: The NHANES I Epidemiologic Follow-Up Study,”
Journal of the American Geriatric Society (1989) 37:9.

9. Feskanich, D. et al. “Milk, Dietary Calcium, and Bone Fractures in Women: A 12-Year Prospective Study,”
American Journal of Public Health (1997) 87:992.

10. Feskanich, D. et al. “Calcium, Vitamin D, Milk Consumption, and Hip Fractures: A Prospective Study Among Postmenopausal Women,”
American Journal of Clinical Nutrition (2003) 77:504.

11. Grant, A.M. et al. “Oral Vitamin D3 and Calcium for Secondary Prevention of Low-Trauma Fractures in Elderly People (Randomized Evaluation of Calcium Or vitamin D, the RECORD study): A Randomized, Placebo-Controlled Trial,”
Lancet (2005) 365(9471):1621.

12. Hagino, H. et al. “Case-Control Study of Risk Factors for Fractures of the Distal Radius and Proximal Humerus Among the Japanese Population,”
Osteoporosis International (2004) 15:226.

13. Huopio, J. et al. “Risk Factors for Perimenopausal Fractures: A Prospective Study,”
Osteoporosis International (2000) 11:219.

14. Jonsson, B. et al. “Lifestyle and Different Fracture Prevalence: A Cross-Sectional Comparative Population-Based Study,”
Calcified Tissue International (1993) 52:425.

15. Kanis, J.A. et al. “A Meta-Analysis of Milk Intake and Fracture Risk: Low Utility for Case Finding,”
Osteoporosis International (2005) 16:799.

16. Kato, I. et al. “Diet, Smoking, and Anthropometric Indices and Postmenopausal Bone Fractures: A Prospective Study,”
International Journal of Epidemiology (2000) 29:85.

17. Kawada, T. “Factors Influencing Bone Fractures in Severely Disabled Persons,”
American Journal of Physical Medicine and Rehabilitation (2002) 81:424.

18. Kelsey, J.L. et al. “Risk Factors for Fracture of the Distal Forearm and Proximal Humerus. The Study of Osteoporotic Fractures Research Group,”
American Journal of Epidemiology (1992) 135:477.

19. Kelsey, J.L. et al. “Risk Factors for Fracture of the Shafts of the Tibia and Fibula in Older Individuals.”
Osteoporosis International (2006) 17:143.

20. Kleerekoper, M. et al. “Identification of Women at Risk for Developing Postmenopausal Osteoporosis with Vertebral Fractures: Role of History and Single Photon Absorptiometry,”
Bone Mineralization (1989) 7:171.

21. Korpelainen, R. et al. “Lifelong Risk Factors for Osteoporosis and Fractures in Elderly Women with Low Body Mass Index: A Population-Based Study,”
Bone (2006) 39:385.

22. La Vecchia, C. et al. “Cigarette Smoking, Body Mass, and Other Risk Factors for Fractures of the Hip in Women,”
International Journal of Epidemiology (1991) 20:671.

23. Loud, K.J. et al. “Correlates of Stress Fractures Among Preadolescent and Adolescent Girls,”
Pediatrics (2005) 115:e399.

24. Ma, D. and G. Jones. “Soft Drink and Milk Consumption, Physical Activity, Bone Mass, and Upper Limb Fractures in Children: A Population-Based, Case-Control Study,”
Calcified Tissues International (2004) 75:286.

25. Meyer, H.E. et al. “Dietary Factors and Incidence of Hip Fracture in Middle-Aged Norwegians: A Prospective Study,”
American Journal of Epidemiology (1997) 145:117.

26. Meyer, H.E. et al. “Risk Factors for Femoral Neck Fractures in Oslo,”
Tidsskr. Nor. Laeeforen. [Norwegian journal]. (1996) 116:2656. Norwegian researchers.

27. Meyer, H.E. et al. “Risk Factors for Hip Fracture in a High-Incidence Area: A Case-Control Study from Oslo, Norway,”
Osteoporosis International (1995) 5:239.

28. Michaelsson, K. et al. “Dietary Calcium and Vitamin D in Relation to Osteoporotic Fracture Risk,”
Bone (2003) 32:694.

29. Michaelsson, K. et al. “Diet and Hip Fracture Risk: A Case-Control Study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment,”
International Journal of Epidemiology (1995) 24:771.

30. Mussolino, M.E. et al. “Risk Factors for Hip Fracture in White Men: the NHANES I Epidemiologic Follow-Up Study,”
Journal of Bone and Mineral Research (1998) 13:918.

31. Nguyen, T.V. et al. “Risk Factors for Osteoporotic Fractures in Elderly Men,”
American Journal of Epidemiology (1996) 144:255.

32. Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.

33. O’Neill, T.W. et al. “Risk Factors, Falls, and Fracture of the Distal Forearm in Manchester, UK,”
Journal of Epidemiology and Community Health (1996) 50:288.

34. Owusu. W. et al. “Calcium Intake and Incidence of Forearm and Hip Fractures Among Men,”
Journal of Nutrition (1997) 127:1782.

35. Paganinin-Hill, A et al. “Menopausal Estrogen Therapy and Hip Fractures,”
Annals of Internal Medicine (1981) 95:28.

36. Paganini-Hill A. et al. “Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study,”
Epidemiology (1991) 2:16.

37. Petridou, E. et al. “The Role of Dairy Products and Non-Alcoholic Beverages in Bone Fractures Among School-Age Children,”
Scandinavian Journal of Social Medicine (1997) 25:119.

38. Ramalho, A.C. et al. “Osteoporotic Fractures of the Proximal Femur: Clinical and Epidemiological Features in a Population of the City of Sao Paulo,”
Sao Paulo Medical Journal (2001) 119:48.

39. Ribot, C. and J.M. Pouilles. “Postmenopausal Osteoporosis: Clinical Characteristics in Patients’ First Vertebral Crush Fracture. Results of the GRIO National Multicenter Survey. Groupe de Recherche et d’Information sure les Osteoporoses,”
Review of Rheumatology Education, France (1993) 60:427.

40. Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

41. Roy, D.K. et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

42. Tavani, A. et al. “Calcium, Dairy Products, and the Risk of Hip Fracture in Women in Northern Italy,” Epidemiology (1995) 6:554.

43. Taylor, B.C. et al. “Long-Term Prediciton of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures,” Journal of the American Geriatric Society (2004) 52:1479.


44. Turner, L.W. et al. “Osteoporotic Fracture Among Older U.S. Women: Risk Factors Quantified,” Journal of Aging and Health (1998) 10:372.

45. Turner, L.W. et al. “Risk Factors for Hip Fracture Among Southern Older Women,”
Southern Medical Journal (1998) 91:533.

46. Valimaki, V.V. et al. “Risk Factors for Clinical Stress Fractures in Male Military Recruits: A Prospective Cohort Study,”
Bone (2005) 37:267.

47. Wickham, C.A. et al. “Dietary Calcium, Physical Activity, and Risk of Hip Fracture: A Prospective Study,”
BMJ [formerly British Medical Journal] (1989) 299(6704):889.


Chapter 4:
CALCIUM INTAKE DURING CHILDHOOD
DOES NOT PREVENT FRACTURES AT ANY STAGE OF LIFE

The two reviews showing that calcium intake during childhood has nothing to do with bone health and fracture prevention later in life:

1. Lanou, A.J. et al. “Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Re-Evaluation of the Evidence,”
Pediatrics (2005) 115:736.

2. Winzenberg, T. et al. “Effects of Calcium Supplementation on Bone Density in Healthy Children: Meta-Analysis of Randomized Controlled Trials,”
BMJ [formerly British Medical Journal] (2006) 333(7572):775.

The six studies showing that milk and dairy intake during childhood and adolescence reduce fracture risk later in life:

1. Kalkwarf. H.J. et al. “Milk Intake During Childhood and Adolescence, Adult Bone Density, and Osteoporotic Fractures in U.S. Women,”
American Journal of Clinical Nutrition (2003) 77:257.

2. Manias, K. et al. “Fractures and Recurrent Fractures in Children: Varying Effects of Environmental Factors as Well as Bone Size and Mass,”
Bone (2006) 39:652.

3. Myburgh, K.H. et al. “Low Bone Density is an Etiologic Factor for Stress Fracture in Athletes,”
Annals of Internal Medicine (1990) 113:754.

4. Pires, L.A. et al. “Bone Mineral Density, Milk Intake and Physical Activity in Boys Who Suffer Forearm Fractures,”
Journal of Pediatrics (Rio de Janeiro) (2005) 81:332.

5. Wyshak, G. and R.E. Frisch. “Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosphorus Ratio, and Bone Fracture in Girls and Boys,”
Journal of Adolescent Health (1994) 15:210.

6. Wyshak, G. et al. “Nonalcoholic Carbonated Beverage Consumption and Bone Fractures Among Women Former College Athletes,”
Journal of Orthopedic Research (1989) 7:91.

The seven studies showing that consumption of milk and dairy foods during childhood and adolescence has no effect on fracture risk later in life:

1. Cline, A.D. et al. “Stress Fractures in Female Army Recruits: Implications of Bone Density, Calcium Intake, and Exercise,”
Journal of the American College of Nutrition (1998) 17:128.

2. Cumming, R.G. et al. “Case-Control Study of Risk Factors for Hip Fracture in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

3. Laker, S.R. et al. “Stress Fractures in Elite Cross-Country Athletes,”
Orthopedics (2007) 30:313.

4. Lofthus, C.M. et al. “Young Patients with Hip Fracture: A Population-Based Study of Bone Mass and Risk Factors for Osteoporosis,”
Osteoporosis International (2006) 17:1666.

5. Loud, K.J. et al. “Correlates of Stress Fracture Among Preadolescent and Adolescent Girls,”
Pediatrics (2005) 115:e399. Harvard researchers.

6. Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.

7. Petridou, E. et al. “The Role of Dairy Products and Non-Alcoholic Beverages in Bone Fractures Among Schoolage Children,”
Scandinavian Journal of Social Medicine (1997) 25:119.


Chapter 5:
VITAMIN D WITH OR WITHOUT CALCIUM
PREVENTS FEW, IF ANY, FRACTURES

The seventeen studies showing that vitamin D by itself or with calcium supplementation reduces fractures:

1. Bischoff-Ferrari, H.A. et al. “Fracture Prevention with Vitamin D Supplementation: A Meta-Analysis of Randomized Controlled Trials,” Journal of the American Medical Association (2005) 293:2257.

2. Boonen, S. et al. “Need for Additional Calcium to Reduce the Risk of Hip Fracture with Vitamin D Supplementation: Evidence from a Comparative Meta-Analysis of Randomized Controlled Trials,”
Journal of Clinical Endocrinology and Metabolism (2007) 92:1415.

3. Chapuy, M.C. et al. “Combined Calcium and Vitamin D3 Supplementation in Elderly Women: Confirmation of Reversal of Secondary Hyperparathyroidism and Hip Fracture Risk: The Decalyos II Study,”
Osteoporosis International (2002) 13:257.

4. Chapuy, M.C. et al. “Vitamin D3 and Calcium to Prevent Hip Fracture in Elderly Women,”
New England Journal of Medicine (1992) 327:1637.

5. Dawson-Hughes, B. et al. “Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older,”
New England Journal of Medicine (1997) 337:670.

6. Feskanich, D et al. “Calcium, Vitamin D, Milk Consumption and Hip Fractures: A Prospective Study Among Postmenopausal Women,”
American Journal of Clinical Nutrition (2003) 77:504.

7. Gillespie, W.J. et al. “Vitamin D and Vitamin D Analogues for Preventing Fractures Associated with Involutional and Post-Menopausal Osteoporosis,”
Cochrane Database System Review (2001) CD000227.

8. Izaks, G.J. “Fracture Prevention with Vitamin D Supplementation: Considering the Inconsistent Results,”
BMC Muskuloskeletal Disorders (2007) 8:26.

9. Jackson, C. et al. “The Effect of Cholcalciferol (vitamin D3) on the Risk of Fall and Fracture: A Meta-Analysis,” OJM (2007) 100:185.

10. Larsen, E.R. et al. “Vitamin D and Calcium Supplementation Prevents Osteoporotic Fractures in Elderly Community Dwelling Residents: A Pragmatic Population-Based Three-Year Intervention Study,”
Journal of Bone and Mineral Research (2004) 19:370.

11. Orimo, H. et al. “Reduced Occurrence of Vertebral Crush Fractures in Senile Osteoporosis Treated with 1 Alpha (OH)-vitamin D3,”
Bone and Mineral (1987) 3:47.

12. Orimo, H. et al. “Effects of 2 Alpha-Hydroxyvitamin D3 on Lumbar Bone Mineral Density and Vertebral Fractures in Patients with Postmenopausal Osteoporosis.
Calcified Tissues International (1994) 54:370.

13. Papadimitropoulos, E. et al. “Meta-analysis of Therapies for Postmenopausal Osteoporosis. VIII: Meta-Analysis of the Efficacy of Vitamin D Treatment in Preventing Osteoporosis in Postmenopausal Women,”
Endocrinology Review (2002) 23:560.

14. Riggs, B.L. et al. “Effect of the Fluoride/Calcium Regimen on Vertebral Fracture Occurrence in Postmenopausal Osteoporosis. Comparison with Conventional Therapy,”
New England Journal of Medicine (1982) 306:446.

15. Tang, B.M.P. et al. “Use of Calcium or Calcium in Combination with Vitamin D Supplementation to Prevent Fractures and Bone Loss in People Aged 50 Years and Older: A Meta-Analysis,”
Lancet (2007) 370:657.

16. Tilyard, M.W. et al. “Treatment of Postmenopausal Osteoporosis with Calcitrol or Calcium,”
New England Journal of Medicine (1992) 326:357.

17. Trivedi, D.P. et al. “Effect of Four Monthly Oral Vitamin D3 Supplementations on Fractures and Mortality in Men and Women Living in the Community: Randomized Double-Blind Controlled Trial,”
BMJ [formerly British Medical Journal] (2003) 326(7387):469.

The three studies showing inconclusive results:

1. Avenell, A. et al. “Vitamin D and Vitamin D Analogues for Preventing Fractures Associated with Involutional and Postmenopausal Osteoporosis,”
Cochrane Database Systematic Reviews (2005) CD000227.

2. Boonen S. et al. “Need for Additional Calcium to Reduce the Risk of Hip Fracture With Vitamin D Supplementation: Evidence from a Compative Meta-Analysis of Randomized Controlled Trials,”
Journal of Clinical Endocrinology and Metabolism (2007) 92:1415.

3. Shikari, M. et al. “Effects of 2 Years’ Treatment of Osteoporosis with 1 Alph-Hydroxyvitamin D3 on Bone Mineral Density and Incidence of Fracture: A Placebo-Controlled, Double-Blind Prospective Study,”
Endocrinology Journal (1996) 43:211.


The seventeen studies showing no benefit:

1. Gallagher, J.C. and D. Goldgar. “Treatment of Postmenopausal Osteoporosis with High Doses of Synthetic Calcitrol. A Randomized Controlled Study,”
Annals of Internal Medicine (1990) 113:649.

2. Grant, A.M. et al. “Oral Vitamin D3 and Calcium for Secondary Prevention of Low-Trauma Fractures in Elderly People (Randomized Evaluation of Calcium or Vitamin D, RECORD) Study: A Randomized Controlled Trial,”
Lancet (2005) 365(9471):1621.

3. Jackson, R.D. et al. “Calcium Plus Vitamin D and the Risk of Fractures,”
New England Journal of Medicine (2006) 354:669.

4. Jackson, C. et al. “The Effect of Cholecalciferol (Vitamin D3) on the Risk of Fall and Fracture: A Meta-Analysis,”
QJM [formerly Quarterly Journal of Medicine] 100:185.

5. Komulainen, M.H. et al. “HRT and Vitamin D in Prevention of Non-Vertebral Fractures in Postmenopausal Women: A Five-Year Randomized Trial,”
Maturitas (1998) 31:45.

6. Law, M. et al. “Vitamin D Supplementation and the Prevention of Fractures and Falls: Results of a Randomized Trial in Elderly People in Residential Accommodation,”
Age and Ageing (2006) 35:482.

7. Lips, P. et al. “Vitamin D Supplementation and Fracture Incidence in Elderly People. A Randomized, Placebo-Controlled Clinical Trial,”
Annals of Internal Medicine (1996) 124:400.

8. Loud, K.J. et al. “Correlates of Stress Fracture Among Preadolescent and Adolescent Girls,”
Pediatrics (2005) 115:e399.

9. Lyons, R.A. et al. “Preventing Fractures Among Older People Living in Institutional Care: A Pragmatic Randomized Double-Blind Placebo-Controlled Trial of Vitamin D Supplementation,”
Osteoporosis International (2007) 18:811.

10. Meyer, H.E. et al. “Can Vitamin D Supplementation Reduce the Risk of Fracture in the Elderly? A Randomized Controlled Trial,”
Journal of Bone and Mineral Research (2002) 17:709.

11. Michaelsson, K. et al. “Dietary Calcium and Vitamin D Intake in Relation to Osteoporotic Fracture Risk,”
Bone (2003) 32:694.

12. Munger, R.G. et al. “Prospective Study of Dietary Protein Intake and Risk of Hip Fracture in Postmenopausal Women,”
American Journal of Clinical Nutrition (1999) 69:147.

13. Ott, S.M and C.H. Chestnut. “Calcitrol Treatment is Not Effective in Postmenopausal Osteoporosis,”
Annals of Internal Medicine (1989) 110:267.

14. Porthouse, J. et al. “Randomized Controlled Trial of Calcium and Supplementation with Cholecalciferol (Vitamin D3) for Prevention of Fracture in Primary Care,”
BMJ [formerly British Medical Journal] (2005) 330(7498):1003.

15. Richy, F et al. “Efficacy of Alphacalcidol and calcitrol in Primary and Corticosteroid-Induced Osteporosis: A Meta-Analysis of Their Effects on Bone Mineral Density and Fracture Rate,”
Osteoporosis International (2004) 15:301.

16. Smith, H. et al. “Effect of Annual Intramuscular vitamin D on Fracture Risk in Elderly Men and Women: A Population-based, Randomized, Double-Blind, Placebo-Controlled Trial,”
Rheumatology (2007) 46:1852.

17. Wooton, R. et al. “Fractured Neck of Femur in the Elderly: An Attempt to Identify Patients at Risk,” Clinical Sciences (1979) 57:93.


Chapter 6
THE FINAL SCORE:
WE NEED A THEORY THAT WORKS

The article that first suggested low-acid eating to prevent and cure for osteoporosis:

Wachman, A. and D.S. Bernstein. “Diet and Osteoporosis,”
Lancet, May 4, 1968, p. 958.


Chapter 7
THE KEY TO STRONG BONES AND FRACTURE PREVENTION:
THE BLOODSTREAM’S ACID/ALKALINE BALANCE

Studies showing that as dietary protein increases, so does the amount of calcium in urine:

Barzel, U.S. and L.K. Massey. “Excess Dietary Protein Can Adversely Affect Bone,”
Journal of Nutrition (1998) 128:1051.

Buclin, T. et al. “Diet Acids and Alkalis Influence Calcium Retention in Bone,”
Osteoporosis International (2001) 12:493.

Hegsted, M. et al. “Urinary Calcium and Calcium Balance in Young Men as Affected by Level of Protein and Phosphorus Intake,” Journal of Nutrition (1981) 111:553.


Ince, B.A. et al. “Lowering Dietary Protein to U.S. Recommended Dietary Allowance Levels Reduces Urinary Calcium Excretion and Bone Resorption in Young Women,”
Journal of Clinical Endocrinology and Metabolism (2004) 89:3801.

Jenkins, D.J. et al. “Effect of High Vegetable Protein Diets on Urinary Calcium Loss in Middle-Aged Men and Women,”
European Journal of Clinical Nutrition (2003) 57:376.

Kim, Y. and H.M. Linkswiler. “Effect of Level of Protein Intake on Calcium Metabolism and on Parathyroid and Renal Function in the Adult Human Male,” Journal of Nutrition (1979) 109:1399.

Kitano, T. et al. “Effect of Protein Intake on Mineral (Calcium, Magnesium, and Phosphorus) Balance in Japanese Males,”
Journal of Nutrition Science and Vitaminology (Tokyo) (1988) 34:387.

Licata, A.A. et al. “Adverse Effects of Liquid Protein Fast on the Handling of Magnesium, Calcium, and Phosphorus,” American Journal of Medicine (1981) 71:767.

Licata, A.A. et al. “Acute Effects of Dietary Protein on Calcium Metabolism in Patients with Osteoporosis,” Journal of Gerontology (1981) 36:14.

Linkswiler, H.M. et al. “Protein-Induced Hypercalciuria,”
Federation Proceedings (1981) 40:2429.

Lutz, J. and H.M. Linkswiler. “Calcium Metabolism in Postmenopausal and Osteoporotic Women Consuming Two Levels of Dietary Protein,”
American Journal of Clinical Nutrition (1981) 34:2178.

Reddy, S.T. et al. “Effect of Low-Carbohydrate High-Protein Diets on Acid-Base Balance, Stone-Forming Propensity, and Calcium Metabolism,” American Journal of Kidney Disease (2002) 40:265.

Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences.
DRI: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academy Press, Washington, D.C., 1997, p. 75.

Zemel, M.B. et al. “Role of the Sulfur-Containing Amino Acids in Protein-Induced Hypercalciuria in Men,” Journal of Nutrition (1981) 111:545.


Source of Table 7.1

Remer, T. and F. Mannz. “Potential Renal Acidal Loads of Foods and It’s Influence on Urine pH,”
Journal of the American Dietetic Association (1995) 95:791.


Studies showing that, compared with vegetable protein, animal protein causes considerably more calcium loss from bone:

Breslau, N.A. et al. “Relationship of Animal Protein-Rich Diet to Kidney Stone Formation and Calcium Metabolism,”
Journal of Clinical Endocrinology and Metabolism (1988) 66:140.


Feskanich, D. et al. “Protein Consumption and Bone Fractures in Women,” American Journal of Epidemiology (1996) 143:472.

Hu, J.F. et al. “Dietary Intakes and Urinary Excretion of Calcium and Acids: A Cross-Sectional Study of Women in China,”
American Journal of Clinical Nutrition (1993) 58:398.

Itoh, R. et al. “Dietary Protein Intake and Urinary Excretion of Calcium: A Cross-Sectional Study in a Healthy Japanese Population,”
American Journal of Clinical Nutrition (1998) 67:438.

Tschope, W. and E. Ritz. “Sulfur-Containing Amino Acids Are a Major Determinant of Urinary Calcium,”
Mineral and Electrolyte Metabolism (1985) 11:137.

Weikert, C. et al. “The Relation Between Dietary Protein and Bone Health in Women: Results from the EPIC-Potsdam Cohort,”
Annals of Nutrition and Metabolism (2005) 49:312.

Welch, A.A. et al. “More Acidic Dietary Acid-Base Load is Associated with Reduced Calcaneal Broadband Ultrasound Attenuation in Women But Not in Men: Results from the EPIC-Norfolk Cohort Study,” American Journal of Clinical Nutrition (2007) 85:1134.

Zemel, M.B. et al. “Role of the Sulfur-Containing Amino Acids in Protein-Induced Hypercalciuria in Men,” Journal of Nutrition (1981) 111:545.


Additional studies showing that a diet high in animal foods causes the most bone loss:

Tschope, W. and E. Ritz. “Sulfur-Containing Amino Acids Are a Major Determinant of Urinary Calcium,”
Mineral and Electrolyte Metabolism (1985) 11:137.

Zemel, M.B. et al. “Role of the Sulfur-Containing Amino Acids in Protein-Induced Hypercalciuria in Men,”
Journal of Nutrition (1981) 111:545.


Studies showing that as the ratio of animal to vegetable protein increases, so does the risk of hip fracture:

Abelow, B.J. et al. “Cross-Cultural Association Between Dietary Animal Protein and Hip Fracture: A Hypothesis,”
Calcified Tissue International (1992) 50:14.

Feskanich, D. et al. “Protein Consumption and Bone Fractures in Women,”
American Journal of Epidemiology (1996) 143:472.

Frassetto, L.A. et al. “Worldwide Incidence of Hip Fracture in Elderly Women: Relation to Consumption of Animal and Vegetable Foods,”
Journal of Gerontology: Medical Sciences (2000) 55:M585.

Meyer, H.E. et al. “Dietary Factors and the Incidence of Hip Fracture in Middle-Aged Norwegians: A Prospective Study,”
American Journal of Epidemiology (1997) 145:117.


Sellmeyer, D.E. et al. “A High Ratio of Dietary Animal to Vegetable Protein Increases the Rate of Bone Loss and the Risk of Hip Fracture in Postmenopausal Women: Study of the Osteoporotic Fractures Research Group,”
American Journal of Clinical Nutrition (2001) 73:118.


The study showing that about one-third of omnivorous Americans’ calcium intake comes from non-dairy sources:

Fleming, K.H. and J.T. Heimbach. “Consumption of Calcium in the U.S. Food Sources and Intake Levels,”
Journal of Nutrition (1994) 124(8 Suppl):1426S.

The study documenting the bioavailability of calcium from dairy foods and plant foods:

Weaver, C.M. “Calcium Bioavailability and Its Relation to Osteoporosis,”
Proceedings of the Society for Experimental Biology and Medicine (1992) 200:157.

The review showing that vegans typically consume around 620 mg of calcium a day:

Smith, A.M. “Veganism and Osteoporosis: A Review of the Current Literature,”
International Journal of Nursing Practice (2006) 12:302.

Studies showing the health benefits of a vegan diet:

Barnard, N.D. et al. “The Effects of a Low-Fat, Plant-Based Dietary Intervention on Body Wiehgt, Metabolism, and Insulin Sensitivity,”
American Journal of Medicine (2005) 118:991.

Barnard, N.D. et al. “A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals with Type 2 Diabetes,”
Diabetes Care (2006) 29:1777.

Berkow, S.E. and N. Barnard. “Vegetarian Diets and Weight Loss,”
Nutrition Reviews (2006) 64:175.

Berkow, S.E. and N.D. Barnard. “Blood Pressure Regulation and Vegetarian Diets,”
Nutrition Reviews (2005) 63:1.

Esselstyn, C.B. “Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition,”
Preventive Cardiology (2001) 4:171.

Jenkins, D.J. et al. “Type 2 Diabetes and Vegetarian Diet,”
American Journal of Clinical Nutrition (2003) 78(3 Suppl):610S.

Newby, P.K et al. “Risk of Overweight and Obesity Among Semivegetarian, Lactovegetarian, and Vegan Women,”
American Journal of Clinical Nutrition (2005) 81:1267.

Ornish, D. et al. “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease,”
Journal of the American Medical Association (1998) 280:2001.

Spencer, E.A. et al. “Diet and Body Mass Index in 38,000 EPIC-Oxford Meat-Eaters, Fishj-Eaters, Vegetarians, and Vegans,”
International Journal of Obesity and Related Metaboic Disorders (2003) 27:728.

Turner-McGievy, G.M. et al. “A Two-Year Randomized Weight Loss Trial Comparing a Vegan Diet to a More Moderate Low-Fat Diet,”
Obesity (2007) 15:2276.

The DASH study showing that a Mediterranean diet spurs bone-building:

Lin, P.H.et al. “The DASH Diet and Sodium Restriction Improves Markers of Bone Turnover and Calcium Metabolism in Adults,”
Journal of Nutrition (2003) 133:3130.


Studies mentioned in the concluding section, The Osteoporosis Cure:

Wachman, A. and D.S. Bernstein. “Diet and Osteoporosis,”
Lancet, May 4, 1968, p. 958.

Hegsted, D.M. “Fractures, Calcium, and the Modern Diet,”
American Journal of Clinical Nutrition (2001) 74:571.


Studies documenting how acidic blood accelerates bone loss by suppressing osteoblasts and activating osteoclasts:

Arnett, T.R. and M. Spowage. “Modulation of the Resorptive Activity of Rat Osteoclasts by Small Changes in Extracellular pH near the Physiologic Range,” Bone (1996) 18:277.

Brandao-Burch, A. et al. “Acidosis Inhibits Bone Formation by Osteoblasts in Vitro by Preventing Mineralization,”
Calcified Tissue International (2005) 77:167.

Bushinsky, D.A. “Metabolic Alkalosis Decreases Bone Calcium Efflux by Suppressing Osteoclasts and Stimulating Osteoblasts,”
American Journal of Physiology (1996) 271(1, Pt. 2):F216.

Bushinsky, D.A. “Net Calcium Efflux from Live Bone During Chronic Metabolic, but not Respiratory, Acidosis,”
American Journal of Physiology (1989) 256(5,Pt .2):F836.

Krieger, N.S. et al. “Acidosis Inhibits Osteoblastic and Stimulates Osteoclalstic Activity in Vitro,”
American Journal of Physiology (1992) 262(3, Part 2):F442.

Meghji, S. et al. “pH-Dependence of Bone Resorption: Mouse Calvarial Osteoclasts Are Activated by Acidosis,”
American Journal of Physiology, Endocrinology, and Metabolism (2001) 280:E112.


Studies documenting the health benefits of a Mediterranean diet:

Bamia, C. et al. “Dietary Pattern and Survival of Older Europeans: The EPIC-Elderly Study,”
Public Health Nutrition (2007) 10:590.

Barzi, F. “Mediterranean Diet and All-Cause Mortality After Myocardial Infarction: Results from the GISSI-Prevenzione Trial,”
European Journal of Clinical Nutrition (2003) 57:604.

Lagiou, P. et al. “Mediterranean Dietary Pattern and Mortality Among Youn Women: A Cohort Study in Sweden,”
British Journal of Nutrition (2006) 96:384.

Mitrou, P.N. et al. “Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a U.S. Population: Results from the NIH-AARP Diet and Health Study,”
Archives of Internal Medicine (2007) 167:2461.

Scarmeas, N et al. “Mediterranean Diet and Risk for Alzheimer’s Disease,”
Annals of Neurology (2006) 59:912.

Serra-Majem, L et al. “Scientific Evidence of Interventions Using the Mediterranean Diet: A Systematic Review,”
Nutrition Review (2006) 64(2, Part 2): S27.

Trichopoulou, A et al. “Modified Mediterranean Diet and Survival: EPIC-Elderly Prospective Cohort Study,” BMJ [formerly British Medical Journal] (2005) 330(7498):991.


Sources for The Acidifiers: Why Animal Foods? Why Grains?

Cordain, Loren.
The Paleo Diet. Wiley, NY 2002.

Eaton, S. Boyd, et al.
The Paleolithic Prescription. Harper & Row, NY, 1988.

Eaton, S.B. and S.B. Eaton 3
rd. “Paleolithic Vs. Modern Diets: Selected Pathophysiological Implications,” European Journal of Nutrition (2000) 39:67.

Frassetto, L. et al. “Diet, Evolution, and Aging: The Pathophysiological Effects of the Post-Agricultural Inversion of the Potassium-to-Sodium and Base-to-Chloride Ratios in the Human Diet,”
European Journal of Nutrition (2001) 40:200.



Chapter 8
WHY A FORTY-YEAR OLD EXPLANATION IS “NEW”

Albala, Ken. Beans: A History. Berg Publishing. Oxford, New York, 2007

Campbell, T. Colin.
The China Study: Startling Implications for Diet, Weight Loss, andLong-ter Health. Benbella Books, Dallas, TX. 2006.

Nestle, Marion.
Food Politics: How the Food Industry Influences Nutrition and Health. University of California Press, Berkeley, CA 2007.

Pollan, Michael.
In Defense of Food: An Eater’s Manifesto. Penguin, NY, 2008.

Schlosser, Eric.
Fast Food Nation: The Dark Side of the All-American Meal. Houghton Mifflin, Boston, 2001.


Chapter 9:
BRICKS AND MORTAR: FOR STRONG BONES,
THE BODY NEEDS MORE THAN CALCIUM

The 111 studies showing that milk, dairy foods, and calcium improve BMD:

1. Aloia, J.F. et al. “Calcium Supplementation With and Without Hormone Replacement Therapy to Prevent Postmenopausal Bone Loss,”
Annals of Internal Medicine (1994) 120:97.

2. Andon, M.B. et al. “Spinal Bone Density and Calcium Intake in Healthy Postmenopausal Women,”
American Journal of Clinical Nutrition (1991) 54:927.

3. Aptel, I. et al. “Association Between Calcium Ingested from Drinking Water and Femoral Bone Density in Elderly Women: Evidence from the EPIDOS Cohort,”
Journal of Bone and Mineral Research (1999) 14:829.

4. Baran, D. et al. “Dietary Modifications with Dairy Products for Preventing Vertebral Bone Loss in Premenopausal Women: A Three- Year Prospective Study,”
Journal of Clinical Endocrinology and Metabolism (1990) 70:264.

5. Black, R.E. et al. “Children Who Avoid Drinking Cow Milk Have Low Dietary Calcium Intakes and Poor Bone Health,”
American Journal of Clinical Nutrition (2002) 76:675.

6. Bonjour, J.P. et al. “Calcium-Enriched Foods and Bone Mass Growth in Prepubertal Girls: A Randomized Double-Blind Placebo-Controlled Trial,”
Journal of Clinical Investigations (1997) 99:1287.

7. Cadogan, J. et al. “Milk Intake and Bone Mineral Acquisition in Adolescent Girls: Randomized Controlled Intervention Trial,”
BMJ [formerly British Medical Journal] (1997) 315(7118):1255.

8. Cameron, M.A. et al. “Effect of Calcium Supplementation on Bone Density in Premenarcheal Females: A Co-Twin Approach,”
Journal of Clinical Endocrinology and Metabolism (2004) 89:4916.

9. Cauley, J.A. et al. “Factors Associated with the Lumbar Spine and Proximal Femur Bone Mineral Density in Older Men,”
Osteoporosis International (2005) 16:1525.

10. Cepollaro, C. et al. “Effect of Calcium Supplementation as a High-Calcium Mineral Water on Bone Loss in Early Postmenopausal Women,”
Calcified Tissues International (1996) 59:238.

11. Chan, G.M. “Dietary Calcium and Bone Mineral Status of Children and Adolescents,”
American Journal of Diseases of Children (1991) 145:631.

12. Chan, G.M. et al. “Effects of Increased Dietary Calcium Intake Upon the Calcium and Bone Mineral Status of Lactating adolescent and Adult Women,”
American Journal of Clinical Nutrition (1987) 46:319.

13. Chan, G.M. et al. “Effects of Dairy Products on Bone and Body Composition in Pubertal Girls,”
Journal of Pediatrics (1995) 126:551.

14. Chee, W.S. et al. “Effect of Milk Supplementation on Bone Mineral Density in Postmenopausal Chinese Women in Malaysia,”
Osteoporosis International (2003) 14:828.

15. Chang, S. et al. “Effects of Calcium, Dairy Products, and Vitamin D Supplementation on Bone Mass Accrual and Body Composition in 10-12-Year-Old Girls: A 2-Year Randomized Trial,”
American Journal of Clinical Nutrition (2005) 82:1115.

16. Chevvalley, T. et al. “Interaction Between Calcium Intake and Menarcheal Age on Bone Mass Gain: An Eight-Year Follow-Up Study from Prepuberty to Postmenarche,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:44.

17. Cimino, P.M. et al. “The Effects of Calcium on Bone Mineral Density in Postmenopausal Women with Colles Fractures,”
Journal of the Louisiana State Medical Society (1989) 141:24.

18. Daly, R.M. et al. “Calcium and Vitamin D3-fortified Milk Reduces Bone Loss at Clinically Relevant Skeletal Sites in Older Men: A 2-Year Randomized Controlled Trial,”
Journal of Bone and Mineral Research (2006) 21:397.

19. Davis, J.W. et al. “Estrogen and Calcium Supplementation Use Among Japanese-American Women: Effects Upon Bone Loss When Used Singly and in Combination,”
Bone (1995) 17:369.

20. Dawson-Hughes, B. et al. “Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older,”
New England Journal of Medicine (1997) 337:670.

21. DeBar, L.L. et al. “Youth: A Health Plan-Based Lifestyle Intervention Increases Bone Mineral Density in Adolescent Girls,”
Archives of Pediatric and Adolescent Medicine (2006) 160:1269.

22. DeLuis-Roman, D.A. et al. “Effects of Dietary Intake and Lifestyle on Bone Density in Patients with Diabetes Mellitus Type 2,”
Annals of Nutrition and Metabolism (2004) 48:141.

23. Devine, A. et al. “A Longitudinal Study of the Effect of Sodium and Calcium Intakes on Regions Bone Density in Postmenopausal Women,”
American Journal of Clinical Nutrition (1995) 62:740.

24. Devine, A. et al. “A 4-Year Follow-Up Study of the Effects of Calcium Supplementation on Bone Density in Elderly Postmenopausal Women,”
Osteoporosis International (1997) 7:23.

25. Dibba, B. et al. “Effect of Calcium Supplementation on Bone Mineral Accrual in Gambian Children Accustomed to a Low-Calcium Diet,”
American Journal of Clinical Nutrition (2000) 71:544.

26. DiDaniele, N. et al. “Effect of Supplementation of Calcium and Vitamin D on Bone Mineral Density and Bone Mineral Content in Peri- and Post-Menopause Women: A Double-Blind Randomized, Controlled Trial,”
Pharmacology Research (2004) 50:637.

27. Du, X.O. et al. “Milk Consumption and Bone Mineral Content in Chinese Adolescent Girls,”
Bone (2002) 30:521.

28. Elders, P.J. et al. “Long-Term Effect of Calcium Supplementation on Bone Loss in Perimenopausal Women,”
Journal of Bone and Mineral Research (1994) 9:963.

29. Fehily, A.M. et al. “Factors Affecting Bone Density in Young Adults,”
American Journal of Clinical Nutrition (1992) 56:579.

30. Fuss, M. et al. “Involvement of Low-Calcium Diet in the Reduced Bone Mineral Content of Idiopathic Renal Stone Formers,”
Calcified Tissues International (1990) 46:9.

31. Ganpule, A. et al. “Bone Mass in Indian Children: Relationships to Maternal Nutritional Status and Diet During Pregnancy: The Pune Maternal Nutrition Study,”
Journal of Clinical Endocrinology and Metabolism (2006) 91:2994.

32. Grados, F. et al. “Effects on Bone Mineral Density of Calcium and Vitamin D Supplementation in Elderly Women with Vitamin D Deficiency,” Joint, Bone, Spine (2003) 70:203.

33. Gunnes, M. and E.H. Lehmann. “Dietary Calcium, Saturated Fat, Fiber and Vitamin C as Predictors of Forearm Cortical and Travecular Bone Mineral Density in Healthy Children and Adolescents,”
Acta Pediatrica (1995) 84:388.

34. Gunnes, M. and E.H. Lehmann. “Physical Activity and Dietary Constituents as Predictors of Forearm Cortical and Trabecular Bone Gain in Healthy Children and Adolescents: A Prospective Study,”
Acta Pediatrica (1996) 85:19.

35. Halioua, L. and J.J. Anderson. “Lifetime Calcium Intake and Physical Activity Habits: Independent and Combined Effects on the Radial Bone of Healthy Premenopausal Caucasian Women,”
American Journal of Clinical Nutrition (1989) 49:534.

36. Hansen, M.A. et al. “Potential Risk Factors for Development of Postmenopausal Osteoporosis Examined Over a 12-Year Period,”
Osteoporosis International (1991) 1:95.

37. Hansen, M.A. “Assessment of Age and Risk Factors on Bone Density and Bone Turnover in Healthy Premenopausal Women,”
Osteoporosis International (1994) 4:123.

38. Henderson, R.C. and P.R. Hayes. “Bone Mineralization in Children and Adolescents with a Milk Allergy,”
Bone Minerals (1994) 27:1.

39. Hernandez-Avila, M. et al. “Caffeine and Other Predictors of Bone Mineral Density Among Pre- and Perimenopausal Women,”
Epidemiology (1993) 4:128.

40. Hirota, T. et al. “Effect of Diet and Lifestyle on Bone Mass in Asian Young Women,”
American Journal of Clinical Nutrition (1992) 55:1168.

41. Hirota, T. et al. “Improvement of Nutrition Stimulates Bone Mineral Gain in Japanese School Children and Adolescents,”
Osteoporosis International (2005) 16:1057.

42. Hoppe, C. et al. “Bone Size and Bone Mass in 10-Year-Old Danish Children: Effect of Current Diet,”
Osteoporosis International (2000) 11:1024.

43. Hu, J.F. et al. “Dietary Calcium and Bone Density Among Middle-Aged and Elderly Women in China,”
American Journal of Clinical Nutrition (1993) 58:219.

44. Huuskonen, J. et al. “Determinants of Bone Mineral Density in Middle-Aged Men: A Population-Based Study,”
Osteoporosis International (2000) 11:702.

45. Ilich, J.Z. et al. “Relation of Nutrition, Body Composition, and Physical Activity to Skeletal Development: A Cross-Sectional Study in Preadolescent Females,”
Journal of the American College of Nutrition (1998) 17:136.

46. Ilich, J.Z et al. “Bone and Nutrition in Elderly Women: Protein, Energy, and Calcium as Main Determinants of Bone Mineral Density,”
European Journal of Clinical Nutrition (2003) 57:554.

47. Infante, D. and R. Tormo. “Risk of Inadequate Bone Mineralization in Diseases Involving Long-Term Suppression of Dairy Products,”
Journal of Pediatric Gastroenterology and Nutrition (2000) 30:310.

48. Ishikawa, K. et al. “Relation of Lifestyle Factors to Metacarpal Bone Mineral Density Was Different Depending on Menstrual Condition and Years Since Menopause in Japanese Women,”
European Journal of Clinical Nutrition (2000) 54:9.

49. Ishikawa-Takata, K. and T. Ohta. “Relationship of Lifestyle Factors to Bone Mass in Japanese Women,”
Journal of Nutrition, Health, and Aging (2003) 7:44.

50. Kalkwarf, H.J. et al. “Milk Intake During Childhood and Adolescence, Adult Bone Density, and Osteoporotic Fractures in U.S. Women,” American
Journal of Clinical Nutrition (2003) 77:257.

51. Kopaliani, M.G. et al. “Biochemical Markers of Bone Metabolism and Cortical Bone Mineral Density in Young Healthy Females,”
Georgian Medical News (2005) 120:58.

52. Kyriazopoulos, P. et al. “Lifestyle Factors and Forearm Bone Density in Young Greek Men,”
Clinical Endocrinology (Oxford) (2006) 65:234.

53. Lacey, J.M. et al. “Correlates of Cortical Bone Mass Among Premenopausal and Postmenopausal Japanese Women,”
Journal of Bone and Mineral Research (1991) 6:651.

54. Lau, E.M. et al. “Milk Supplementation of the Diet of Postmenopausal Chinese Women on a Low-Calcium Intake Retards Bone Loss,”
Journal of Bone and Mineral Research (2001) 16:1704.

55. Lee, W.T. et al. “Relationship Between Long-Term Calcium Intake and Bone Mineral Content of Children from Birth to 5 Years,”
British Journal of Nutrition (1993) 70:235.

56. Lee, W.T. et al. “Double-Blind, Controlled Calcium Supplementation and Bone Mineral Accretion in Children Accustomed to a Low-Calcium Diet,”
American Journal of Clinical Nutrition (1994) 60:744.

57. Lee. W.T. et al. “Bone Mineral Content of Two Populations of Chinese Children with Different Calcium Intakes,”
Bone and Minerals (1993) 23:195.

58. Lloyd, T. et al. “Calcium Supplementation and Bone Mineral Density in Adolescent Girls,”
Journal of the American Medical Association (1993) 270:841.

59. Lunt, M. et al. “Effects of Lifestyle, Dietary Dairy Intake and Diabetes on Bone Density and Vertebral Deformity Prevalence: the EVOS Study,”
Osteoporosis International (2001) 12:688.

60. Matkovic, V. et al. “Urinary Calcium, Sodium, and Bone Mass of Young Females,”
American Journal of Clinical Nutrition (1995) 62:417.

61. Matlik, L. et al. “Preceived Milk Intolerance Is Related to Bone Mineral Content in 10-to13-Year-Old Female Adolescents,”
Pediatrics (2007) 120:e669.

62. Meier, C. et al. “Supplementation with Oral Vitamin D3 and Calcium During Winter Prevents Seasonal Bone Loss: A Randomized Controlled Open-Label Prospective Trial,”
Journal of Bone and Mineral Research (2004) 19:1221.

63. Merrilees, M.J. et al. “Effects of Dairy Food Supplements on Bone Mineral Density in Teenage Girls,”
European Journal of Nutrition (2000) 39:256.

64. Metz, J.A. et al. “Intakes of Calcium, Phosphorus, and Protein and Physical Activity Level Are Related to Radial Bone Mass and Young Adult Women,”
American Journal of Clinical Nutrition (1993) 58:537.

65. Michaelsson, K. et al. “A High Dietary Calcium Intake is Needed for a Positive Effect on Bone Density in Swedish Postmenopausal Women,”
Osteoporosis International (1997) 7:155.

66. Murphy, S. et al. “Milk Consumption and Bone Mineral Density in Middle-Aged and Elderly Women,”
BMJ [formerly British Medical Journal] (1994) 308(6934):939.

67. Napoli, N. et al. “Effects of Dietary Calcium Compared with Calcium Supplements on Estrogen Metabolism and Bone Mineral Density,”
American Journal of Clinical Nutrition (2007) 85:1428.

68. Naves, M. et al. “Prevalence of Osteoporosis in Men and Determinants of Change in Bone Mass in a Non-Selected Spanish Population,”
Osteoporosis International (2005) 16:603.

69. New, S.A. et al. “Nutritional Influences on Bone Mineral Density: A Cross-Sectional Study in Premenopausal Women,”
American Journal of Clinical Nutrition (1997) 65:1831.

70. Nguyen, T.V. et al. “Lifestyle Factors and Bone Density in the Elderly: Implications for Osteoporosis Prevention,”
Journal of Bone and Mineral Research (1994) 9:1339.

71. Nives, J.W. et al. “Calcium Potentiates the Effect of Estrogen and Calcitonin on Bone Mass: Review and Analysis,”
American Journal of Clinical Nutrition (1998) 67:18.

72. Nowson, C.A. et al. “A Co-Twin Study of the Effect of Calcium Supplementation on Bone Density During Adolescence,”
Osteoporosis International (1997) 7:219.

73. Obermayer-Pietsch, B.M. et al. “Genetic Predisposition for Adult Lactose Intolerance and Relation to Diet, Bone Density, and Bone Fractures,”
Journal of Bone and Mineral Research (2004) 19:42.

74. Orwoll, E.S. et al. “Axial Bone Mass in Older Women. Study of Osteoporotic Fractures Research Group,”
Annals of Internal Medicine (1996) 124:187.

75. Pettifor, J.M. and G.P. Moodley. “Appendicular Bone Mass in Children with a High Prevalance of Low Dietary Calcium Intakes,”
Journal of Bone and Mineral Research (1997) 12:1824.

76. Piaseu, N et al. “Differences in Bone Mineral Density and Lifestyle Factors of Postmenopausal Women Living in Bangkok and Other Provinces,”
Journal of the Medical Association of Thailand (2001) 84:772.

77. Picard, D. et al. “Premenopausal Bone Mineral Content Relates to Height, Weight, and Calcium Intake During Early Adulthood,”
Bone and Minerals (1988) 4:299.

78. Polley, K.J. et al. “Effect of Calcium Supplementation on Forearm Bone Mineral Content in Postmenopausal Women: A Prospective, Sequential Controlled Trial,”
Journal of Nutrition (1987) 117:1929.

79. Pongchaiyakul, C. et al. “Effects of Physical Activity and Dietary Calcium Intake on Bone Mineral Density and Osteoporosis Risk in a Rural Thai Population,”
Osteoporosis International (2004) 15:807.

80. Prince, R.L. et al. “Prevention of Postmenopausal Osteoporosis. A Comparative Study of Exercise, Calcium Supplementation, and Hormone Replacement Therapy,”
New England Journal of Medicine (1991) 325:1189.

81. Prince, R. et al. “Effects of Calcium Supplementation (Milk Powder or Tablets) and Exercise on Bone Density in Postmenopausal Women,”
Journal of Bone and Mineral Research (1995) 10:1068.

82. Recker, R.R. et al. “Effect of Estrogens and Calcium Carbonate on Bone Loss in Postmenopausal Women,”
Annals of Internal Medicine (1977) 87:649.

83. Recker, R.R. et al. “Bone Gain in Young Adult Women,”
Journal of the American Medical Association (1992) 268:2403.

84. Reid, I.R. et al. “Effect of Calcium Supplementation on Bone Loss in Postmenopausal Women,”
New England Journal of Medicine (1993) 328:460.

85. Reid, I.R. et al. “Determinants of the Rate of Bone Loss in Normal Postmenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (1994) 79:950.

86. Reid, I.R. et al. “Long-Term Effects of Calcium Supplementation on Bone Loss and Fractures in Postmenopausal Women: A Randomized Controlled Trial,”
American Journal of Medicine (1995) 98:331.

87. Rubin, K. et al. “Predictors of Axial and Peripheral Bone Mineral Density in Healthy Children and Adolescents with Special Attention to the Role of Puberty,”
Journal of Pediatrics (1993) 123:863.

88. Ruiz, J.C. et al. “Influence of Spontaneous Calcium Intake and Physical Exercise on the Vertebral and Femoral Bone Mineral Density of Children and Adolescents,”
Journal of Bone and Mineral Research (1995) 10:675.

89. Ruml, L.A. et al. “Effect of Calcium Citrate on Bone Density in the Early and Mid-Postmenopausal Period: A Randomized Placebo-Controlled Study,”
American Journal of Therapy (1999) 6:303.

90. Salamone, L.M. et al. “Determinants of Premenopausal Bone Mineral Density: The Interplay of Genetic and Lifestyle Factors,”
Journal of Bone and Mineral Research (1996) 11:1557.

91. Sandler, R.B. et al. “Postmenopausal Bone Density and Milk Consumption in Childhood and Adolescence,”
American Journal of Clinical Nutrition (1985) 42:270.

92. Senipal, J.M. et al. “Influence of Calcium Intake and Growth Indexes on Vertebral Bone Mineral Density in Young Females,”
American Journal of Clinical Nutrition (1991) 54:425.

93. Shea, B. et al. “Meta-Analyses of Therapies for Postmenopausal Osteoporosis. VII. Meta-analysis of Calcium Supplementation for the Prevention of Postmenopausal Osteoporosis,”
Endocrinology Reviews (2002) 23:552.

94. Shea, B. et al. “Calcium Supplementation on Bone Loss in Postmenopausal Women,”
Cochrane Database Systematic Reviews (2004) CD004526.

95. Sone, T. et al. “Influence of Exercise and Degenerative Vertebral Changes on BMD: A Cross-Sectional Study in Japanese Men,”
Gerontology (1996) 42(Suppl 1):57.

96. Specker, B.L. et al. “Longitudinal Study of Calcium Intake, Physical Activity, and Bone Mineral Content in Infants 6-18 Months of Age,”
Journal of Bone and Mineral Research (1999) 14:569.

97. Stear, S.J. et al. “Effect of a Calcium and Exercise Intervention on the Bone Mineral Status of 16-18-Year-Old Adolescent Girls,”
American Journal of Clinical Nutrition (2003) 77:985.

98. Storm, D. et al. “Calcium Supplementation Prevents Seasonal Bone Loss and Changes in Biochemical Markers of Bone Turnover in Elderly New England Women: A Randomized Placebo-Controlled Trial,”
Journal of Clinical Endocrinology and Metabolism (1998) 83:3817.

99. Stacke, H. et al. “Osteoporosis and Bone Metabolic Parameters in Dependence Upon Calcium Intake Through Milk and Milk Products,”
European Journal of Clinical Nutrition (1993) 47:617.

100. Suleiman, S. et al. “Effect of Calcium Intake and Physical Activity Level on Bone Mass and Turnover in Healthy, White, Postmenopausal Women,”
American Journal of Clinical Nutrition (1997) 66:937.

101. Teegarden, D. et al. “Dietary Calcium Intake Protects Women Consuming Oral Contraceptives from Spine and Hip Bone Loss,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:5127.

102. Teegarden, D. et al. “Previous Milk Consumption is Associated with Greater Bone Mineral Density in Young Women,”
American Journal of Clinical Nutrition (1999) 69:1014.

103. Tsukahara, N. et al. “Effects of Physical Characteristics and Dietary Habits on Bone Mineral Density in Adolescent Girls,”
Journal of Nutrition Science and Vitaminology (Tokyo) (1997) 43:643.

104. Ulrich, C.M. et al. “Bone Mineral Density in Mother-Daugher Pairs: Relations to Lifetime Exercise, Lifetime Milk Consumption, and Calcium Supplements,”
American Journal of Clinical Nutrition (1996) 63:72.

105. Varenna, M. et al. “Unbalanced Diet to Lower Serum Cholesterol Level is a Risk Factor for Postmenopausal Osteoporosis and Distal Forearm Fracture,”
Osteoporosis International (2001) 12:296.

106. Wallace, L.S. and J.E. Ballard. “Lifetime Physical Activity and Calcium Intake Related to Bone Mineral Density in Young Women,”
Journal of Women’s Health and Gender-Based Medicine (2002) 11:389.

107. Wolman, R.L. et al. “Dietary Calcium as a Statistical Determinant of Spinal Trabecular Bone Density in Amenorrheic and Estrogen-Replete Athletesk,”
Bone and Minerals (1992) 17:415.

108. Yano, K. et al. “Relationship Between Diet and Bone Mineral Content of Multiple Skeletal Sites in Elderly Japanese-American Men and Women Living in Hawaii,”
American Journal of Clinical Nutrition (1985) 42:877

109. Yoneyama, K. and J. Ikeda. “Effects of Increased Dietary Calcium Intake on Bone Mineral Density in Long-term Lactating Women, and Recovery of Bone Loss Caused by Long-Term Lactation with a Low-Calcium Diet,”
Nippon Koshu Eisei Zasshi [Japanese journal] (2004) 51:1008.

110. Zhu, K. et al. “Effects of School Milk Intervention on Cortical Bone Accretion and Indicators Relevant to Bone Metabolism in Chinese Girls Aged 10-12 Years in Beijing,”
American Journal of Clinical Nutrition (2005) 81:1168.

111. Zhu, K. et al. “Growth, Bone Mass and Vitamin D Status of Chinese Adolescent Girls 3 Years After Withdrawal of Milk Supplementation,”
American Journal of Clinical Nutrition (2006) 83:714.

The forty-one studies showing that milk, dairy foods and calcium have inconclusive effects on BMD:

1. Alhava, E.M. et al. “Influence of Calcium and Calcium + Vitamin D2 Treatment on Bone Mineral After Partial Gastrectomy,” Scandinavian
Journal of Gastroenterology (1975) 10:689.

2. Bass, S.L. et al. “Exercise and Calcium Combined Results in a Greater Osteogenic Effect Than Either Factor Alone: A Blinded Randomized Placebo-Controlled Trial in Boys,”
Journal of Bone and Mineral Research (2007) 22:458.

3. Bauer, D.C. et al. “Factors Associated with Appendicular Bone Mass in Older Women. The Study of Osteoporotic Fractures Research Group,”
Annals of Internal Medicine (1993) 118:657.

4. Buckley, L.M. et al. “Calcium and Vitamin D3 Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthrtis. A Randomized Double-Blind Placebo-Controlled Trial,”
Annals of Internal Medicine (1996) 125:961.

5. Chevalley, T. et al. “Skeletal Site Selectivity in the Effects of Calcium Supplementation on Areal Bone Mineral Density Gain: A Randomized, Double-Blind, Placebo-Controlled Trial in Prepubertal Boys,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:3342.

6. Davis, J.W. “Anthropometric, Lifestyle, and Menstrual Factors Influencing Size-Adjusted Bone Mineral Content in a Multiethnic Population of Premenopausal Women,”
Journal of Nutrition (1996) 126:2968.

7. Dawson-Hughes, B. et al. “A Controlled Trial of the Effect of Calcium Supplementation on Bone Density in Postmenopausal Women,”
New England Journal of Medicine (1990) 323:878.

8. Devine, A. et al. “Physical Activity and Calcium Consumption are Important Determinants of Lower Limb Bone Mass in Older Women,”
Journal of Bone and Mineral Research (2004) 19:1634.

9. Elders, P.J. et al. “Calcium Supplementation Reduces Vertebral Bone Loss in Perimenopausal Women: A Controlled Trial in 248 Women Between 46 and 55 Years of Age,”
Journal of Clinical Endocrinology and Metabolism (1991) 73:533.

10. Enattah, N. et al. “Genetically Defined Adult-Type Hypolactasia and Self-Reported Lactose Intolerance as Risk Factors of Osteporosis in Finnish Postmenopausal Women,”
European Journal of Clinical Nutrition (2005) 59:1105.

11. Haines, C.J. et al. “Calcium Supplementation and Bone Mineral Density in Postmenopausal Women Using Estrogen Replacement Therapy,”
Bone (1995) 16:529.

12. Henderson, N.K. et al. “Bone Density in Young Women is Associated with Body Weight and Muscle Strength but Not Dietary Intakes,”
Journal of Bone and Mineral Research (1995) 10:384.

13. Ho, S.C. et al. “High Habitual Calcium Intake Attenuates Bone Loss in Early Postmenopausal Chinese Women: 18-Month Follow-up Study,”
Journal of Clinical Endocrinology and Metabolism (2004) 89:2166.

14. Honkanen, R. et al. “Does Lactose Intolerance Predispose to Low Bone Density? A Population-Based Study of Perimenopausal Finnish Women,”
Bone (1996) 19:23.

15. Hoover, P.A. et al. “Postmenopausal Bone Mineral Density: Relationship to Calcium Intake, Calcium Absorption, Residual Estrogen, Body Composition, and Physical Activity,”
Canadian Journal of Physiology and Pharmacology (1996) 74:911.

16. Johnston, C.C. et al. “Calcium Supplementation and Increases in Bone Mineral Density in Children,”
New England Journal of Medicine (1992) 327:82.

17. Kelly, P.J. et al. “Dietary Calcium, Sex Hormones, and Bone Mineral Density in Men,”
BMJ [formerly British Medical Journal] 300(6736):1361.

18. Krahe. C. et al. “Risk Factors for Decreased Bone Density in Premenopausal Women,”
Brazilian Journal of Medicine and Biological Research (1997) 30:1061.

19. Kristinsson, J.O. et al. “Relation Between Calcium Intake, Grip Strength, and Bone Mineral Density in the Forearms of Girls Aged 13 and 15,”
Journal of Internal Medicine (1994) 236:385.

20. Lee. W.T. et al. “A Randomized Double-Blind Controlled Calcium Supplementation Trial and Bone Height Acquisition in Children,”
British Journal of Nutrition (1995) 74:125.

21. Lloyd, T. et al. “Effect of Calcium Supplementation and Tanner Stage on Bone Density, Content, and Area in Teenage Women,”
Osteoporosis International (1996) 6:276.

22. MacInnis, R.J. et al. “Determinants of Bone Density in 30- to 65-Year-Old Women: A Co-Twin Study,”
Journal of Bone and Mineral Research (2003) 18:1650.

23. McCabe, L.D. et al. “Dairy Intakes Affect Bone Density in the Elderly,”
American Journal of Clinical Nutrition (2004) 80:1066.

24. Miazgowski, T. et al. “Prevalence and Risk Factors of Osteoporosis in a Population of Szczecin Residents Over 50 Years of Age,”
Pol. Tyg. Lek. [Polish Journal] (1993) 48(Suppl 3):13.

25. Molgaard, C. et al. “Influence of Calcium Intake and Physical Activity on Bone Mineral Content and Bone Size in Healthy Children an Adolescents,”
Osteoporosis International (2001) 12:887.

26. Neville, C.E. et al. “Effect of Nuterient Intakes on Bone Mineral Status in Young Adults: The Northern Ireland Young Hearts Project,”
Calcified Tissues International (2002) 70:89.

27. Nieves, J.W. et al. “Teenage and Current Calcium Intake Are Related to Bone Mineral Density of the Hip and Forearm in Women Aged 30 to 39 Years,”
American Journal of Epidemiology (1995) 141:342.

28. Parsons, T.J. et al. “Reduced Bone Mass in Dutch Adolescents Fed a Macrobiotic Diet in Early Life,”
Journal of Bone and Mineral Research (1997) 12:1486.

29. Opotowski, A.R. et al. “Racial Differences in the Effect of Early Milk Consumption on Peak and Postmenopausal Bone Mineral Density,”
Journal of Bone and Mineral Research (2003) 18:1978.

30. Ramsdale, S.J. et al. “Dietary Calcium Intake Relates to Bone Mineral Density in Premenopausal Women,”
British Journal of Nutrition (1994) 71:77.

31. Riis, B. et al. “Does Calcium Supplementation Prevent Postmenopausal Bone Loss? A Double-Blind, Controlled Clinical Study,”
New England Journal of Medicine (1987) 316:173.

32. Rubin, L.A. et al. “Determinants of Peak Bone Mass: Clinical and Genetic Analyses in a Young Female Canadian Cohort,”
Journal of Bone and Mineral Research (1999) 14:633.

33. Shaw, C.K. “An Epidemiologic Study of Osteoporosis in Taiwan,”
Annals of Epidemiology (1993) 3:264.

34. Soroko, S. et al. “Lifetime Milk Consumption and Bone Mineral Density in Older Women,”
American Journal of Public Health (1994) 84:1319.

35. Suzuki, Y. et al. “Total Calcium Intake is Associated with Cortical Bone Mineral Density in a Cohort of Postmenopausal Women Not Taking Estrogen,”
Journal of Nutrition, Health, and Aging (2003) 7:296.

36. Turner, J.G. et al. “Factors Affecting Bone Mineral Density in High School Girls,”
New Zealand Medical Journal (1992) 105:95.

37. Uusi-Rasi, K. et al. “Associations of Calcium Intake and Physical Activity with Bone Density and Size in Premenopausal and Postmenopausal Women: A Peripheral Quantitative Computed Tomography Study,”
Journal of Bone and Mineral Research (2002) 17:544.

38. Wang, M.C. et al. “Diet in Midpuberty and Sedentary Activity in Prepuberty Predict Peak Bone Mass,”
American Journal of Clinical Nutrition (2003) 77:495.

39. Weinsier, R.L. et al. “Dairy Foods and Bone Health: Examination of the Evidence,”
American Journal of Clinical Nutrition (2000) 72:681.

40. Whitting S.J. et al. “Factors That Affect Bone Mineral Accrual in the Adolescent Growth Spurt,”
Journal of Nutrition (2004) 134:696S.

41. Wosje, K.S. and B.L. Specker. “Role of Calcium in Bone Health During Childhood,”
Nutrition Reviews (2000) 58:253.

The sixty-two studies showing that milk, dairy foods and calcium have no effect on BMD:

1. Babaroutsi, E. et al. “Lifestyle Factors Affecting Heel Ultrasound in Greek females Across Different Life Stages,”
Osteoporosis International (2005) 16:552.

2. Bakhireva, L.N. et al. “Modifiable Predictors of Bone Loss in Older Men: A Prospective Study,”
American Journal of Preventive Medicine (2004) 26:436.

3. Bass, M. et al. “Variables for the Prediction of Femoral Bone Mineral Status in American Women.”
Southern Medical Journal (2006) 99:115.

4. Blaauw, R. et al. “Risk Factors for the Development of Osteoporosis in a South African Population. A Prospective Analysis,”
South African Medical Journal (1994) 84:328.

5. Bounds, W. et al. “Relationship of Dietary and Lifestyle Factors to Bone Mineral Indexes in Children,”
Journal of the American Dietetic Association (2005) 105:735.

6. Chiu, J.F. et al. “Long-Term Vegetarian Diet and Bone Mineral Density in Taiwanese Women,”
Calcified Tissues International (1997) 60:245.

7. Dirschl, D.R. et al. “Bone Mineral Density Six Years After a Hip Fracture: A Prospective Longitudinal Study,”
Bone (2000) 26:95.

8. Earnshaw, S.A. et al. “Current Diet Does Not Relate to Bone Mineral Density After Menopause: The Nottingham Early Postmenopausal Intervention Cohort (EPIC) Study Group,”
British Journal of Nutrition (1997) 78:65.

9. Elgan, C. et al. “Bone Mineral Density and Lifestyle Among Female Students Aged 16-24 Years,”
Gynecological Endocrinology (20020 16:91.

10. Filip, R.S. and J. Zagorski. “Osteoporosis Risk Factors in Rural and Urban Women from the Lublin Region of Poland,”
Annals of Agricultural and Environmental Medicine (2005) 12:21.

11. Franceschi, S. et al. “Influence of Body Size, Smoking, and Diet on Bone Density in Pre- and Post-Menopausal Women,”
Epidemiology (1996) 7:411.

12. Gibbons, M.J. et al. “Effects of a High Calcium Dairy Food on Bone Health in Pre-Pubertal Children in New Zealand,”
Asia Pacific Journal of Clinical Nutrition (2004) 13:341.

13. Glynn, N.W. et al. “Determinants of Bone Mineral Density in Older Men,”
Journal of Bone and Mineral Research (1995) 10:1769.
4. Hannan, M.T. et al. “Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study,”
Journal of Bone and Mineral Research (2000) 15:710.

15. Hunt, I.F. et al. “Bone Mineral Content in Postmenopausal Women: Comparison of Omnivores and Vegetarians,”
American Journal of Clinical Nutrition (1989) 50:517.

16. Iulaino-Burns, S. et al. “Skeletal Benefits from Calcium Supplementation are Limited in Children with Calcium Intakes Near 80 mg Daily,”
Osteoporosis International (2006) 17:1794.

17. Jarupanich, T. “Prevalence and Risk Factors Associated with Osteoporosis in Women Attending Clinic at Hat Yai Regional Hospital,”
Journal of the Medical Association of Thailand (2007) 90:865.

18. Jones, G. et al. “Maternal Diet During Pregnancy is Associated with Bone Mineral Density in Children: A Longitudinal Study,”
European Journal of Clinical Nutrition (2000) 54:749.

19. Jonsson, B. et al. “Lifestyle and Different Fracture Prevalence: A Cross-Sectional Comparative Population-Based Study,”
Calcified Tissues International (1993) 52:425.

20. Kapotage, S. et al. “Effects of Dietary Nutrients and Food Groups on Bone Loss from the Proximal Femur in Men and Women in the 7
th and 8th Decades of Age,” Osteoporosis International (2003) 14:418.

21. Kardinaal, A.F. et al. “Dietary Calcium and Bone Density in Adolescent Girls and Young Women in Europe,”
Journal of Bone and Mineral Research (1999) 14:583.

22. Katzman, D.K. et al. “Clinical and Anthropometric Correlates of Bone Mineral Acquisition in Healthy Adolescent Girls,”
Journal of Clinical Endocrinology and Metabolism (1991) 73:1332.

23. Koetting, C.A. and G.M. Wardlaw. “Wrist, Spine, and Hip Bone Density in Women with Variable Histories of Lactation,”
American Journal of Clinical Nutrition (1988) 48:1479.

24. Kroger, H. et al. “Development of Bone Mass and Bone Density of the Spine and Femoral Neck: A Prospective Study of 65 Children and Adolescents,”
Bone Minerals (1993) 23:171.

25. Lanou, A.J. et al. “Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Re-Evaluation of the Evidence,”
Pediatrics (2005) 115:736.

26. Lloyd, T. et al. “Modifiable Determinants of Bone Status in Young Women,”
Bone (2002) 30:416.

27. Lloyd, T. et al. “Adult Female Hip Bone Density Reflects Teenage Sports-Exercise Patterns but Not Teenage Calcium Intake,”
Pediatrics (2000) 106 (1 Part 1):40.

28. Maggiolini, M. et al. “Effect of Dietary Calcium Intake on Bone Mineral Density in Health Adolescent Girls and Young Women in Southern Italy,”
International Journal of Epidemiology (1999) 28:479.

29. Matkovic, V. et al. “Factors That Influence Peak Bone Mass Formation: A Study of Calcium Balance and the Inheritance of Bone Mass in Adolescent Females,”
American Journal of Clinical Nutrition (1990) 52:878.

30. Mazess, R.B. and H.S. Barden. “Bone Density in Premenopausal Women: Effects of Age, Dietary Intake, Physical Activity, Smoking, and Birth Control Pills,”
American Journal of Clinical Nutrition (1991) 53:132.

31. Mein, A.L. et al. “Lifestyle Influences on Nine-Year Changes in BMD in Young Women,”
Journal of Bone and Mineral Research (2004) 19:1092.

32. Mendez, R.O. et al. “Effects of Calcium and Phosphorus Intake and Excretion on Bone Density in Postmenopausal women in Hermosillo, Mexico,”
Annals of Nutrition and Metabolism (2002) 46:249.

33. Michaelsson, K. et al. “Diet, Bone Mass, and Osteocalcin: A Cross-Sectional Study,”
Calcified Tissues International (1995) 57:86.

34. Molgaard, C. et al. “Effects of Habitual Dietary Calcium Intake on Calcium Supplementation in 12-14-Year-Old Girls,”
American Journal of Clinical Nutrition (2004) 80:1422.

35. Moro, M. et al. “Body Mass Is the Primarty Determinant of Midfemoral Bone Acquisition During Adolescent Growth,”
Bone (1996) 19:519.

36. Muraki, S. et al. “Diet and Lifestyle Associated with Increased Bone Mineral Density: Cross-Sectional Study of Japanese Elderly Women at an Osteoporosis Outpatient Clinic,”
Journal of Orthopedic Science (2007) 12:317.

37. Nilas, L. et al. “Calcium Supplementation and Postmenopausal Bone Loss,”
British Medical Journal (Clinical Research Edition) (1984) 289(6452):1103.

38. Ooms, M.E. et al. “Determinants of Bone Mineral Density and Risk Factors for Osteoporosis in Healthy Elderly Women,”
Journal of Bone and Mineral Research (1993) 8:669.

39. Orwoll, E.S. et al. “Rate of Bone Mineral Loss in Normal Men and the Effects of Calcium and Cholecalciferol Supplementation,”
Annals of Internal Medicine (1990) 112:29.

40. Orwoll, E.S. et al. “Determinants of Bone Mineral Density in Older Women,”
Osteoporosis International (2000) 11:815.

41. Parr, R.M. et al. “Contribution of Calcium and Other Dietary Components to Global Variations in Bone Mineral Density in Young Adults,”
Food and Nutrition Bulletin (2002) 23(3 Suppl):180.

42. Feid, I.R. et al. “Determinants of Total Body and Regional Bone Mineral Density in Normal Postmenopausal Women: A Key Role for Fat Mass,”
Journal of Clinical Endocrinology and Metabolism (1992) 75:45.

43. Riccik T.A. et al. “Calcium Supplementation Suppresses Bone Turnover During Weight Reduction in Postmenopausal Women,”
Journal of Bone and Mineral Research (1998) 13:1045.

44. Rozen, G.S. et al. “Calcium Intake and Bone Mass Development Among Israeli Adolescent Girls,”
Journal of the American College of Nutrition (2001) 20:219.

45. Rubin, L.A. et al. “Determinants of Peak Bone Mass: Clinical and Genetic Analyses in a Young Female Canadian Cohort,”
Journal of Bone and Mineral Research (1999) 14:633.

46. Slemenda, C.W. et al. “Long-Term Bone Loss in Men: Effects of Genetic and Environmental Factors,”
Annals of Internal Medicine (1992) 117:286.

47. Strause, L. et al. “Spinal Bone Loss in Postmenopausal Women Supplemented with Calciuym and Trace Minerals,”
Journal of Nutrition (1994) 124:1060.

48. Tanaka, T. et al. “Risk Factors for Proximal Femur Osteoporosis in Men Aged 50 Years or Older,”
Osteoporosis International (2001) 12:942.

49. Tylavsky, F.A. and J.J. Anderson. “Dietary Factors in Bone Health of Elderly Lacto-ovo-vegetarian and Omnivorous Women,”
American Journal of Clinical Nutrition (1988) 48(3 Suppl):842.

50. Stevenson, J.C. et al. “Dietary Intake of Calcium and Postmenopausal Bone Loss,”
BMJ [formerly British Medical Journal] 297(6640):15.

51. Uusi-Rasi, K. et al. “Determinants of Bone Mineralizaation in 8- to 20-Year-old Finnish Females,”
European Journal of Clinical Nutrition (1997) 51:54.

52. Valimaki, M.J. et al. “Exercise, Smoking, and Calcium Intake During Adolescence and Early Adulthood as Determinants of Peak Bone Mass. Cardiovascular Risk in Young Finns Study Group,”
BMJ [formerly British Medical Journal] 309(6949):230.

53. Van Berestijn, E.C. et al. “Relation of Axial Bone Mass to Habitual Calcium Intake and to Cortical Bone Loss in Healthy Early Postmenopausal Women,”
Bone (1990) 11:7.

54. Van Berestijn, E.C. et al. “Habitual Dietary Calcium Intake and Cortical Bone Loss in Postmenopausal Women: A Longitudinal Study,”
Calcified Tissues International (1990) 47:338.

55. VandenBergh, M.F. et al. “Physical Activity, Calcium Intake, and Bone Mineral Content in Children in the Netherlands,”
Journal of Epidemiology and Community Health (1995) 49:299.

56. Walker, M.D. et al. “Determinants of Bone Mineral Density in Chinese-American Women,”
Osteoporosis International (2007) 18:471.

57. Wang, M.C. et al. “Associations of Vitamin C, Calcium, and Protein with Bone Mass in Postmenopausal Mexican Women,”
Osteoporosis International (1997) 7:533.

58. Welten, D.C. et al. “Weight-Bearing Acitivity During Youth is a More Important Factor for Peak Bone Mass than Calcium Intake,”
Journal of Bone and Mineral Research (1994) 9:1089.

59. Wittich, A. et al. “Professional Football (Soccer) Players Have a Markdly Greater Skeletal Mineral Content, Density, and Size Than Age- and BMI-Matched Controls,”
Calcified Tissues International (1998) 63:112.

60. Yahata, Y. et al. “Metacarpal Bone Mineral Density, Body Mass Index, and Lifestyle Among Postmenopausal Japanese Women: Relationship of Body Mass Index, Physical Activity, Calcium Intake, Alcohol, and Smoking to Bone Mineral Density: The Hizen-Oshima Study,”
Tohoku Journal of Experimental Medicine (2002) 196:123.

61. Yarbrough, M.M. et al. “Risk Factors Associated with Osteoporosis in Hispanic Women,”
Journal of Women and Aging (2004) 16:91.

62. Young, D. et al. “Determinants of Bone Mass in 10- to 26-Yearl-old Females: A Twin Study,”
Journal of Bone and Mineral Research (1995) 10:558.

The eighty-seven studies showing that fruits and vegetables and nutrients found only or primarily in them improve BDM:

1. Abraham, G.E. and H. Grewal. “A Total Dietary Program Emphasizing Magnesium Instead of Calcium: Effect on Mineral Density of Calcaneous Bone in Postmenopausal Women on Hormone Therapy,”
Journal of Reproductive Medicine (1990) 35:503.

2. Alkel, D.L. et al. “Isoflavone-Rich Soy Protein Isolate Attenuates Bone Loss in the Lumbar Spine and Perimenopausal Women,”
American Journal of Clinical Nutrition (2000) 72:844.

3. Arjmandi, B.H. et al. “Dried Plums Improve Indices of Bone Formation in Postmenopausal Women,”
Journal of Women’s Health and Gender Medicine (2002) 11:61.

4. Atkinson, C. “The Effects of Phytoestrogen Isoflavones on Bone Density in Women: A Double-Blind, Randomized, Placebo-Controlled Trial,”
American Journal of Clinical Nutrition (2004) 79:326.

5. Basu, S. et al. “Association Between Oxidative Stress and Bone Mineral Density,”
Biochemistry and Biophysics Research Communications (2001) 288:275.

6. Booth, S.L. et al. “Dietary Vitamin K Intakes Are Associated with Hip Fracture But Not with Bone Mineral Density in Elderly Men and Women,”
American Journal of Clinical Nutrition (2000) 71:1201.

7. Carpenter, T.O. “A Randomized Controlled Study of Effects of Dietary Magnesium Oxide Supplementation on Bone Mineral Density in Healthy Girls,”
Journal of Clinical Endocrinology and Metabolism (2006) 91:4866.

8. Chen, Y.M. et al. “Beneficial Effect of Soy Isoflavones on Bone Mineral Content was Modified by Years Since Menopause, Body Weight, and Calcium Intake: A Double-Blind, Randomized, Controlled Trial,”
Menopause (2004) 11:246.

9. Chen, Y.M. et al. “Greater Fruit and Vegetable Intake is Associated with Increased Bone Mass Among Postmenopausal Chinese Women,” British
Journal of Nutrition (2006) 96:745.

10. Chen, Y.M. et al. “Soy Isoflavones Have a Favorable Effect on Bone Loss in Chinese Postmenopausal Women with Lower Bone Mass: A Double-Blind, Randomized, Controlled Trial,”
Journal of Clinical Endocrinology and Metabolism (2003) 88:4740.

11. Chiechi, L.M. et al. “Efficacy of a Soy-Rich Diet in Preventing Postmenopausal Osteoporosis: The Menfis Randomized Trial,”
Maturitas (2002) 42:295.

12. Clifton-Bligh. P.B. et al. “The Effect of Isoflavones Extracted from Red Clover (Rimostil) on Lipid and Bone Metabolism,”
Menopause (2001) 8:259.

13. DeBar, L.L. et al. “Youth: A Health Plan-Based Lifestule Intervention Increases Bone Mineral Density in Adolescent Girls,”
Archives of Pediatrics and Adolescent Medicine (2006) 160:1269.

14. Devine, A. et al. “Tea Drinking is Associated with Benefits on Bone Density in Older Women,”
American Journal of Clinical Nutrition (2007) 86:1243.

15. Dimai, H.P. et al. “Daily Oral Magnesium Supplementation Suppresses Bone Turnover in Young Adult Males,”
Journal of Clinical Endocrinology and Metabolism (1998) 83:2742.

16. Evans, E.M. et al. “Effects of Soy Protein Isolate and Moderate Exercise on Bone Turnover and Bone Mineral Density in Postmenopausal Women,”
Menopause (2007) 14(3 Part 1):481.

17. Feskanich, D. et al. “Vitamin K Intake and Hip Fractures in Women: A Prospective Study,”
American Journal of Clinical Nutrition (1999) 69:74.

18. Franklin, M. et al. “Dried Plum Prevents Bone Loss in a Male Osteoporosis Modeal Via IGF-1 and the RANK Pathway,”
Bone (2006) 39:1331.

19. Ganpule, A. et al. “Bone Mass in Indian Children: Relationships to Maternal Nutritional Status and Diet During Pregnancy: The Pune Maternal Nutrition Study,”
Journal of Clinical Endocrinology and Metabolism (2006) 91:2994.

20. Greendale, G.A. et al. “Dietarty Soy Isoflavones and Bone Mineral Density: Results from the Study of Women’s Health Across the Nation,”
American Journal of Epidemiology (2002) 155:746.

21. Grieger, J.A. et al. “Multivitamin Supplementation Improves Nutritional Status and Bone Quality in Aged Care Residents,”
European Journal of Clinical Nutrition (2007) epub.

22. Guthrie, J.R. et al. “Dietary Phytoestrogen Intake in Mid-Life Australian-born Women: Relationship to Health Variables,”
Climacteric (2000) 3:254.

23. Hall, L.L and G.A. Greendale. “Relation of Dietary Vitamin C Intake to Bone Mineral Density: Results from the PEPI Study,”
Calcified Tissues International (1998) 63:183.

24. Harkness, L.S. et al. “Decreased Bone Resporption with Soy Isoflavone Supplementation in Postmenopausal Women,”
Journal of Women’s Health (Larchmt) (2004) 13:1000.

25. Hegarty, V.M. et al. “Tea Drinking and Bone Mineral Density in Older Women,”
American Journal of Clinical Nutrition (2000) 71:1003.

26. Hirota, T. et al. “Improvement of Nutrition Stimulates Bone Mineral Gain in Japanese School Children and Adolescents,”
Osteoporosis International (2005) 16:1057.

27. Ho, S.C. et al. “Soy Protein Consumption and Bone Mass in Early Postmenopausal Chinese Women,”
Osteoporosis International (2003) 14:835.

28. Ho. S.C. et al. “Soy Intake and Maintenance of Peak Bone Mass in Hong Kong Chinese Women,”
Journal of Bone and Mineral Research (2001) 16:1363.

29. Ho, S.C. et al. “A Prospective Study of the Effects of 1-Year Calcium-Fortified Soy Milk Supplementation on Dietary Calcium Intake and Bone Health in Chinese Adolescent Girls Aged 14 to 16,”
Osteoporosis International (2005) 16:1907.

30. Horiuchi, T. et al. “Effect of Soy Protein on Bone Metabolism in Postmenopausal Japanese Women,”
Osteoporosis International (2000) 11:721.

31. Houtkooper, L.B. et al. “Nutrients, Body Composition, and Exercise Are Related to Change in Bone Mineral Density in Premenopausal Women,”
Journal of Nutrition (1995) 125:1229.

32. Huang, H.Y. et al. “One-Year Soy Isoflavone Supplementation Prevents Early Postmenopausal Bone Loss But without a Dose-Dependent Effect,”
Journal of Nutrition and Biochemistry (2006) 17:509.

33. Hyun, T.H. et al. “Zinc Intakes and Plasma Concentrations in Men with Osteoporosis: The Rancho Bernardo Study,”
American Journal of Clinical Nutrition (2004) 80:715.

34. Ikeda, Y. et al. “Intake of Fermented Soybeans, Natto, is Associated with Reduced Bone Loss in Postmenopausal Women: Japanese Population-Based Osteoporosis Study,”
Journal of Nutrition (2006) 136:1323.

35. Ilich, J.Z. et al. “Bone and Nutrition in Elderly Women: Protein, Energy, and Calcium as Main Determinants of Bone Mineral Density,” European Journal of Clinical Nutrition (2003) 57:554.

36. Jones, G. et al. “Maternal Diet During Pregnancy is Associated with Bone Mineral Density in Children: A Longitudinal Study,”
European Journal of Clinical Nutrition (2000) 54:749.

37. Jones, G. et al. “Association Between Urinary Potassium, Urinary Sodium, Current Diet, and Bone Density in Prepubertal Children,”
American Journal of Clinical Nutrition (2001) 73:839.

38. Kaneko, K. et al. “Urinary Calcium and Calcium Balance in Young Women Affected by High Protein Diet of Soy Protein Isolate and Adding Sulfur-Containing Amino Acids and/or Potassium,”
Journal of Nutritional Science and Vitaminology (Tokyo) (1990) 36:105.

39. Kerstetter, J.E. et al. “Meat and Soy Protein Affect Calcium Homeostasis in Healthy Women,” Journal of Nutrition (2006) 136:1890.

40. Kritz-Silverstein, D. and D.L. Goodman-Gruen. “Usual Dietary Isoflavone Intake, Bone Mineral Density, and Bone Metabolism in Postmenopausal Women,”
Journal of Women’s Health and Gender-Based Medicine (2002) 11:69.

41. Lacey, J.M. et al. “Correlates of Cortical Bone Mass Among Premenopausal and Postmenopausal Japanese Women,”
Journal of Bone and Mineral Research (1991) 6:651.

42. Lau, E. et al. “Physical Activity and Calcium Intake in Fracture of the Proximal Femur in Hong Kong,”
BMJ [formerly British Medical Journal] (1988) 297(6661):1441.

43. Lin, Y.C. et al. “Bone Mass Status of School-Aged Children in Taiwan Assessed by Quantitative Ultrasound: The Nutrition and Health Survey in Taiwan Elementary School Children,”
Asia Pacific Journal of Clinical Nutrition (2007) 16(Suppl 2):585.

44. Lin, P.H. et al. “The DASH Diet and Sodium Reduction Improves Markes of Bone Turnover and Calcium Metabolism in Adults,”
Journal of Nutrition (2003) 133:3130.

45. Lydeking-Olsen, E. et al. “Soymilk of Progesterone for Prevention of Bone Loss: A 2-Year Randomized, Placebo-Controlled Trial,”
European Journal of Nurition (2004) 43:246.

46. Ma, D.F. et al. “Soy Isoflavone Intake Increases Bone Mineral Density in the Spine of Menopausal Women: Meta-Analysis of Randomized Controlled Trials,”
Clinical Nutrition (2007) epub.

47. Macdonald, H.M. et al. “Nutritional Associations with Bone Loss During the Menopausal Trannsition: Evidence of a Beneficial Effect of Calcium, Alcohol, and Fruit and Vegetable Nutrients and of a Detrimental Effect of Fatty Acids,”
American Journal of Clinical Nutrition (2004) 79:4.

48. Maggio D. et al. “Marked Decrease in Plasma Antioxidants in Aged Osteoporotic Women: Results of a Cross-Sectional Study,”
Journal of Clinical Endocrinology and Metabolism (2003) 88:1523.

49. Marini, H. et al. “Effects of the Phytoestrogen Genistein on Bone Metabolism in Osteopenic Postmenopausal Women: A Randomized Study,”
Annals of Internal Medicine (2007) 146:839.

50. Messinal, M. et al. “Skeletal Benefits of Soy Isoflavones: A Review of the Clinical Trial and Epidemiologic Data,”
Current Opinion in Clinical Nutrition and Metabolic Care (2004) 7:649.

51. Macdonald, H.M. et al. “Low Dietary Potassium Intakes and High Dietary Estiates of Net Endogenous Acid Production are Associated with Low Bone Mineral Density in Premenopausal Women and Increased Markers of Bone Resorption in Postmenopausal Women,”
American Journal of Clinical Nutrition (2005) 81:923.

52. McGartland, C.P. et al. “Fruit and Vegetable Consumption and Bone Mineral Density: The Northern Ireland Young Hearts Project,”
American Journal of Clinical Nutrition (2004) 80:1019.

53. Messina, M. et al. “Skeletal Benefits of Soy Isoflavones: A Review of the Clinical Trial and Epidemiologic Data,”
Current Opinion in Clinical Nutrition and Metabolic Care (2004) 7:649.

54. Morabito, N. et al. “Effects of Genistein and Hormone-Replacement Therapy on Bone Loss in Early Postmenopausal Women: a Randomized Double-Blind Placebo-Controlled Study,”
Journal of Bone and Mineral Research (2002) 17:1904.

55. Morton, D.J. et al. “Vitamin C Use and Bone Mineral Density in Postmenopausal Women,”
Journal of Bone and Mineral Research (2001) 16:135.

56. Muraki, S. et al. “Diet and Lifestyle Associated with Increased Bone Mineral Density: Cross-Sectional Study of Japanese Elderly Women at an Osteoporosis Outpatient Clinic,”
Journal of Orthopedic Science (2007) 12:317.

57. New, S.A. et al. “Dietary Influences on Bone Mass and Bone Metabolism: Further Evidence of a Positive Link Between Fruit and Vegetable Consumption and Bone Health?”
American Journal of Clinical Nutrition (2000) 71:142.

58. New, S.A. et al. “Nutritional Influences on Bone Mineral Density: A Cross-Sectional Study in Premenopausal Women,”
American Journal of Clinical Nutrition (1997) 65:1831.

59. Okubo, H. et al. “Dietary Patterns Associated with Bone Mineral Density in Premenopausal Japanese Farm Women,”
American Journal of Clinical Nutrition (2006) 83:1185.

60. Otsuki, T. et al. “Effects of Genetic and Nutritional Factors on Bone Mineral Density in Young Adults,”
International Journal of Molecular Medicine (2004) 14:669.

61. Pasco, J.A. et al. “Antioxidant Vitamin Supplements and Markers of Bone Turnover in a Community Sample of Nonsmoking Women,”
Journal of Women’s Health (2006) 15:295.

62. Prynne, C.J. et al. “Fruit and Vegetable Intakes and Bone Mineral Status: A Cross-Sectional Study in 5 Age and Sex Cohorts,”
American Journal of Clinical Nutrition (2006) 83:1420.

63. Sakhaee, K. et al. “Effects of Potassium Alkalai and Calcium Supplementation on Bone Turnover in Postmenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:3528.

64. Saltman, P.D. and L.G. Strause. “The Role of Trace Minerals in Osteoporosis,”
Journal of the American College of Nutrition (1993) 12:384.

65. Sellmeyer, D.E. et al. “Potassium Citrate Prevents Increased Urine Calcium Excretion and Bone Resorption Induced by a High-Sodium Chloride Diet,”
Journal of Clinical Endocrinology and Metabolism (2002) 87:2008.

66. Shiraki, M. et al. “Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis,”
Journal of Bone and Mineral Research (2000) 15:515.

67. Simon, J.A. and E.S. Hudes. “Relation of Ascorbic Acid to Bone Mineral Density and Self-Reported Fractures Among U.S. Adults,”
American Journal of Epidemiology (2001) 154:427.

68. Somekawa, Y. et al. “Soy Intake Related to Menopausal Symptoms, Serum Lipids, and Bone Mineral Density in Postmenopausal Japanese Women,”
Obstetrics and Gynecology (2001) 97:109.

69. Strause, L. et al. “Spinal Bone Loss in Postmenopausal Women Supplemented with Calcium and Trace Minerals,”
Journal of Nutrition (1994) 124:1060.

70. Tsuchida, K. et al. “Dietary Soybeans Intake and Bone Mineral Density Among 995 Middle-Aged Women in Yokahama,”
Journal of Epidemiology (1999) 9:14.

71. Tucker, K.L. et al. “Bone Mineral Density and Dietary Patterns in Older Adults: The Framingham Osteoporosis Study,”
American Journal of Clinical Nutrition (2002) 76:245.

72. Tucker, K.L. et al. “The Acid-Base Hypothesis: Diet and Bone in the Framingham Osteoporosis Study,”
European Journal of Nutrition (2001) 40:231.

73. Tylavsky, F.A. et al. “Fruit and Vegetable Intakes Are an Independent Predictor of Bone Size in Early Pubertal Children,”
American Journal of Clinical Nutrition (2004) 79:311.

74. Uesugi, T. et al. “Evidence of Estrogenic Effect by the Three-Month-Intervention of Isoflalvone on Vaginal Maturation and Bone Metabolism in Early Postmenopausal Women,”
Endocrinology Journal (2003) 50:613.

75. Uesugi, T. et al. “Beneficial Effects of Soybean Isoflavone Supplements on Bone Metabolism and Serum Lipids in Postmenopausal Japanese Women: A Four-Week Study,”
Journal of the American College of Nutrition (2002) 21:97.

76. Vatanparast, H. et al. “Positive Effects of Vegetable and Fruit Consumption and Calcium Intake on Bone Mineral Accrual in Boys During Growth from Childhood to Adolsecence: The University of Saskatchwean Pediatric Bone Mineral Accrual Study,”
American Journal of Clinical Nutrition (2005) 82:700.

77. Wattanapenpaiboon, N. et al. “Dietary Carotenoid Intake as a Predictor of Bone Mineral Density,”
Asia-Pacific Journal of Clinical Nutrition (2003) 12:467.

78. Weikert, C. et al. “The Relation Between Dietary Protein, Calcium, and Bone Health in Women: Results from the EPIC-Potsdam Cohort,”
Annals of Nutrition and Metabolism (2005) 49:312.

79. Welch, A.A. et al. “Urine pH is an Indicator of Dietary Acid-Base Load, Fruit and Vegetable and Meat Intakes: Results from the European Prospectivd Investigation in Cancer and Nutrition (EPIC)-Norfolk Population Study,”
British Journal of Nutrition (2007) epub.

80. Wu, C.H. et al. “Epidemiological Evidence of Increased Bone Mineral Density in Habitual Tea Drinkers,”
Archives of Internal Medicine (2002) 162:1001.

81. Wu, J. et al. “Cooperative Effects of Isoflavones and Exercise on Bone and Lipid Metabolism in Postmenopausal Japanese Women: A Randomized, Placebo-Controlled Trial,”
Metabolism (2006) 55:423.

82. Yamori, Y. et al. “Soybean Isoflavones Reduce Postmenopausal Bone Resporption in Female Japanese Immigrants in Brazil: A Ten-Week Study,”
Journal of the American College of Nutrition (2002) 21:560.

83. Ye, Y.B. et al. “Soy Isoflavones Attenuate Bone Loss in Early Postmenopausal Chinese Women: A Single-Blind Randomized Placebo-Controlled Trial,”
European Journal of Nutrition (2006) 45:327.

84. Zemel, M.B. “Calcium Utilization: Effect of Varying Level and Source of Dietary Protein,”
American Journal of Clinical Nutrition (1988) 48(3 Suppl):880.

85. Zhang, X. et al. “Prospective Cohort Study of Soy Food Consumption and Risk of Bone Fracture AmongPostmenopausal Women,”
Archives of Internal Medicine (2005) 165:1890.

86. Zhang, G. et al. “Epimedium-Derived Phytoestrogen Flavonoids Exert Beneficial Effect on Preventing Bone Loss in Late Postmenopausal Women: A 24-Month Randomized Double-Blind Placebo-Controlled Trial,”
Journal of Bone and Mineral Research (2007) 22:1072.

87. Zhang, J. et al. “Antioxidant Intake and Risk of Osteoporotic Hip Fracture in Utah: An Effect Modified by Smoking Status,”
American Journal of Epidemiology (2006) 163:9.

The nine studies showing that fruits and vegetables—and nutrients found only or primarily in them—have inconclusive effects on BDM:

1. Arjmandi, B.H. et al. “One Year Soy Protein Supplementation Has Positive Effects on Bone Formation Markers But Not Bone Density in Postmenopausal Women,”
Nutrition Journal (2005) 4:8.

2. Booth, S.L. et al. “Vitamin K Intake and Bone Mineral Density in Men and Women,”
American Journal of Clinical Nutrition (2003) 77:512.

3. Mei, J. et al. “High Density Phytoestrogen Intake is Associated with Higher Bone Mineral Density in Postmenopausal but not Premenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (2001) 86:5217.

4. Newton, K.M. et al. “Soy Protein and Bone Mineral Density in Older Men and Women: A Randomized Trial,”
Maturitas (2006) 55:270.

5. Potter, S.M. et al. “Soy Protein and Isoflavones: Effects of Blood Lipids and Bone Density in Postmenopausal Women,”
American Journal of Clinical Nutrition (1998) 68(6 Suppl):1375S.

6. Tucker, K.L. et al. “Potassium, Magnesium, and Fruit and Vegetable Intakes Are Associated with Greater Bone Mineral Density in Elderly Men and Women,”
American Journal of Clinical Nutrition (1999) 69:727.

7. Whiting, S.J. et al. “Factors that Affect Bone Mineral Accrual in the Adolescent Growth Spurt,”
Journal of Nutrition (2004) 134:696S.

8. Wu, J. et al. “Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial,”
Journal of Bone and Mineral Research (2006) 21:780.

9. Zalloua, P.A. et al. “Impact of Seafood and Fruit Consumption on Bone Mineral Density,”
Maturitas (2007) 56:1.

The seven studies showing that fruits and vegetables—and nutrients found only or primarily in them—have no effect on BDM:

1. Anderson, J.J. et al. “Soy Isoflavones: No Effects on Bone Mineral Content and Bone Mineral Density in Healthy, Menstruating Young Adult Women After One Year,”
Journal of the American College of Nutrition (2002) 21:388.

2. Evans, E.M. et al. “Effects of Soy Protein Isolate and Moderate Exercise on Bone Turnover and Bone Mineral Density in Postmenopausal Women,”
Menopause (2007) 145(3 Part 1):481.

3. Gallagher, J.C. et al. “The Effect of Soy Protein Isolate on Bone Metabolism,”
Menopause (2004) 11:290.

4. Kapotage, S. et al. “Effects of Dietary Nutrients and Food Groups on Bone Loss from the Proximal Femur in Men and Women in the 7
th and 8th Decades of Age,” Osteoporosis International (2003) 14:418.

5. Kreijkamp-Kaspers S. et al. “Effect of Soy Protein Containing Isoflavones on Cognitive Function, Bone Mineral Density, and Plasma Lipids in Postmenopausal Women: A Randomized Controlled Trial,”
Journal of the American Medical Association (2004) 292:65.

6. Nagata, C. et al. “Soy Product Intake and Serum Isoflavonoid and Estradiol Concentrations in Relation to Bone Mineral Density in Postmenopausal Japanese Women,”
Osteoporosis International (2002) 13:200.

7. Wolf, R.L. et al. “Lack of a Relation Between Vitamin and Mineral Antioxidants and Bone Mineral Density: Results from the Women’s Health Initiative,”
American Journal of Clinical Nutrition (2005) 82:581.

Sources describing the contributions of non-calcium nutrients to bone health:


Brown, Susan.
Better Bones, Better Body. Keats Publishing, Los Angeles, 2000.

Institute of Medicine.
Dietary Reference Intakes. National Academy Press, Washington, D.C., 2000.

Lieberman, Shari and Nancy Bruing.
The Real Vitamin and Mineral Book, Avery Publishing, Garden City, New York, 1997.

Nelson, Miriam E.
Strong Women, Strong Bones. Perigee, NY, 2000.

The editorial touting fruits and vegetables as the best way to prevent osteoporosis:

New. S.A. “Fruits and Vegetables: The Unexpected Natural Answer to the Question of Osteoporosis Prevention?”
American Journal of Clinical Nutrition (2006) 83:1254.

Studies showing that vitamin D deficiency is common among the elderly, especially among those with fractures:

Beringer, T. et al. “Prevalence of Vitamin D Inadequacy in Belfast Following Fragility Fracture,”
Current Medical Research and Opinion (2006) 22:101.

Dixon, T. et al. “An Overview of the Prevalence of 25-Hydroxy-Vitamin D Inadequacy Among Elderly Patients with or without Fragility Fracture in the U.K.,”
Current Medical Research and Opinion (2006) 22:405.

Gallacher, S.J. et al. “Prevalence of Vitamin D Inadequacy in Scottish Adults with Non-Vertebral Fragility Fracture,”
Current Medical Research and Opinion (2005) 21:1355.

Komar, L. et al. “Calcium Homeostasis of an Elderly Population Upon Admission to a Nursing Home,”
Journal of the American Geriatric Society (1993) 41:1057.

LeBoff, M.S. et al. “Occult Vitamin D Deficiency in Postmenopausal U.S. Women with Acute Hip Fracture,”
Journal of the American Medical Association (1999) 281:1505.

Moniz, C. et al. “Prevalence of Vitamin D Inadequacy in Osteoporotic Hip Fracture Patients in London,”
Current Medical Research and Opinion (2005) 21:1891.

Nurmi, I. et al. “Half of the Patients with Acute Hip Fracture Suffer from Hypovitaminosis D: A Prospective Study in Southeastern Finland,”
Osteoporosis International (2005) 16:2018.

Nuti, R. et al. “Vitamin D Status and Bone Turnover in Women with Acute Hip Fracture,”
Clinical Orthopedics and Related Research (2004) 422:208.

Perez-Lopez, R. “Vitamin D and Its Implications for Musculoskeletal Health in Women: And Update,”
Maturitas (2007) 58:117.

Studies showing that blood levels of vitamin D plummet during winter months in northern climes, and near the equator if clothing prevents skin exposure to sunlight:

Bhattoa, H.P. et al. “Prevalence and Seasonal Variation of Hypovitaminosis D and its Relationship to Bone Metabolism in Community Dwelling Postmenopausal Hungarian Women,”
Osteoporosis International (2004) 15:447.

Gannage-Yared, M.H. et al. “Hypovitaminosis D in a Sunny Country: Relation to Lifestyle and Bone Markers,”
Journal of Bone and Mineral Research (2000) 15:1856.

Meddeb, N. et al. “Vitamin D Deficiency in Tunisia,”
Osteoporosis International (2005) 16:180.

Meier, C. et al. “Supplementation with Oral Vitamin D3 and Calcium During Winter Prevents Seasonal Bone Loss: A Randomized Controlled Open-Label Prospective Trial,”
Journal of Bone Mineral Research (2004) 19:1221.

Rosen, C.J. et al. “Elderly Women in Northern New England Exhibit Seasonal Changes in Bone Mineral Density and Calciotropic Hormones,”
Bone Minerals (1994) 25:83.

Studies showing that mushrooms contain significant amounts of vitamin D:

Jasinghe. V.J. et al. “Vioavailability of Vitamin D2 from Irradiated Mushrooms: An In Vivo Study,”
British Journal of Nutrition (2005) 93:951.

Outila, T.A. et al. “Bioavailability of Vitamin D from Wild Edible Mushrooms (Cantharellus Tubaeformis) as Measured with a Human Bioassay,”
American Journal of Clinical Nutrition (1999) 69:95.

The six studies showing that vitamin K reduces risk of fractures:

1. Booth, S.L. et al. “Dietary Vitamin K Intakes are Associated with Hip Fracture But Not With Bone Mineral Density in Elderly Men and Women,”
American Journal of Clinical Nutrition (2000) 71:1201.

2. Cockayne, S. et al. “Vitamin K and the Prevention of Fractures: Systematic Review and Meta-Analysis of Randomized Clinical Trials,”
Archives of Internal Medicine (2006) 166:1256.

3. Feskanich, D. et al. “Vitamin K and Hip Fractures in Women: A Prospective Study,”
American Journal of Clinical Nutrition (1999) 69:74.

4. Shiraki, M. et al. “Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis,”
Journal of Bone and Mineral Research (2000) 15:515.

5. Tsugawa, N. et al. “Low Plasma Phylloquinone (Vitamin K) Concentration is Associated with High Incidence of Vertebral Fracture in Japanese Women,”
Journal of Bone and Mineral Research (2008) 26:79.

6. Yaegashi, Y. et al. “Association of Hip Fracture Incidence and Intake of Calcium, Magnesium, Vitamin D, and Vitamin K,”
European Journal of Epidemiology (2008) epub ahead of print.

The one study showing no fracture prevention using Vitamin K:

1. Reinmark, L. et al. “No Effect of Vitamin K1 on Bone Mineral Density and Fracture Risk in Perimenopausal Women,”
Osteoporosis International (2006) 17:1122.

The five studies showing that vitamin A decreases BMD and increases risk of fractures:

1. Crandal, C. “Vitamin A intake and Osteoporosis: A Clinical Review,”
Journal of Women’s Health (2004) 13:939.

2. Feskanich, D. et al. “Vitamin A Intake and Hip Fractures Among Postmenopausal Women,”
Journal of the American Medical Association (2002) 287:47.

3. Melhus, H. et al. “Excessive Dietary Intake of Vitamin A Is Associated with Reduced Bone Mineral Density and Increased Risk of Hip Fracture,”
Annals of Internal Medicine (1998) 129:770.

4. Michaelsson, K. et al. “Serum Retinol Levels and Risk of Fracture,”
New England Journal of Medicine (2003) 348:287.

5. White, S.C. et al. “Risk Factors for Fractures in Older Men and Women: The Leisure World Cohort Study,”
Gender Medicine (2006) 3:110.

The two studies showing no bone harm from vitamin A:

1. Barker, M.E. et al. “Serum Retinoids and Beta-Carotene as Predictors of Hip and Other Fractures in Elderly Women,”
Journal of Bone and Mineral Research (2005) 20:913.

2. Lim, L.S. et al. “Vitamin A Intake and the Risk of Hip Fracture in Postmenopausal Women: The Iowa Women’s Health Study,”
Osteoporosis International (2004) 15:552.

The twenty-two studies showing that soy foods improve bone mineral density and/or reduce risk of fractures:

1. Alekel, D.L. et al. “Isoflavone-Rich Soy Protein Isolate Attenuates Bone Loss in the Lumbar Spine of Perimenopausal Women,”
American Journal of Clinical Nutrition (2000) 72:844.

2. Chen, Y.M. et al. “Soy Isoflavones Have a Favorable Effect on Bone Loss in Chinese Postmenopausal Women with Lower Bone Mass: A Double-Blind, Randomized, Controlled Trial,”
Journal of Clinical Endocriminology and Metabolism (2003) 88:4740.

3. Chen, Y.M. et al. “Beneficial Effect of Soy Isoflavones on Bone Mineral Content Was Modified by Years Since Menopause, Body Weight, and Calcium Intake: A Double-Blind, Randomized, Controlled Trial,”
Menopause (2004) 11:246.

4. Chiechi, L.M. et al. “Efficacy of a Soy-Rich Diet in Preventing Postmenopausal Osteoporosis: The Menfis Randomized Trial,”
Maturitas (2002) 42:295.

5. Harkness, L.S. et al. “Decreased Bone Resorption with Soy Isoflavone Supplementation in Postmenopausal Women,”
Journal of Women’s Health (2004) 13:1000.

6. Ho, S.C. et al. “A Prospective Study of the Effects of 1-Year Calcium-Fortified Soy Milk Supplementation on Dietary Calcium Intake and Bone Health in Chinese Adolsecent Girls Aged 14 to 16,”
Osteoporosis International (2005) 16:1907.

7. Ho, S.C. et al. “Soy Protein Consumption and Bone Mass in Early Postmenopausal Chinese Women,”
Osteoporosis International (2003) 14:835.

8. Ho, S.C. et al. “Soy Intake and the Maintenance of Peak Bone Mass in Hong Kong Chinese Women”
Journal of Bone and Mineral Research (2001) 16:1363.

9. Horiuchi, T. et al. “Effect of Soy Protein on Bone Metabolism in Postmenopausal Japanese Women,”
Osteoporosis International (2000) 11:721.

10. Kaneko, K. et al. “Urinary Calcium and Calcium Balance in Young Women Affected by High Protein Diet of Soy Protein Isolate and Adding Sulfur-Containing Amino Acids and/or Potassium,”
Journal of Nutritional Science and Vitaminology (1990) 36:105.

11. Kerstetter, J.E. et al. “Meat and Soy Protein Affect Calcium Homeostasis in Healthy Women,”
Journal of Nutrition (2006) 136:1890.

12. Kritz-Silverstein, D. and D.L. Goodman-Gruen. “Usual Dietary Isoflavone Intake, Bone Mineral Density, and Bone Metabolism in Postmenopausal Women,”
Journal of Women’s Health and Gender-Based Medicine (2002) 11:69.

13. Lydeking-Olsen, E. et al. “Soymilk or Progesterone for Prevention of Bone Loss: 2-Year Randomized, Placebo-Controlled Trial,”
European Journal of Nutrition (2004) 43:246.

14. Ma, D.F. et al. “Soy Isoflavone Intake Increases Bone Mineral Density in the Spine of Menopausal Women: Meta-Analysis of Randomized Controlled Trials,”
Clinical Nutrition (2007) epub.

15. Marini, H. et al. “Effects of the Phytoestrogen Genistein on Bone Metabolism in Osteopenic Postemenopausal Women: A Randomized Trial,”
Annals of Internal Medicine (2007) 146:839.

16. Messina, M. et al. “Skeletal Benefits of Soy Isoflavone: A Review of the Clinical Trial and Epidemiological Data,”
Current Opinion in Clinical Nutrition and Metabolism Care (2004) 7:649.

17. Somekawa, Y. et al. “Soy Intake Related to Menopausal Symptoms, Serum Lipids, and Bone Mineral Density in Postmenopausal Japanese Women,”
Obstetrics and Gynecology (2001) 97:109.

18. Uesugi, T. et al. “Evidence of Estrogenic Effect by the Three-Month-Intervention of Isoflavone on Vaginal Maturation and Bone Metabolism in Early Postmenopausal Women,”
Endocrinology Journal (2003) 50:613.

19. Uesugi, T. et al. “Beneficial Effects of Soybean Isoflavone Supplementation on Bone Metabolism and Serum Lipids in Postmenopausal Japanese Women: A Four-Week Study,”
Journal of the American College of Nutrition (2002) 21:97.

20. Ye, Y.B. et al. “Soy Isoflavones Attenuate Bone Loss in Early Postmenopausal Chinese Women: A Single-Blind Randomized, Placebo-Controlled Trial,”
European Journal of Nutrition (2006) 45:327.

21. Zemel, M.B. “Calcium Utlilization: Effect of Varying Level and Source of Dietary Protein,”
American Journal of Clinical Nutrition (1988) 48(3 Suppl):880.

22. Zhang, X. et al. “Prospective Cohort Study of Soy Food Consumption and Risk of Bone Fracture Among Postmenopausal Women,”
Archives of Internal Medicine (2005) 165:1890.

The five studies of soy and bone mineral density showing inconclusive results:

1. Arjmandi, B.H. et al. “One Year Soy Protein Supplementation Has Positive Effects on Bone Formation Markers but Not Bone Density in Postmenopausal Women,”
Nutrition Journal (2005) 4:8.

2. Mei, J. et al. “High Dietary Phytoestrogen Intake is Assocated with Higher Bone Mineral Density in Postmenopausal but not Premenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (2001) 86:5217.

3. Newton, K.M. et al. “Soy Protein and Bone Mineral Density in Older Men and Women: A Randomized Trial,”
Maturitas (2006) 55:270.

4. Potter, S.M. et al. “Soy Protein and Isoflavones: Their Effects on Blood Lipids and Bone Density in Postmenopausal Women,”
American Journal of Clinical Nutrition (1998) 68(6 Suppl):1375S.

5. Wu, J. et al. “Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial,”
Journal of Bone and Mineral Research (2006) 21:780.

The four studies showing that soy has no effect on bone mineral density:

1. Anderson, J.J. et al. “Soy Isoflavones: No Effects on Bone Mineral Content and Bone Mineral Density in Healthy, Menstruating Young Adult Women After One Year,”
Journal of the American College of Nutrition (2002) 21:388.

2. Evans, E.M. et al. “Effects of Soy Protein Isolate and Moderate Exercise on Bone Turnover and Bone Mineral Density in Postmenopausal Women,”
Menopause (2007) 14(3 Part 1): 481.

3. Gallagher, J.C. et al. “The Effect of Soy Protein Isolate on Bone Metabolism,”
Menopause (2004) 11:290.

4. Kreijkamp-Kaspers, S et al. “Effect of Soy Protein Containing Isoflavones on Cognitive Function, Bone Mineral Density, and Plasma Lipids in Postmenopausal Women: A Randsomized Controlled Trial,”
Journal of the American Medical Association (2004) 292:65.

Chapter 10:
THE CASE AGAINST LOW-ACID EATING

The five studies showing that a diet high in animal foods reduces fracture risk, or that a vegan diet increases risk:

1. Appleby, P. et al. “Comparative Fracture Risk in Vegetarians and Nonvegetarians in EPIC-Oxford,”
European Journal of Clinical Nutrition (2007) 61:1400.

2. Munger, R.G. et al. “Prospective Study of Dietary Protein Intake and Risk of Hip Fracture in Postmenopausal Women,”
American Journal of Clinical Nutrition (1999) 69:147.

3. Thorpe, D.L et al. “Effects of Meat Consumption and Vegetarian Diet on Wrist Fracture Over 25 Years in a Cohort of Peri- and Postmenopausal Women,”
Public Health Nutrition (2007) epub ahead ofprint.

4. Wengreen, H.J. et al. “Dietary Protein Intake and Risk of Osteoporotic Hip Fracture in Elderly Residents of Utah,”
Journal of Bone and Mineral Research (2004) 19:537.

The five studies described in Chapter 9 showing that as intake of animal protein increases, so does hip fracture risk:

1. Abelow, B.J. et al. “Cross-Cultural Association Between Dietary Animal Protein and Hip Fracture: A Hypothesis,”
Calcified Tissue International (1992) 50:14.

2. Feskanich, D. et al. “Protein Consumption and Bone Fractures in Women,”
American Journal of Epidemiology (1996) 143:472.


3. Frassetto, L.A. et al. “Worldwide Incidence of Hip Fracture in Elderly Women: Relation to Consumption of Animal and Vegetable Foods,” Journal of Gerontology: Medical Sciences (2000) 55:M585.

4. Meyer, H.E. et al. “Dietary Factors and the Incidence of Hip Fracture in Middle-Aged Norwegians: A Prospective Study,”
American Journal of Epidemiology (1997) 145:117.

5. Sellmeyer, D.E. et al. “A High Ratio of Dietary Animal to Vegetable Protein Increases the Rate of Bone Loss and the Risk of Hip Fracture in Postmenopausal Women: Study of the Osteoporotic Fractures Research Group,” American Journal of Clinical Nutrition (2001) 73:118.

The two studies showing that antioxidant nutrients found only in plant foods reduce risk of hip fracture:

Melhus, H. et al. “Smoking, Antioxidant Vitamins, and Risk of Hip Fracture,” Journal of Bone and Mineral Research (1999) 14:129.

Zhang, J. et al. “Antioxidant Intake and Risk of Osteoporotic Hip Fracture in Utah: An Effect Modified by Smoking Status,”
American Journal of Epidemiology (2006) 163:9.

The six studies showing that vitamin K reduces risk of fractures:

1. Booth, S.L. et al. “Dietary Vitamin K Intakes are Associated with Hip Fracture But Not With Bone Mineral Density in Elderly Men and Women,”
American Journal of Clinical Nutrition (2000) 71:1201.

2. Cockayne, S. et al. “Vitamin K and the Prevention of Fractures: Systematic Review and Meta-Analysis of Randomized Clinical Trials,”
Archives of Internal Medicine (2006) 166:1256.

3. Feskanich, D. et al. “Vitamin K and Hip Fractures in Women: A Prospective Study,”
American Journal of Clinical Nutrition (1999) 69:74.

4. Shiraki, M. et al. “Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis,”
Journal of Bone and Mineral Research (2000) 15:515.

5. Tsugawa, N. et al. “Low Plasma Phylloquinone (Vitamin K) Concentration is Associated with High Incidence of Vertebral Fracture in Japanese Women,”
Journal of Bone and Mineral Research (2008) 26:79.

6. Yaegashi, Y. et al. “Association of Hip Fracture Incidence and Intake of Calcium, Magnesium, Vitamin D, and Vitamin K,”
European Journal of Epidemiology (2008) epub ahead of print.

The one study showing no fracture prevention using Vitamin K:

1. Reinmark, L. et al. “No Effect of Vitamin K1 on Bone Mineral Density and Fracture Risk in Perimenopausal Women,”
Osteoporosis International (2006) 17:1122.

The one study showing that soy foods reduce fractures:

Zhang, X. et al. “Prospective Cohort Study of Soy Food Consumption and Risk of Bone Fracture Among Postmenopausal Women,”
Archives of Internal Medicine (2005) 165:1890.

Studies showing that animal protein supplements improve bone health:

Bonjour, J.P. “Dietary Protein: An Essential Nutrient for Bone Health,”
Journal of the American College of Nutrition (2005) 24(6 Suppl):526S.

Dawson-Hughes, B. et al. “Effect of Protein Supplements on Calcium Excretion in Healthy Older Men and Women,”
Journal of Clinical Endocrinology and Metabolism (2004) 89:1169.

Dawson-Hughes, B. “Interaction of Calcium and Dietary Protein in Bone Health in Humans,”
Journal of Nutrition (2003) 133:852S.

Dawson-Hughes, B. and S.S. Harris. “Calcium Intake Influences the Association of Protein Intake with Rates of Bone Loss in Elderly Men and Women,”
American Journal of Clinical Nutrition (2002) 75:773.

Geinoz, G. et al. “Relationship Between Bone Mineral Density and Dietary Intakes in the Elderly,”
Osteoporosis International (1993) 3:242.

Hannan, M.T. et al. “Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study,”
Journal of Bone and Mineral Research (2000) 15:2504.

Roughead, Z.K. “Is the Interaction Between Dietary Protein and Calcium Destructive or Constructive for Bone?”
Journal of Nutrition (2003) 133:866S.

Schurch, M.A. et al. “Protein Supplements Increase Serum Insulin-Like Growth Factor-1 Levels and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fracture: A Randomized, Double-Blind, Controlled Trial,”
Annals of Internal Medicine (1998) 128:801.

Tengstrand, B. et al. “Effects of Protein-Rich Supplementation and Nandrolone on Bone Tissue After a Hip Fracture,”
Clinical Nutrition (2007) 26:460.

Studies documenting high rates of malnutrition among the oldest elderly, especially frail nursing home residents with recent hip fractures:

Bonjour, J.P. et al. “Proteins and Bone Health,”
Pathology and Biology (Paris) (1997) 45:57.

Bonjour, J.P. et al. “Nutritional Aspects of Hip Fracture,”
Bone (1996) 18(3 Suppl):139S.

Delmi, M. et al. “Dietary Supplementation in Elderly Patients with Fractured Neck of the Femur,”
Lancet (1990) 335(8696):1013.

Eneroth, M. et al. “Nutritional Supplementation Decreases Hip Fracture-Related Complications,”
Clinical Orthopedics and Related Research (2006) 451:212.

Espaulella, J. et al. “Nutritional Supplementation of Elderly Hip Fracture Patients,” A Randomized, Double-Blind, Placebo-Controlled Trial,”
Age and Ageing (2000) 29:425.

Geinoz, G. et al. “Relationship Between Bone Mineral Density and Dietary Intakes in the Elderly,”
Osteoporosis International (1993) 3:242.

Ozeraitiene, V. and V. Butenaite. “The Evaluation of Bone Mineral Density Based on Nutritional Status, Age, and Anthropometric Parameters in Elderly Women,”
Medicina (Kaunas) (2006) 42:836.

Rizzoli, R. et al. “Protein Intake and Bone Disorders in the Elderly,”
Joint, Bone, and Spine (2001) 68:383.

Schurch, M.A. et al. “Protein Supplements Increase Serum Insulin-Like Growth Factor-1 and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fractures. A Randomized, Double-Blind, Placebo-Controlled Trial,”
Annals of Internal Medicine (1998) 128:801.

Tkatch, L. et al. “Benefits of Oral Protein Supplementation in Elderly Patients with Fracture of the Proximal Femur,”
Journal of the American College of Nutrition (1992) 11:519.

The three studies showing that a high-meat diet does not increase calcium in urine:

1. Duff, T.L. et al. “Calciuric Effect of Short-Term Dietary Loading of Protein, Sodium Chloride, and Potassium Citrate in Prepubescent Girls,”
Journal of the American College of Nutrition (1998) 17:148.

2. Roughead, Z.K. et al. “Controlled High-Meat Diets Do Not Affect Calcium Retention or Indices of Bone Status in Healthy Postmenopausal Women,”
Journal of Nutrition (2003) 133:1020.

3. Spencer, H. et al. “Further Studies of the Effect of a High-Protein Diet as Meat on Calcium Metabolism,”
American Journal of Clinical Nutrition (1983) 37:924.

The fifteen studies showing that as dietary protein increases, so does the amount of calcium in urine:

1. Allen, L.H. et al. “Protein-Induced Hypercalciuria: A Longer-Term Study,”
American Journal of Clinical Nutrition (1979) 32:741.

2. Buclin, T. et al. “Diet Acids and Alkalis Influence Calcium Retention in Bone,”
Osteoporosis International (2001) 12:493.
3. Harrington, M. et al. “Effect of a High-Protein, High-Sodium Diet on Calcium and Bone Metabolism in Postmenopausal Women and Its Interaction with Vitamin D Receptor Geneotype,”
British Journal of Nutrition (2004) 91:41.

4. Hegstead, M. and H.M. Linkswiler. “Long-Term Effects of Level of Protein Intake on Calcium Metabolism in Young Adult Women,”
Journal of Nutrition (1981) 111:244.


5. Hegsted, M. et al. “Urinary Calcium and Calcium Balance in Young Men as Affected by Level of Protein and Phosphorus Intake,”
Journal of Nutrition (1981) 111:553.


6. Ince, B.A. et al. “Lowering Dietary Protein to U.S. Recommended Dietary Allowance Levels Reduces Urinary Calcium Excretion and Bone Resorption in Young Women,”
Journal of Clinical Endocrinology and Metabolism (2004) 89:3801.

7. Jenkins, D.J. et al. “Effect of High Vegetable Protein Diets on Urinary Calcium Loss in Middle-Aged Men and Women,”
European Journal of Clinical Nutrition (2003) 57:376.

8. Kerstetter, J.E. et al. “Low-Protein Intake: The Impact on Calcium and Bone Homeostasis in Humans,”
Journal of Nutrition (2003) 133:855S.

9. Kim, Y. and H.M. Linkswiler. “Effect of Level of Protein Intake on Calcium Metabolism and on Parathyroid and Renal Function in the Adult Human Male,” Journal of Nutrition (1979) 109:1399.

10. Kitano, T. et al. “Effect of Protein Intake on Mineral (Calcium, Magnesium, and Phosphorus) Balance in Japanese Males,”
Journal of Nutrition Science and Vitaminology (Tokyo) (1988) 34:387.

11. Licata, A.A. et al. “Adverse Effects of Liquid Protein Fast on the Handling of Magnesium, Calcium, and Phosphorus,” American Journal of Medicine (1981) 71:767.

12. Licata, A.A. et al. “Acute Effects of Dietary Protein on Calcium Metabolism in Patients with Osteoporosis,” Journal of Gerontology (1981) 36:14.

13. Lutz, J. and H.M. Linkswiler. “Calcium Metabolism in Postmenopausal and Osteoporotic Women Consuming Two Levels of Dietary Protein,”
American Journal of Clinical Nutrition (1981) 34:2178.

14. Reddy, S.T. et al. “Effect of Low-Carbohydrate High-Protein Diets on Acid-Base Balance, Stone-Forming Propensity, and Calcium Metabolism,” American Journal of Kidney Disease (2002) 40:265.

15. Zemel, M.B. et al. “Role of the Sulfur-Containing Amino Acids in Protein-Induced Hypercalciuria in Men,” Journal of Nutrition (1981) 111:545.


Studies suggesting that in the context of a diet high in animal protein, excess calcium in urine might not come from bone:

Allen, L.H. et al. “Protein-Induced Hypercalciuria: A Longer-Term Study,”
American Journal of Clinical Nutrition (1979) 32:741.

Chu, J.Y. et al. “Studies in Calcium Metabolism. II. Effects of Low Calcium and Variable Protein Intake on Human Calcium Metabolism,”
American Journal of Clinical Nutrition (1975) 28:1028.

Heany, R.P. et al. “Dietary Changes Favorably Affect Bone Remodeling in Older Adults,”
Journal of the American Dietetic Association (1999) 99:1228.

Kerstetter, J.E. et al. “The Impact of Dietary Protein on Calcium Absorption and Kinetic Measures of Bone Turnover in Women,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:26.

Kerstetter, J.E. et al. “Dietary Protein, Calcium Metabolism, and Skeletal Homeostasis Revisited,”
American Journal of Clinical Nutrition (2003) 78(3 Suppl):584S.

Kim, Y. and H.M. Linkswiler. “Effect of Level of Protein Intake on Calcium Metabolism and on Parathyroid and Renal Function in the Adult Human Male,”
Journal of Nutrition (1979) 109:1399.

Linkswiler, H.M. et al. “Protein-Induced Hypercalciuria,”
Federation Proceedings (1981) 40:2429.

Schuette, S.A. et al. “Studies on the Mechanism of Protein-Induced Hypercalciuria in Older Men and Women,”
Journal of Nutrition (1980) 110:305.

Chapter 11
EVOLVING TOWARD LOW-ACID EATING—PAINLESSLY

The eight studies summarized in the chapter showing that soy foods improve bone mineral density and/or decrease calcium and acid excretion in urine:

1. Alkel, D.L. et al. “Isoflavone-Rich Soy Protein Isolate Attenuates Bone Loss in the Lumbar Spine of Perimenopausal Women,”
American Journal of Clinical Nutrition (2000) 72:844.

2. Ho, S.C. et al. “Soy Protein Consumption and Bone Mass in Early Postmenopausal Chinese Women,”
Osteoporosis International (2003) 14:835.

3. Ho, S.C. et al. “Soy Intake and the Maintenance of Peak Bone Mass in Hong Kong Chinese Women,”
Journal of Bone and Mineral Research (2001) 16:1363.

4. Kaneko, K. et al. “Urinary Calcium and Calcium Balance in Young Women Affected by High-Protein Diet of Soy Protein Isolate and Adding Sulfur-Containing Amino Acids and/or Potassium,”
Journal of Nutrition and Scientific Vitaminology (Tokyo). (1990) 36:105.

5. Kerstetter, J.E. et al. “Meat and Soy Protein Affect Calcium Homeostasis in Healthy Women,”
Journal of Nutrition (2006) 136:1890.

6. Lydeking-Olsen, E et al. “Soymilk or Progesterone for Prevention of Bone Loss: A Two-Year Randomized, Placebo-Controlled Trial,”
European Journal of Nutrition (2004) 43:246.

7. Marini, H. et al. “Effects of the Phytoestrogen Genistein on Bone Metabolism in Osteopenic Postmenopausal Women: A Randomized Trial,”
Annals of Internal Medicine (2007) 146:839.

8. Ye, Y.B. et al. “Soy Isoflavones Attenuate Bone Loss in Early Postmenopausal Chinese Women: A Single-Blind, Randomized, Placebo-Controlled Trial,” European Journal of Nutrition (2006) 45:327.

The one study showing that soy foods help prevent fractures:

Zhang, X. et al. “Prospective Cohort Study of a Soy Food Consumption and Risk of Bone Fracture Among Postmenopausal Women,”
Archives of Internal Medicine (2005) 165:1890.

The 13 other studies showing that soy foods improve BMD and/or decrease urinary calcium and acid:

1. Chen, Y.M et al. “Beneficial Effect of Soy Isoflavones on Bone Mineral Content Was Modified by Years Since Menopause, Body Weight, and Calcium Intake: A Double-Blind, Randomized, Controlled Trial,”
Menopause (2004) 11:246.

2. Chen, Y.M. et al. “Soy Isoflavones Have a Favorable Effect on Bone Loss in Chinese Postmenopausal Women with Lower Bone Mass: A Double-Blind, Randomized Controlled Trial,”
Journal of Clinical Endocrinology and Metabolism (2003) 88:4740.

3. Chiechi, L.M. et al. “Efficacy of a Soy-Rich Diet in Preventing Postmenopausal Osteoporosis: The Menfis Randomized Trial,”
Maturitas (2002) 42:295.

4. Harkness, L.S. et al. “Decreased Bone Resorption with Soy Isoflavone Supplementation in Postmenopausal Women,”
Journal of Women’s Health (2004) 13:1000.

5. Ho, S.C. et al. “A Prospective Study of the Effects of One-Year Calcium-Fortified Soy Milk Supplementation on Dietary Calcium Intake and Bone Health in Chinese Adolescent Girls Aged 14 to 16,”
Osteoporosis International (2005) 16:1907.

6. Horiuchi, T. et al. “Effect of Soy Protein on Bone Metabolism in Postmenopausal Japanese Women”
Osteoporosis International (2000) 11:721.

7. Kritz-Silverstein, D. and D.L. Goodman-Gruen. “Usual Dietary Isoflavone Intake, Bone Mineral Density, and Bone Metabolism in Postmenopausal Women,”
Journal of Women’s Health and Gender-Based Medicine (2002) 11:69.

8. Ma, D.F. et al. “Soy Isoflavone Intake Increases Bone Mineral Density in the Spine of Menopausal Women: Meta-Analysis of Randomized Controlled Trials,”
Clinical Nutrition (2007) epub ahead of print.

9. Messina, M. et al. “Skeletal Benefits of Soy Isoflavones: A Review of the Clinical Trial and Epidemiologic Data,”
Current Opinion in Clinical Nutrition, Metabolism, and Care (2004) 7:649.

10. Somekawa, Y. et al. “Soy Intake Related to Menopausal Symptoms, Serum Lipids, and Bone Mineral Density in Postmenopausal Japanese Women,”
Obstetrics and Gynecology (2001) 97:109.

11. Uesugi, T. et al. “Beneficial Effects of Soybean Isoflavone Supplementation on Bone Metabolism and Serum Lipids in Postmenopausal Japanese Women: A Four-Week Study,”
Journal of the American College of Nutrition (2002) 21:97.

12. Uesugi, T. et al. “Evidence of Estrogenic Effect by the Three-Month-Intervention of Isoflavone on Vaginal Maturation and Bone Metabolism in Early Postmenopausal Women,”
Endocrinology Journal (2003) 50:613.

13. Zemel, M.B. “Calcium Utilization: Effect of Varying Levels and Source of Dietary Protein,”
American Journal of Clinical Nutrition (1988) 48(Suppl 3):880.

The five soy studies with inconclusive results:

1. Arjmandi, B.H. et al. “One-Year Soy Protein Supplementation Has Positive Effects on Bone Formation Markers But Not Bone Density in Postmenopausal Women,”
Nutrition Journal (2005) 4:8.

2. Mei, J. et al. “High Dietary Phytoestrogen Intake Is Associated with Higher Bone Mineral Density in Postmenopausal But Not Premenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (2001) 86:5217.

3. Newton, K.M. et al. “Soy Protein and Bone Mineral Density in Older Men and Women: A Randomized Trial,”
Maturitas (2006) 55:270.

4. Potter, S.M. et al. “Soy Protein and Isoflavones: Their Effects on Blood Lipids and Bone Density in Postmenopausal Women,”
American Journal of Clinical Nutrition (1998) 68(6 Suppl):1375S.

5. Wu, J. et al. “Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A One-Year Randomized Placebo-Controlled Trial,”
Journal of Bone and Mineral Research (2006) 21:780.

The four studies showing that soy foods do not improve bone health:

1. Anderson, J.J. et al. “Soy Isoflavones: No Effects on Bone Mineral Content and Bone Mineral Density in Healthy, Menstruating Young Adult Women After One Year,”
Journal of the American College of Nutrition (2002) 21:388.

2. Evans, E.M. et al. “Effects of Soy Protein Isolate and Moderate Exercise on Bone Turnover and Bone Mineral Density in Postmenopausal Women,”
Menopause (2007) 14(3 Part 1):481.

3. Gallagher, J.C. et al. “The Effect of Soy Protein Isolate on Bone Metabolism,”
Menopause (2004) 11:290.

4. Kreijkamp-Kaspers, S. et al. “Effect of Soy Protein Containing Isoflavones on Cognitive Function, Bone Mineral Density, and Plasma Lipids in Postmenopausal Women: A Randomized Controlled Trial,”
Journal of the American Medical Association (2004) 292:65.

Chapter 13
AS IMPORTANT AS LOW-ACID EATING:
WALK YOUR WAY TO STRONGER BONES

The fifty-nine studies showing that exercise reduces risk of fractures:

1. Albrand, G. et al. “Independent Predictors of All Osteoporosis-Related Fractures in Healthy Postmenopausal Women: The OFELY Study,”
Bone (2003) 32:78.

2. Astrom, J. et al. “Physical Activity in Women Sustaining Fracture of the Neck of the Femur,”
Journal of Bone and Joint Surgery (British) (1987) 69:381.

3. Boonyaratavej, N. et al. “Physical Activity and Risk Factors for Hip Fractures in Thai Women,”
Osteoporosis International (2001) 12:244.

4. Chan, H.H. et al. “Dietary Calcium Intake, Physical Activity, and the Risk of Vertebral Fracture in Chinese,”
Osteoporosis International (1996) 6:228.

5. Chu, S.P. et al. “Risk Factors for Proximal Humerus Fracture,”
American Journal of Epidemiology (2004) 160:360.

6. Cooper, C. et al. “Physical Activity, Muscle Strength, and Calcium Intake in Fracture of the Proximal Femur in Britain,”
BMJ [formerly British Medical Journal] 297(6661):1443.

7. Coupland, C. et al. “Physical Inactivity Is an Independent Risk Factor for Hip Fracture in the Elderly,”
Journal of Epidemiology and Community Health (1993) 47:441.

8. Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women. Study of Osteoporotic Fractures Research Group,”
New England Journal of Medicine (1995) 332:767.

9. Farahmand, B.Y. et al. “Physical Activity and Hip Fracture: A Population-Based Case-Control Study. Swedish Hip Fracture Study Group,”
International Journal of Epidemiology (2000) 29:308.

10. Feskanich, D. et al. “Walking and Leisure-Time Activity and Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2002) 288:2300.

11. Gajic-Veljanoski, O. et al. “Age and Drug Therapy are Key Prognostic Factors for First Clinical in Patients with Primary Osteoporosis,”
Osteoporosis International (2007) 18:1091.

12. Gregg, E.W. et al. “Physical Activity and Osteoporotic Fracture Risk in Older Women. Study of Osteoporotic Fractures Group,”
Annals of Internal Medicine (1998) 129:81.

13. Gregg, E.W. et al. “Physical Activity, Falls, and Fractures Among Older Adults: A Review of the Epidemiologic Evidence,”
Journal of the American Geriatric Society (2000) 48:883.

14. Grisso, J.A. et al. “Risk Factors for Hip Fracture in Men. Hip Fracture Study Group,”
American Journal of Epidemiology (1997) 145:786.

15. Hagino, H. et al. “Case-Control Study of Risk Factors for Fractures of the Distal Radius and Proximal Humerus Among the Japanese Population,”
Osteoporosis International (2004) 15:226.

16. Herala, M. et al. “Recent Decline in Heavy Outdoor Work Activity Predicts Occurrence of Fractures Among the Home-Dwelling Elderly,”
Osteoporosis International (2002) 13:42.

17. Hoidrup, S. et al. “Leisure Time Physical Activity Levels and Changes in Relation to Risk of Hip Fracture in Men and Women,”
American Journal of Epidemiology (2001) 154:60.

18. Hundrup, Y.A. et al. “Risk Factors for Hip Fracture and a Possible Effect Modification by Hormone Replacement Therapy. The Danish Nurse Cohort Study,”
European Journal of Epidemiology (2005) 20:871.

19. Jaglal, S.B. et al. “Lifetime Occupational Physical Activity and Risk of Hip Fracture in Women,”
Annals of Epidemiology (1995) 5:321.

20. Jaglal, S.B. et al. “Past and Recent Physical Activity and Risk of Hip Fracture,”
American Journal of Epidemiology (1993) 138:107.

21. Joakimsen, R.M. et al. “The Tromo Study: Physical Activity and the Incidence of Fractures in a Middle-Age Population,”
Journal of Bone and Mineral Research (1998) 13:1149.

22. Joakimsen, R.M. et al. “Physical Activity and Predisposition for Hip Fractures: A Review”
Osteoporosis International (1997) 7:503.

23 Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: The MEDOS Study. Mediterranean Osteoporosis Study,”
Journal of Bone and Mineral Research (1995) 10:1802.

24. Jonsson, B. et al. “Lifestyle and Different Fracture Prevalence: A Cross-Sectional Comparative Population-Based Study,”
Calcified Tissues International (1993) 52:425.

25. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: the MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

26. Kelsey, J.L. et al. “Risk Factors for Fracture of the Tibia and Fibula in Older Individuals,”
Osteoporosis International (2006) 17:143.

27. Kelsey, J.L. et al. “Risk Factors for Fractures of the Distal Forearm and Proximal Humerus. The Study of Osteoporotic Fractures Research Group,”
American Journal of Epidemiology (1992) 135:477.

28. Korpelainen, R. et al. “Lifelong Risk Factors for Osteoporosis and Fractures in Elderly Women with Low Body Mass Index: A Population-Based Study,”
Bone (2006) 39:385.

29. Kujala, U.M. et al, “Physical Activity and Osteoporotic Hip Fracture Risk in Men,”
Archives of Internal Medicine (2000) 160:705.

30. Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fracture in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

31. Lau, E. et al. “Physical Activity and Calcium Intake in Fracture of the Proximal Femur in Hong Kong,”
BMJ [formerly British Medical Journal] 297(6661):1441.

32. Lau, E.M. et al. “Risk Factors for Hip Fracture in Asian Men and Women: The Asian Osteoporosis Study,”
Journal of Bone and Mineral Research (2001) 16:572.

33. Lee, S.H. et al. “Risk Factors for Fractures of the Proximal Humerus: Results from the EPIDOS Prospective Study,”
Journal of Bone and Mineral Research (2002) 17:817.

34. Ma, D. and G. Jones. “Television, Computer, and Video Viewing; Physical Activity; and Upper Limb Fracture Risk in Children: A Population-Based Case-Control Study,”
Journal of Bone and Mineral Research (2003) 18:1970.

35. Manias, K. et al. “Fractures and Recurrent Fractures in Children: Varying Effects of Environmental Factors as well as Bone Size and Mass,”
Bone (2006) 39:652.

36. Meyer, H.E. et al. “Risk Factors of Femoral Neck Fractures in Oslo,”
Tidsskr. Nor. Laegeforen. [Norwegian Journal] (1996) 116:2656.

37. Michaelsson, K. et al. “Leisure Physical Activity and the Risk of Fracture in Men,”
PLoS Medicine (2007) 4:e199.

38. Michaelsson, K. et al. “Diet and Hip Fracture Risk: A Case-Control Study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment,”
International Journal of Epidemiology (1995) 24:771.

39. Nevitt, M.C. et al. “Risk Factors for a First-Incident Radiographic Vertebral Fracture in Women > or = 65 Years of Age: The Study of Osteoporotic Fractures,”
Journal of Bone and Mineral Research (2005) 20:131.

40. Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.

41. Norton, R. et al. “Is Physical Activity Protective Against Hip Fracture in Frail Older People?”
Age and Ageing (2001) 30:262.

42. Paganini-Hill, A. et al. “Menopausal Estrogen Therapy and Hip Fractures,”
Annals of Internal Medicine (1981) 95:28.

43. Paganini-Hill, A. et al. “Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study,”
Epidemiology (1991) 2:16.

44. Peel, N.M. et al. “Health-Protective Behaviors and Risk of Fall-Related Hip Fractures: A Population-Based Case-Control Study,”
Age and Ageing (2006) 35:491.

45. Perez Cano, R. et al. “Risk Factors for Hip Fracture in Spanish and Turkish Women,”
Bone (1993) 14(Suppl 1):S69.

46. Pfister, A.K. et al. “Hip Fracture Outcomes and Their Prevention in Kanawha County, West Virginia,”
West Virginia Medical Journal (1999) 95:170.

47. Pires, L.A. et al. “Bone Mineral Density, Milk Intake, and Physical Activity in Boys Who Suffered Forearm Fractures,”
Journal of Pediatrics (Rio de Janeiro) (2005) 81:332.

48. Ramalho, A.C. et al. “Osteoporotic Fractures of the Proximal Femur: Clinical and Epidemiological Features in a Population of the City of Sao Paulo,”
Sao Paulo Medical Journal (2001) 119:48.

49. Ringsberg, K.A. et al. “The Impact of Long-Term Moderate Physical Activity on Functional Performance, Bone Mineral Density, and Fracture Incidence in Elderly Women,”
Gerontology (2001) 47:15.

50. Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

51. Schwartz, A.V. et al. “Characteristics of Falls and Risk of Hip Fracture in Elderly Men,”
Osteoporosis International (1998) 8:240.

52. Sorock, G.S. et al. “Physical Activity and Fracture Risk in a Free-Living Elderly Cohort,”
Journal of Gerontology (1988) 43:M134.

53. Stel, V.S. et al. “Functional Limitations and Poor Physical Performance As Independent Risk Factors for Self-Reported Fractures in Older Persons,”
Osteoporosis International (2004) 15:742.

54. Stevens, J.A. et al. “Physical Activity, Functional Limitations, and the Risk of Fall-Related Fractures in Community-Dwelling Elderly,”
Annals of Epidemiology (1997) 7:54.

55. Suriyawongpaisal, P. et al. “Physical Activity and Risk Factors for Hip Fractures in Thai Men,”
Southeast Asia Journal of Tropical Medicine and Public Health (2001) 32:196.

56. Thorpe, D.L. et al. “The Effect of Vigorous Physical Activity and Risk of Wrist Fracture Over 25 Years in a Low-Risk Survivor Cohort,”
Journal of Bone and Mineral Research (2006) 24:476.

57. Turner, L.W. et al. “Osteoporotic Fracture Among Older U.S. Women: Risk Factors Quantified,”
Journal of Aging and Health (1998) 10:372.

58. Verma, S,K. et al. “Occupational Physical Demands and Same-Level Falls Resulting in Fracture in Female Workers: An Analysis of Workers’ Compensation Claims,”
Injury Prevention (2007) 13:32.

59. Wainwright, S.A. et al. “Hip Fracture in Women Without Osteoporosis,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:2787.

The nine studies showing no fracture-preventive benefits from exercise:

1. Clark, P. et al. “Risk Factors for Osteoporotic Hip Fractures in Mexicans,”
Archives of Medical Research (1998) 29:253.

2. Huang, Z. et al. “Nutrition and Subsequent Hip Fracture Risk Among a National Cohort of White Women,”
American Journal of Epidemiology (1996) 144:124.

3. Jones, I.E. et al. “Associations of Birth Weight and Length, Childhood Size, and Smoking with Bone Fractures During Growth: Evidence From a Birth Cohort Study,”
American Journal of Epidemiology (2004) 159:343.

4. Kleerekoper, M. et al. “Identification of Women at Risk for Developing Postmenopausal Osteoporosis with Vertebral Fractures: Role of History and Single Photon Absorptiometry,”
Bone and Minerals (1989) 7:171.

5. Loud, K.J. et al. “Correlates of Stress Fractures Among Preadolescent and Adolescent Girls,”
Pediatrics (2005) 115:e399.

6. Malimin, H. et al. “Risk Factors for Fractures of the Distal Forearm: A Population-Based, Case-Control Study,”
Osteoporosis International (1994) 4:298.

7. Ribot, C. and J.M. Pouilles, “Postmenopausal Osteoporosis: Clinical Characteristics in Patients First Vertebral Crush Fracture. Results of the GRIO National Multicenter Survey. Groupe de Recherche et d’Information sur les Osteoporoses,”
Review of Rheum. Ed. France (1993) 60:427.

8. Roy, D.K. et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

9. Samelson, E.J. et al. “Incidence and Risk Factors for Vertebral Fracture in Women and Men: 25-Year Follow-Up Results from the Population-Based Framingham Study,”
Journal of Bone and Mineral Research (2006) 21:1207.

The studies showing that modest regular exercise reduces risk of hip fracture 45 percent:

Feskanich, D. et al. “Walking and Leisure-Time Activity and Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2002) 288:2300.

Gregg, E.W. et al. “Physical Activity and Osteoporotic Fracture Risk in Older Women. Study of Osteoporotic Fractures Group,”
Annals of Internal Medicine (1998) 129:81.

Hoidrup, S. et al. “Leisure Time Physical Activity Levels and Changes in Relation to Risk of Hip Fracture in Men and Women,”
American Journal of Epidemiology (2001) 154:60.

Hundrup, Y.A. et al. “Risk Factors for Hip Fracture and a Possible Effect Modification by Hormone Replacement Therapy. The Danish Nurse Cohort Study,”
European Journal of Epidemiology (2005) 20:871.

Joakimsen, R.M. et al. “The Tromo Study: Physical Activity and the Incidence of Fractures in a Middle-Age Population,”
Journal of Bone and Mineral Research (1998) 13:1149.

Kujala, U.M. et al, “Physical Activity and Osteoporotic Hip Fracture Risk in Men,”
Archives of Internal Medicine (2000) 160:705.

Lee, S.H. et al. “Risk Factors for Fractures of the Proximal Humerus: Results from the EPIDOS Prospective Study,”
Journal of Bone and Mineral Research (2002) 17:817.

Paganini-Hill, A. et al. “Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study,”
Epidemiology (1991) 2:16.

Studies showing that moderate regular exercise helps prevent fractures at every age:

Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fracture in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

Ma, D. and G. Jones. “Television, Computer, and Video Viewing; Physical Activity; and Upper Limb Fracture Risk in Children: A Population-Based Case-Control Study,”
Journal of Bone and Mineral Research (2003) 18:1970.

Manias, K. et al. “Fractures and Recurrent Fractures in Children: Varying Effects of Environmental Factors as well as Bone Size and Mass,”
Bone (2006) 39:652.

Pires, L.A. et al. “Bone Mineral Density, Milk Intake, and Physical Activity in Boys Who Suffered Forearm Fractures,”
Journal of Pediatrics (Rio de Janeiro) (2005) 81:332.

Studies describing how normal strain stimulates bone-building and keeps bones strong:

Bartlet, J.P. et al. “Physical Exercise and the Skeleton,”
Archives of Physiology and Biochemistry (1995) 103:681.

Lanyon, L.E. “Using Functional Loading to Influence Bone Mass and Architecture: Objectives, Mechanisms, and Relationship with Estrogens of the Mechanically Adaptive Process in Bone,”
Bone (1996) 18(1 Suppl):37S.

Lau, E. et al. “Physical Activity and Calcium Intake in Fracture of the Proximal Femur in Hong Kong,”
BMJ [formerly British Medical Journal] 297(6661):1441.

Mosley, J.R. and L.E. Lanyon. “Strain Rate as a Controlling Influence on Adaptive Modeling in Response to Dynamic Loading of the Ulna in Growing Male Rats,”
Bone (1998) 23:313.

Rubin, C.T. and L.E. Lanyon. “Kappa Delta Award Paper: Osteoregulatory Nature of Mechanical Stimuli. Function as a Determinant for Adaptive Remodeling in Bone,”
Journal of Orthopedic Research (1987) 5:300.

Smith, E.L. and C. Gilligan. “Dose-Response Relationship Between Physical Loading and Mechanical Competence in Bone,”
Bone (1996) 18(1 Suppl):455.

The seminal study showing that regular, moderate exercise provides the same health benefits as more strenuous aerobic workouts:

Duncan, J.J. et al. "Women Walking for Health and Fitness: How Much is Enough?"
Journal of the American Medical Association (1991) 266:3295.

The study showing that only 1 percent of hip fractures occur spontaneously:

Michaelson, J.D. et al. “Epidemiology of Hip Fractures Among the Elderly. Risk Factors for Fracture Type,”
Clinical Orthopedics and Related Research (1995) 311:129.

Studies showing that falls cause 80 percent of hip fractures:

Aharonoff, G.B. et al. “Circumstances of Falls Causing Hip Fractures in the Elderly,”
Clinical Orthopedics and Related Research (1998) 348:10.

Lofthus, C.M. et al. “Young Patients with Hip Fracture: A Population-Based Study of Bone Mass and Risk Factors for Osteoporosis,”
Osteoporosis International (2006) 17:1666.

Pechlaner, S. et al. “Distal Radius Fractures: Aetiology, Treatment, and Outcome,”
Handchir. Mikrochir. Plast. Chir. [German journal] (2007) 39:19.

Stevens, J.A. and S. Olson. “Reducing Falls and Resulting Hip Fractures Among Older Women,”
MMWR [Morbidity and Mortality Weekly Report] (2000) 49(RR-2):3.

The fourteen studies showing that exercise training reduces falls by 40 to 89 percent:

1. Becker, C. et al. “Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents,”
Journal of the American Geriatrics Society (2003) 51:306.

2. Brooke-Wavell, K. et al. “Effects of Physical Activity and Menopausal Hormone Replacement Therapy on Postural Stability in Postmenopausal Women: A Cross-Sectional Study,”
Maturitas (2001) 37:167.

3. Chan, B.K. et al. “Incident Fall Risk and Physical Activity and Physical Performance Among Older Men: The Osteoporotic Fractures in Men Study,”
American Journal of Epidemiology (2007) 165:696.

4. Close, J. et al. “Prevention of Falls in the Elderly Trial (PROFET): A Randomized Controlled Trial,”
Lancet (1999) 353(9147):93.

5. Dargent-Molina, P. et al. “Fall-Related Factors and Risk of Hip Fracture: the EPIDOS Prospective Study,”
Lancet (1996) 348(9021):145.

6. Howe, T.E. et al. “Exercise for Improving Balance in Older People,”
Cochrane Database Systems Review (2007) 17:CD004963.

7. Kita, K. et al. “A Simple Protocol for Preventing Falls and Fractures in Elderly Individuals with Musculoskeletal Disease,”
Osteoporosis International (2007) 18:611.

8. Liu-Ambrose, T. et al. “Resistance and Agility Training Reduce Fall Risk in Women Aged 75 to 85 with Low Bone Mass: A Six-Month Randomized, Controlled Trial,”
Journal of the American Geriatrics Society (2004) 52:657.

9. Morris, R. et al. “A Comparision of Different Balance Tests in Prediction of Falls in Older Women with Vertebral Fractures: A Cohort Study,”
Age and Ageing (2007) 36:78.

10. Nnodim, J.O. et al. “Dynamic Balance and Stepping Vs. Tai Chi Training to Improve Balance and Stepping in At-Risk Older Adults,”
Journal of the American Geriatrics Society (2006) 54:1825.

11. Stenvall, M. et al. “A Multidisciplinary, Multifactorial Intervention Program Reduces Postoperative Falls and Injuries After Femoral Neck Fracture,”
Osteoporosis International (2007) 18:167.

12. Stevens, J.A. et al. “Physical Activity, Functional Limitations, and the Risk of Fall-Related Fractures in Community-Dwelling Elderly,”
Annals of Epidemiology (1997) 7:54.

13. Suzuki, T. et al. “Randomized, Controlled Trial of Exercise Intervention for the Prevention of Falls in Community-Dwelling Elderly Japanese Women,”
Journal of Bone and Mineral Research (2004) 22:602.

14. Swanenburg, J. et al. “Effects of Exercise and Nutrition on Postural Balance and Risk of Falling in Elderly People with Decreased Bone Mineral Density: Randomized, Controlled Trial Pilot Study,”
Clinical Rehabilitation (2007) 21:523.

The one study with inconclusive results about exercise for fall prevention:

Hauer, K. et al. “Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls,”
Journal of the American Geriatrics Society (2001)

The one study showing that exercise increases risk of falling:

Ebrahim, S. et al. “Randomized Placebo-Controlled Trial of Brisk Walking in the Prevention of Postmenopausal Osteoporosis,”
Age and Ageing (1997) 26:253.

The study showing that falls predict fracture better than low bone mineral density:

Kapotage, S. et al. “Low BMD is Less Predictive Than Reported Falls for Future Limb Fractures in Women Across Europe: Results from the European Prospective Osteoporosis Study,”
Bone. (205) 36:387.

Studies describing risk factors for falls other than osteoporosis:

Arden, N.K. et al. “Knee Pain, Knee Osteoarthritis, and the Risk of Fracture,”
Arthritis and Rheumatism (2006) 55:610.

Ensrud, K.E. et al. “Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures,”
The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences (2007) 62:744.

Harwood, R.H. et al. “Falls and Health Status in Elderly Women Following First Eye Cataract Surgery: A Randomized Controlled Trial,”
British Journal of Ophthalmology (2005) 89:53.

Kaukonen, J.P. et al. “Acute Alcohol Use Among Patients with Acute Hip Fracture: A Descriptive Incidence Study in Southeastern Finland,”
Alcohol and Alcoholism (2006) 41:345.

Nguyen, N.D. et al. “Risk Factors for Fracture in Nonosteoporotic Men and Women,”
Journal of Clinical Endocrinology and Metabolism (2007) 92:955.

Stone, K.L. et al. “Self-Reported Sleep and Nap Habits and Risk of Falls and Fractures in Older Women: The Study of Osteoporotic Fractures,”
Journal of the American Geriatric Society (2006) 54:1177.

Vestergaard, P. et al. “Fracture Risk Associated with the Use of Morphine and Opiates,”
Journal of Internal Medicine (2006) 260:76.

Studies showing that being overweight or obese reduces fracture risk:

DeLaet, C. et al. “Body Mass Index as a Predictor of Fracture Risk: A Meta-Analysis,”
Osteoporosis International (2005) 16:1330.

Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: the MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

Kato, I. et al. “Diet, Smoking, and Anthropometric Indices and Postmenopausal Fractures: A Prospective Study,”
International Journal of Epidemiology (2000) 29:85.

Kelsey, J.L. et al. “Risk Factors for Fracture of the Shaft of the Tibia and Fibula in Older Individuals,”
Osteoporosis International (2006) 17:143.

Kelsey, J.L. et al. “Risk Factors for Pelvis Fracture in Older Persons,”
American Journal of Epidemiology (2005) 162:879.

Liu, H. et al. “Screening for Osteoporosis in Men: A Systematic Review for an American College of Physicians Guideline,”
Annals of Internal Medicine (2008) 148:685.

McTigue, K.M. et al. “Obesity in Older Adults: A Systematic Review of the Evidence for Diagnosis and Treatment,”
Obesity (Silver Spring) (2006) 14:1485.

Reeves, K.W. et al. “Body Mass Index and Mortality Among Older Breast Cancer Survivors in the Study of Osteoporotic Fractures,”
Cancer Epidemiology, Biomarkers, and Prevention (2007) 16:1468.

Roy, D.K. et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporiosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

The seven studies showing that exercise while young reduces fracture risk from youth to old age:

1. Astrom, J. et al. “Physical Activity in Women Sustaining Fracture of the Neck of the Femur,”
Journal of Bone and Joint Surgery (British) (1987) 69:381.

2. Jaglal, S.B. et al. “Past and Recent Physical Activity and Risk of Hip Fracture.”
American Journal of Epidemiology (1993) 138:107.

3. Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fracture in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

4. Ma, D. and G. Jones. “Television, Computer, and Video Viewing; Physical Activity; and Upper Limb Fracture Risk in Children: A Population-Based Case-Control Study,”
Journal of Bone and Mineral Research (2003) 18:1970.

5. Manias, K. et al. “Fractures and Recurrent Fractures in Children: Varying Effects of Environmental Factors as well as Bone Size and Mass,”
Bone (2006) 39:652.

6. Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.

7. Pires, L.A. et al. “Bone Mineral Density, Milk Intake, and Physical Activity in Boys Who Suffered Forearm Fractures,”
Journal of Pediatrics (Rio de Janeiro) (2005) 81:332.

The one study showing that exercise during youth has no effect on fracture risk throughout life:

1. Jones, I.E. et al. “Associations of Birth Weight and Length, Childhood Size, and Smoking with Bone Fractures During Growth: Evidence From a Birth Cohort Study,”
American Journal of Epidemiology (2004) 159:343.

The one study showing that exercise during youth increases fracture risk:

1. Loud, K.J. et al. “Correlates of Stress Fractures Among Preadolescent and Adolescent Girls,”
Pediatrics (2005) 115:e399.

The two exercise studies that calculate a numerical reduction in hip fracture risk:

Jaglal. S.B. et al. “Past and Recent Physical Activity and Risk of Hip Fracture,”
American Journal of Epidemiology (1993) 138:107.

Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.


Chapter 14
DIABETES, FRAILTY, AND FRACTURES


Studies showing that epilepsy, HIV/AIDS, kidney failure, rheumatoid arthritis, and chronic obstructive pulmonary disease increase fracture risk:

Dooley, A.C. et al. “Increased Risk of Hip Fracture Among Men with Chronic Kidney Disease,” American Journal of Kidney Disease (2008) 51:38.

El-Husseini, A.A. et al. “Treatment of Osteopenia and Osteoporosis in Renal Transplant Children and Adolescents,”
Pediatric Transplantation (2004) 8:357.

Jamal, S.A. et al. “Impaired Muscle Strength is Associated with Fractures in Hemodialysis Patients,”
Osteoporosis International (2006) 17:1390.

Jamal, S.A. et al. “Low Bone Mineral Density and Fractures in Long-Term Hemodialysis Patients: A Meta-Analysis,”
American Journal of Kidney Disease (2007) 49:674.

McComsey, G.A. et al. “Fragility Fractures in HIV0Infected Patients: Need for Better Understanding of Diagnosis and Management,”
Journal of the International Association of Physicians and AIDS Care (Chicago, IL) (2004) 3:86.

Palmer, S.C. et al. “Interventions for Preventing Bone Disease in Kidney Transplant Recipients,”
Cochrane Database Systematic Reviews (2007) CD005015.

Prior, J. et al. “Fragility Fractures and Bone Mineral Density in HIV-Positive Women: A Case-Control Population-Based Study,”
Osteoporosis International (2007) 18:1345.

Richy, F. et al. “Inhaled Corticosteroids Effects on Bone in Athmatic and COPD Patients: A Quantitative Systematic Review,”
Osteoporosis International (2003) 14:179.

Vestergaard, P. et al. “Fracture Risk Is Increased in Epilepsy,”
Acta Neurologica Scandinavia (1999) 99:269.

Vestergaard, P. et al. “Epilepsy, Osteoporosis, Fracture Risk,”
Acta Neurologica Scandinavia (2005) 112:277.

The four studies summarized in the chapter showing that type 2 diabetes is a major risk factor for osteoporotic fractures:

1. Ahmed, L.A. et al. “Diabetes Mellitus and the Risk of Non-Vertebral Fractures: The Tromso Study,”
Osteoporosis International (2006) 17:495.

2. Holmsberg, A.H. et al. “Risk of Hip Fractures in a Middle-Aged Population: A Study of 33,000 Men and Women,”
Osteoporosis International (2005) 16:2185.

3. Janghorbani, M. et al. “Prospective Study of Diabetes and Risk of Hip Fracture: The Nurse’s Health Study,”
Diabetes Care (2006) 29:1573.

4. Meyer, H.E. et al. “Risk Factors for Hip Fracture in Middle-Aged Norwegian Women and Men”
American Journal of Epidemiology (1993) 137:1203.

The 16 other studies showing that type 2 diabetes is a major risk factor for osteoporotic fractures:

1. Bonds, D.E. et al. “Risk of Fracture in Women with Type 2 Diabetes: The Women’s Health Initiative Observational Study”
Journal of Clinical Endocrinology and Metabolism (2006) 91:3404.

2. Chen, H.F. et al. “Increased Risk of Hip Fracture in Diabetic Patients of Taiwan: A Population-Based Study,”
Diabetes Care (2008) 31:75.

3. DeLiefde. I.I. et al. “Bone Mineral Density and Fracture Risk in Type 2 Diabetes Mellitus: The Rotterdam Study,”
Osteoporosis International (2005) 16:1713.

4. Forsen, L. et al. “Diabetes Mellitus and the Incidence of Hip Fracture: Results from the Nord-Trondelag Health Survey,”
Diabetologia (1999) 42:920.

5. Ivers, R.O. et al. “Diabetes and Risk of Fracture: The Blue Mountains Eye Study,”
Diabetes Care (2001) 24:1198.

6. Janghorbani, M. et al. “Systematic Review of Type 1 and Type 2 Diabetes Mellitus and Risk of Fracture,”
American Journal of Epidemiology (2007) 166:495.

7. Kelsey, J.L. et al. “Risk Factors for Fractures of the Distal Forearm and Proximal Humerus: The Study of Osteoporotic Fractures Research Group,”
American Journal of Epidemiology (1992) 135:477.

8. Michaelsson, K. et al. “Diet and Hip Fracture Risk: A Case-Control Study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment,”
International Journal of Epidemiology (1995) 24:771.

9. Nicodemus, K.K. et al. “Type 1 and Type 2 Diabetes and Incident Hip Fractures in Postmenopausal Women,”
Diabetes Care (2001) 24:1192.

10. Ottenbacher, K.J. et al. “Diabetes Mellitus as a Risk Factor for Hip Fracture in Mexican-American Older Adults,”
Journal of Gerontology, Series A, Biological Science and Medical Science (2002) 57:M648.

11. Paganini-Hill, A. et al. “Menopausal Estrogen Therapy and Hip Fractures,”
Annals of Internal Medicine (1981) 95:28.

12. Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

13. Schwartz, A.V. et al. “Older Women with Diabetes Have Increased Risk of Fracture: A Prospective Study,”
Journal of Clinical Endocrinology and Metabolism (2001) 86:32.

14. Strotmeyer, E.S. et al. “Nontraumatic Fracture Risk with Diabetes Mellitus and Impaired Fasting Glucose in Older White and Black Adults: The Health, Aging, and Body Composition Study,”
Archives of Internal Medicine (2005) 165:1612.

15. Taylor, B.C. et al. “Long-Term Prediction on Incident Hip Fracture Risk in Elderly While Women: Study of Osteoporotic Fractures,”
Journal of the American Gerontological Society (2004) 52:1479.

16. Vestergaard, P. “Discrepancies in Bone Mineral Density and Fracture Risk in Patients with Type 1 and Type 2 Diabetes: A Meta-Analysis,”
Osteoporosis International (2007) 18:427.

The two studies showing that type 2 diabetes does not raise risk of fracture:

Gerdhem, P. et al. “Increased Bone Density and Decreased Bone Turnover, but No Evident Alternation of Fracture Susceptibility in Elderly Women with Diabetes Mellitus,”
Osteoporosis International (2005) 16:1506.

Korpelainen, R. et al. “Lifelong Risk Factors for Osteoporosis and Fractures in Elderly Women with Low Body Mass Index: A Population Study,”
Bone (2006) 39:385.

The studies suggesting explanations for the link between fractures and type 2 diabetes:

Schwartz, A.V. et al. “Diabetes and Bone Loss at the Hip in Older Black and White Adults,”
Journal of Bone and Mineral Research (2005) 20:596.

Vogt, M.T. et al. “Bone Mineral Density and Blood Flow to the Lower Extremities: The Study of Osteoporotic Fractures,”
Journal of Bone and Mineral Research (1997) 12:283.

The forty-two studies showing that unusually low weight or significant weight loss while elderly (frailty) increases risk of osteoporotic fractures:

1. Bensen, R. et al. “Evaluation of Easily Measured Risk Factors in the Prediction of Osteoporotic Fractures,”
BMC Musculoskeletal Disorders (2005) 6:47.

2. Chan, H.H. et al. “Daily Calcium Intake, Physical Activity, and the Risk of Vertebral Fracture in Chinese,”
Osteoporosis International (1996) 6:228.

3. Cumming, R.G. and R.J. Klineberg. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

4. Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women: Study of Osteoporotic Fractures Research Group,”
New England Journal of Medicine (1995) 332:767.

5. DiPietro, L. et al. “Body Mass and Risk of Hip Fracture Among a National Cohort of Postmenopausal White Women: A Reanalysis,”
Obesity Research (1993) 1:357.

6. Elliot, J.R. et al. “A Comparison of Elderly Patients with Proximal Femoral Fractures and a Normal Elderly Population: A Case-Control Study,”
New Zealand Medical Journal (1992) 105:420.

7. Ensrud, K.E. et al. “Weight Change and Fractures in Older Women: Study of Osteoporotic Fractures Research Group,”
Archives of Internal Medicine (1997) 157:857.

8. Ensrud, K.E. et al. “Bosy Size and Hip Fracture Risk in Older Women: A Prospective Study, Study of Osteoporotic Fractures Research Group,”
American Journal of Medicine (1997) 103:274.

9. Forsen L. et al. “Interaction Between Current Smoking, Leanness, and Physical Inactivity in the Prediction of Hip Fracture”
Journal of Bone and Mineral Research (1994) 9:1671.

10. Fujiwara, S. et al. “Risk Factors for Hip Fracture in a Japanese Cohort,”
Journal of Bone and Mineral Research (1997) 12:998.

11. Grisso, J.A. et al. “Risk Factors for Hip Fracture in Men. Hip Fracture Study Group,”
American Journal of Epidemiology (1997) 145:786.

12. Hagino, H. et al. “Case-Control Study of Risk Factors for Fractures of the Distal Radius and Proximal Humerus Among the Japanese Population,”
Osteoporosis International (2004) 15:226.

13. Hemenway, D. et al. “Fractures and Lifestyle: Effect of Cigarette Smoking, Alcohol Intake, and Relative Weight on the Risk of Hip and Forearm Fractures in Middle-Aged Women,”
American Journal of Public Health (1988) 78:1554.

14. Honkanen, R.J. et al. “Risk Factors for Perimenopausal Distal Forearm Fracture,”
Osteoporosis International (2000) 11:265.

15. Huang, Z. et al. “Nutrition and Subsequent Hip Fracture Risk Among a National Cohort of White Women,”
American Journal of Epidemiology (1996) 144:124.

16. Hundkrup, Y.A. et al. “Risk Factors for Hip Fracture and a Possible Effect Modification by Hormone Replacement Therapy. The Danish Nurse Cohort Study,”
European Journal of Epidemiology (2005) 20:871.

17. Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: the MEDOS Study. Mediterranean Osteoporosis Study,”
Journal of Bone and Mineral Research (1995) 10:1802.

18. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: the MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

19. Kato, I. et al. “Diet, Smoking, and Anthropometric Indices and Postmenopausal Bone Fracture: A Prospective Study,”
International Journal of Epidemiology (2000) 29:85.

20. Kelsey, J.L. et al. “Risk Factors for Fracture of the Shafts of the Tibia and Fibula in Older Individuals,”
Osteoporosis International (2006) 17:143.

21. Kelsey, J.L. et al. “Risk Factors for Pelvis Fracture in Older Persons,”
American Journal of Epidemiology (2005) 162:879.

22. Langlois, J.A. et al. “Hip Fracture Risk in Older White Men is Associated with Change in Body Weight from Age 50 Years to Old Age,”
Archives of Internal Medicine (1998) 158:990.

23. Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fractures in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

24. LaVecchia, C. et al. “Cigarette Smoking, Body Mass and Other Risk Factors for Fractures of the Hip in Women,”
International Journal of Epidemiology (1991) 20:671.

25. Meyer, H.E. et al. “Risk Factors for Hip Fracture in a High-Incidence Area: A Case-Control Study from Oslo, Norway,”
Osteoporosis International (1995) 5:239.

26. Meyer, H.E. et al. “Risk Factors for Hip Fracture in Middle-Aged Norwegian Women and Men,”
American Journal of Epidemiology (1993) 137:1203.

27. Michaelsson, K. et al. “Diet and Hip Fracture Risk: A Case-Control Study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment,”
International Journal of Epidemiology (1995) 24:771.

28. Mussolino, M.E. et al. “Risk Factors for Hip Fracture in White Men: the NHANES I Epidemiologic Follow-Up Study,”
Journal of Bone and Mineral Research (1998) 13:918.

29. Nevitt, M.C. et al. “Risk Factors for a First-Incident Radiographic Vertebral Fracture in Women > or = 65 Years of Age: The Study of Osteoporotic Fractures,”
Journal of Bone and Mineral Research (2005) 20:131.

30. Paganini-Hill, A. et al. “Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study,”
Epidemiology (1991) 2:16.

31. Peel, N.M. et al. “Health-Protective Behaviors and Risk of Fall-Related Hip Fractures: A Population-Based Case-Control Study,”
Age and Ageing (2006) 35:491.

32. Perez Cano, R. et al. “Risk Factors for Hip Fracture in Spanish and Turkish Women,”
Bone (1993) 14(Suppl 1):S69.

33. Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

34. Ramalho, A.C. et al. “Osteoporotic Fractures of Proximal Femur: Clinical and Epidemiological Features in a Population of the City of Sao Paulo,”
Sao Paulo Medical Journal (2001) 119:48.

35. Roy, D.K. et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

36. Stewart, A. et al. “Prevalence of Hip Fracture Risk Factors in Women Aged 70 Years and Over,”
QJM (2000) 93:677.

37. Taylor, B.C. et al. “Long-Term Prediction of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures,”
Journal of the American Geriatric Society (2004) 52:1479.

38. Turner, L.W. et al. “Risk Factors for Hip Fracture Among Southern Older Women,”
Southern Medical Journal (1988) 91:533.

39. Turner. L.W. et al. “Osteoporotic Fracture Among Older U.S. Women: Risk Factors Quantified,”
Journal of Aging and Health (1998) 10:372.

40. Van der Voort, D.J. et al. “Risk Factors for Osteoporosis Related to their Outcome: Fractures,”
Osteoporosis International (2001) 12:630.

41. Williams, A.R. et al. “Effect of Weight, Smoking, and Estrogen Use on the Risk of Hip and Forearm Fractures in Postmenopausal Women,”
Obstetrics and Gynecology (1982) 60:695.

42. Woods, N.F. et al. “Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women’s Health Initiative Observational Study,”
Journal of the American Geriatric Society (2005) 53:1321.

The two studies of body weight and fractures that are inconclusive:

1. Holmberg, A.H. et al. “Risk Factors for Fragility Fracture in Middle Age. A Prospective Population-Based Study of 33,000 Men and Women,”
Osteoporosis International (2006) 17:1065.

2. White, S.C. et al. “Risk Factors for Fractures in Older Men and Women: The Leisure World Cohort Study,”
Gender Medicine (2006) 3:110.

The five studies showing that body weight has no effect on fracture risk:

1. Albrand, G. et al. “Independent Predictors of All Osteoporosis-Related Fractures in Healthy Postmenopausal Women: the OFELY Study,”
Bone (2003) 32:78.

2. Hemenway, D. et al. “Risk Factors for Wrist Fracture: Effect of Age, Cigarettes, Alcohol, Body Height, Relative Weight, and Handedness on the Risk of Distal Forearm Fractures in Men,”
American Journal of Epidemiology (1994) 140:361.

3. Huopio, J. et al. “Risk Factors for Perimenopausal Fractures: A Prospective Study,”
Osteoporosis International (2000) 11:219.

4. Johansson, C. et al. “Coffee Drinking: A Minor Risk Factor for Bone Loss and Fractures,”
Age and Ageing (1992) 21:20.

5. Samelson, E.J. et al. “Incidence and Risk Factors for Vertebral Fracture in Women and Men: 25-Year Follow-up Results from the Population-Based Framingham Study,”
Journal of Bone and Mineral Research (2006) 21:1207.

The two studies showing that low body weight reduces fracture risk:

1. Clark, P. et al. “Risk Factors for Osteoporotic Hip Fractures in Mexicans,”
Archives of Medical Research (1998) 29:253.

2. Gajic-Veljanoski, O. et al. “Age and Drug Therapy Are Key Prognostic Factors for First Clinical Fracture in Patients with Primary Osteoporosis,” Osteoporosis International (2007) 18:1091.

Chapter 15
RISK FACTORS FOR FRACTURES?
SALT, CAFFEINE, ALCOHOL, SMOKING,
DEPRESSION, AND SEVERAL PRESCRIPTION DRUGS

Studies showing that a high salt intake increases calcium in urine:
Itoh, R. et al. “The Interrelation of Urinary Calcium and Sodium Intake in Healthy Elderly Japanese,” International Journal of Vitaminology and Nutritional Research (1991) 61:159.

Itoh, R. and Y. Suyama. “Sodium Excretion in Relation to Calcium and Hydroxyproline Excretion in a Healthy Japanese Population,”
American Journal of Clinical Nutrition (1996) 63:735.

Mizushima, S. et al. “Preventive Nutritional Factors in Epidemiology: Interaction Between Sodium and Calcium,”
Clinical and Experimental Pharmacology and Physiology (1999) 26:573.

Sellmeyer, D.E. et al. “Potassium Citrate Prevents Increased Urine Calcium Excretion and Bone Resorption Induces by a High-Sodium Chloride Diet,”
Journal of Clinical Endocrinology and Metabolism (2002) 87:2008.

Shortt, C. et al. “Influence of Dietary Sodium Intake on Urinary Calcium Excretion in Selected Irish Individuals,”
European Journal of Clinical Nutrition (1988) 42:595.

The three human trials showing that a high-salt diet reduces BMD:

1. Blaauw, R. et al. “Risk Factors for the Development of Osteoporosis in a South African Population. A Prospective Analysis,” South African Medical Journal (1994) 84:328.

2. Jones, G. et al. “A Population-Based Study of the Relationship Between Salt Intake, Bone Resorption, and Bone Mass,”
European Journal of Clinical Nutrition (1997) 51:561.

3. Martini, L.A. et al. “High Sodium Chloride Intake is Associated with Low Bone Density in Calcium Stone-Forming Patients,”
Clinical Nephrology (2000) 54:85.

The three human trials showing that a high-salt diet has no effect on BMD:

1. Jones, G. et al. “Association Between Urinary Potassium, Urinary Sodium, Current Diet, and Bone Density in Prepubertal Children,”
American Journal of Clinical Nutrition (2001) 73:839.

2. Reid, I.R. et al. “Determinants of the Rate of Bone Loss in Normal Postmenopausal Women,”
Journal of Clinical Endocrinology and Metabolism (1994) 79:950.

3. Schoppen, S. et al. “Bone Remodeling is Not Affected by Consumption of a Sodium-Rich Carbonated Mineral Water in Healthy Postmenopausal Women,”
British Journal of Nutrition (2005) 93:339.

Other studies that deal with salt as a possible risk factor for osteoporosis:

Antonios T.F and G.A. MacGregor. “Deleterious Effects of Salt Intake Other Than Effects of Blood Pressure,”
Clinical and Experimental Pharmacology and Physiology (1995) 22:180.

Burger, H. et al. “Osteoporosis and Salt Intake,”
Nutrition, Metabolism, and Cardiovascular Disease (2000) 10:46.

Cohen, A.J. and F.J. Roe. “Review of Risk Factors for Osteoporosis with Particular Reference to a Possible Aetiological Role of Dietary Salt,”
Food Chemistry and Toxicology (2000) 38:237.

Kotha, S.P. et al. “Varying the Mechanical Properties of Bone Tissue by Changing the Amount of its Structurally Effective Bone Mineral Content,”
Biomedical Materials and Engineering (1998) 8:321.

Saric, M. and M. Piasek. “Effect of Sodium Chloride on Bone Health,”
Arh. Hig. Rada. Toksikol. [Croatian journal] (2005) 56:39.

Teucher, B. and S. Fairweather-Tait. “Dietary Sodium as a Risk Factor for Osteoporosis: Where is the Evidence?”
Proceeding of the Nutrition Society (2003) 62:859.

Studies showing that caffeine increases calcium excretion in urine:

Heaney, R.P. “Effects of Caffeine on Bone and the Calcium Economy,”
Food Chemistry and Toxicology (2002) 40:1263.

Heaney, R.P. and K. Rafferty. “Carbonated Beverages and Urinary Calcium Excretion,”
American Journal of Clinical Nutrition (2001) 74:343.

Heaney, R.P. and R.R. Recker. “Effects of Nitrogen, Phosphorus, and Caffeine on Calcium Balance in Women,”
Journal of Laboratory and Clinical Medicine (1982) 99:46.

The ten studies showing that caffeine increases fracture risk:

1. Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women. Study of Osteoporotic Fractures Research Group,”
New England Journal of Medicine (1995) 332:767.

2. Hallstrom, H. et al. “Coffee, Tea, and Caffeine Consumption in Relation to Osteoporotic Fracture Risk in a Cohort of Swedish Women,”
Osteoporosis International (2006) 17:1055.

3. Hansen, S.A. et al. “Association of Fractures with Caffeine and Alcohol in Postmenopausal Women: The Iowa Women’s Health Study,”
Public Health Nutrition (2000) 3:253.

4. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: the MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

5. Kiel, D.P. et al. “Caffeine and the Risk of Hip Fracture: The Framingham Study,”
American Journal of Epidemiology (1990) 132:675.

6. Manias, K. et al. “Fractures and Recurrent Fractures in Children: Varying Effects of Environmental Factors as well as Bone Size and Mass,”
Bone (2006) 39:652.

7. Petridou, E. et al. “The Role of Dairy Products and Nonalcoholic Beverages in Bone Fractures Among Schoolage Children,”
Scandinavian Journal of Social Medicine (1997) 25:119.

8. Wyshak, G. “Teenaged Girls, Carbonated Beverage Consumption and Bone Fracture,”
Archives of Pediatric and Adolescent Medicine (2000) 154:610.

9. Wyshak, G. and R.E. Frisch. “Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosphorus Ratio, and Bone Fractures in Girls and Boys,”
Journal of Adolescent Health (1994) 15:210.

10. Yoshimura, N. et al. “Epidemiology of Hip Fracture in Japan: Incidence and Risk Factors,”
Journal of Bone and Mineral Metabolism (2005) 23(Suppl):78.

The four studies with inconclusive results on the question of caffeine and fractures:

1. Hernandez-Avila, M. et al. “Caffeine, Moderate Alcohol Intake, and Risk of Fractures of the Hip and Forearm in Middle-Aged Women,”
American Journal of Clinical Nutrition (1991) 54:157.

2. Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: The MEDOS Study. Mediterranean Osteoporosis Study,”
Journal of Bone and Mineral Research (1995) 10:1802.

3. Meyer, H.E. et al. “Dietary Factors and the Incidence of Hip Fracture in Middle-Aged Norwegians. A Prospective Study,”
American Journal of Epidemiology (197) 145:117.

4. Wyshak, G. et al. “Nonalcoholic Carbonated Beverage Consumption and Bone Fractures Among Women Former College Athletes,”
Journal of Orthopedic Research (1989) 7:91.

The nine studies showing that caffeine has no effect on fracture risk:

1. Chen, Z. et al. “Habitual Tea Consumption and Risk of Osteoporosis: A Prospective Study in the Women’s Health Initiative Observational Cohort,”
American Journal of Epidemiology (2003) 158:772.

2. Cumming, R.G. and R.J. Klineberg. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

3. Fujiwara, S. et al. “Risk Factors for Hip Fracture in a Japanese Cohort,”
Journal of Bone and Mineral Research (1997) 12:998.

4. Huopio, J. et al. “Risk Factors for Perimenopausal Fractures: A Prospective Study,”
Osteoporosis International (2000) 11:219.

5. Johansson, C. et al. “Coffee Drinking: A Minor Risk Factor for Bone Loss and Fractures,”
Age and Ageing (1992) 21:20.

6. Krieger, N. et al. “Dietary Factors and Fracture in Postmenopausal Women: A Case-Control Study,”
International Journal of Epidemiology (1992) 21:953.

7. Nieves, J.W. et al. “A Case-Control Study of Hip Fracture: Evaluation of Selected Dietary Variables and Teenage Physical Activity,”
Osteoporosis International (1992) 2:122.

8. Ramalho, A.C. et al. “Osteoporotic Fractures of Proximal Femur: Clinical and Epidemiological Features in a Population of the City of Sao Paulo,”
Sao Paulo Medical Journal (2001) 119:48.

9. Tavani, A. et al. “Coffee Intake and Risk of Hip Fracture in Women in Northern Italy,”
Preventive Medicine (1995) 24:396.

Studies showing that alcohol suppresses bone-building osteoblasts:

Chakkalakal, D.A. “Alcohol-Induced Bone Loss and Deficient Bone Repair,”
Alcohol Clinical and Experimental Research (2005) 29:2077.

Chakkalakal, D.A. et al. “Chronic Alcohol Consumption Results in Deficient Bone Repair in Rats,”
Alcohol and Alcoholism (2002) 37:13.

Laitinen, K. and M. Valimaki. “Alcohol and Bone,”
Calcified Tissues International (1991) 49(Suppl):S70.

The fifteen studies showing that alcohol raises risk of fractures:

1. Boonyaratavej, N. et al. “Physical Activity and Risk Factors for Hip Fractures in Thai Women,”
Osteoporosis International (2001) 12:244.

2. Clark, P. et al. “Risk Factors for Osteoporotic Hip Fractures in Mexicans,”
Archives of Medical Research (1998) 29:253.

3. Clark, M.K. et al. “Bone Mineral Density and Fractures Among Alcohol-Dependent Women in Treatment and Recovery,”
Osteoporosis International (2003) 14:396.

4. Felson, D.T. et al. “Alcohol Consumption and Hip Fractures: The Framingham Study,”
American Journal of Epidemiology (1988) 128:1102.

5. Hansen, S.A. et al. “Association of Fractures with Caffeine and Alcohol in Postmenopausal Women: The Iowa Women’s Health Study,”
Public Health Nutrition (2000) 3:253.

6. Hemenway, D. et al. “Fractures and Lifestyle: Effect of Cigarette Smoking, Alcohol Intake, and Relative Weight on the Risk of Hip and Forearm Fractures in Middle-Aged Women,”
American Journal of Public Health (1988) 78:1554.

7. Hernandez-Avila, M. et al. “Caffeine, Moderate Alcohol Intake, and Risk of Fractures of the Hip and Forearm in Middle-Aged Women,”
American Journal of Clinical Nutrition (1991) 54:157.

8. Jacqmin-Gadda, H. et al. “Risk Factors for Fractures in the Elderly,”
Epidemiology (1998) 9:417.

9. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: the MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

10. Lappe, J.M. et al. “The Impact of Lifestyle on Stress Fractures in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

11. Lau, E.M. et al. “Risk Factors for Hip Fracture in Asian Men and Women: the Asian Osteoporosis Study,”
Journal of Bone and Mineral Research (2001) 16:572.

12. Lofthus, C.M. et al. “Young Patients with Hip Fracture: A Population-Based Study of Bone Mass and Risk Factors for Osteoporosis,”
Osteoporosis International (2006) 17:1666.

13. Pfister, A.K. et al. “Hip Fracture Outcomes and Their Prevention in Kanawha County, West Virginia,”
West Virginia Medical Journal (1999) 95:170.

14. Scane, A.C. et al. “Case-Control Study of the Pathogenesis and Sequelae of Symptomatic Vertebral Fractures in Men,”
Osteoporosis International (1999) 9:91.

15. Tuppurainen, M. et al. “Risks of Perimenopausal Fractures: A Prospective Population-Based Study,”
Acta Obstetrica et Gynecologica Scandinavia (1995) 74:624.

The one study with inconclusive results on alcohol and fractures:

1. Samelson, E.J. et al. “Incidence and Risk Factors for Vertebral Fracture in Women and Men: 25-Year Follow-Up Results from the Population-Based Framingham Study,”
Journal of Bone and Mineral Research (2006) 21:1207.

The eleven studies showing that alcohol has no effect on fracture risk:

1. Cumming, R.G. and R.J. Klineberg. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

2. Elliot, J.R. et al. “A Comparison of Elderly Patients with Proximal Femoral Fractures and a Normal Elderly Population: A Case-Control Study,”
New Zealand Medical Journal (1992) 105:420.

3. Hagino, H. et al. “Case-Control Study of Risk Factors for Fractures of the Distal Radius and Proximal Humerus Among the Japanese Population,”
Osteoporosis International (2004) 15:226.

4. Hemenway, D. et al. “Risk Factors for Wrist Fracture: Effect of Age, Cigarettes, Alcohol, Body Height, Relative Weight, and Handedness on the Risk for Distal Forearm Fractures in Men,”
American Journal of Epidemiology (1994) 140:361. Same study as: Hemenway, D. et al. “Risk Factors for Hip Fracture in U.S. Men Aged 40 through 75 Years,” American Journal of Public Health (1994) 84:1843.

5. Huang, Z. et al. “Nutrition and Subsequent Hip Fracture Risk Among a National Cohort of White Women,”
American Journal of Epidemiology (1996) 144:124.

6. Huopio, J. et al. “Risk Factors for Perimenopausal Fractures: A Prospective Study,”
Osteoporosis International (2000) 11:219.

7. Kleerkoper, M. et al. “Identification of Women at Risk for Developing Postmenopausal Osteoporosis with Vertebral Fractures: Role of History and Single Photon Absorptiometry,”
Bone Minerals (1989) 7:171.

8. LaVecchia, C. et al. “Cigarettes Smoking, Body Mass and Other Risk Factors for Fractures of the Hip in Women,”
International Journal of Epidemiology (1991) 20:671.

9. O’Neill, T.W. et al. “Risk Factors, Falls, and Fracture of the Distal Forearm in Manchester, U.K.,”
Journal of Epidemiology and Community Health (1996) 50:288.

10. Ribot, C. and J.M. Pouilles. “Postmenopausal Osteoporosis: Clinical Characteristics in Patients’ First Vertebral Crush Fracture. Results of the GRIO National Multicenter Survey. Groupe de Recherche et d’Information Sur Les Osteoporoses,”
Revue du rhumatisme (Ed. Francaise) (1993) 60:427.

11. Roy, D.K et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

The nine studies showing that moderate alcohol consumption reduces risk of fractures:

1. Cawthorn, P.M. et al. “Alcohol Intake and Its Relationship with Bone Mineral Density, Falls, and Fracture Risk in Older Men,”
Journal of the American Geriatric Society (2006) 54:1649.

2. Hoidrup, S. et al. “Alcohol Intake, Beverage Preference, and Risk of Hip Fracture in Men and Women. Copenhagen Center for Prospective Population Studies,”
American Journal of Epidemiology (1999) 149:993.

3. Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: The MEDOS Study. Mediterranean Osteoporosis Study,”
Journal of Bone and Mineral Research (1995) 10:1802.

4. Kanis, J.A. et al. “Alcohol Intake as a Risk Factor for Fracture,”
Osteoporosis International (2005) 16:737.

5. Muykamal, K.J. et al. “Alcohol Consumption, Bone Density, and Hip Fracture Among Older Adults: The Cardiovascular Health Study,”
Osteoporosis International (2007) 18:593.

6. Nguyen, T.V. et al. “Risk Factors for Osteoporotic Fractures in Elderly Men,”
American Journal of Epidemiology (1996) 144:255.

7. Peel, N.M. et al. “Health-Protective Behaviors and Risk of Fall-Related Hip Fractures: A Population-Based Case-Control Study,”
Age and Ageing (2006) 35:491.

8. Suzuki, T. et al. “Case-Control Study of Risk Factors for Hip Fractures in the Japanese Elderly by a Mediterranean Osteoporosis Study (MEDOS) Questionnaire,”
Bone (1997) 21:461.

9. Woods, N.F. et al. “Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women’s Health Initiative Observational Study,”
Journal of the American Geriatrics Society (2005) 53:1321.

The one study showing that as alcohol use rises, fracture risk decreases:

1. Baron, J.A. et al. “Cigarette Smoking, Alcohol Consumption, and Risk of Hip Fracture in Women,”
Archives of Internal Medicine (2001) 161:983.

The forty-two studies showing that smoking increases fracture risk:

1. Baron, J.A. et al. “Cigarette Smoking, Alcohol Consumption, and Risk of Hip Fracture in Women,”
Archives of Internal Medicine (2001) 161:983.

2. Bensen, R. et al. “Evaluation of Easily Measured Risk Factors in the Prediction of Osteoporotic Fractures,”
BMC Musculoskeletal Disorders (2005) 6:47.

3. Cornuz, J. et al. “Smoking, Smoking Cessation and Risk of Hip Fracture in Women,”
American Journal of Medicine (1999) 106:311.

4. Cumming, R.G. and R.J. Klineberg. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly,”
American Journal of Epidemiology (1994) 139:493.

5. Forsen, L. et al. “Interaction Between Current Smoking, Leanness, and Physical Inactivity in the Prediction of Hip Fracture,”
Journal of Bone and Mineral Research (1994) 9:1671.

6. Forsen, L. et al. “Ex-Smokers and Risk of Hip Fracture,”
American Journal of Public Health (1998) 88:1481.

7. Friedl, K.E. et al. “Factors Associated with Stress Fracture in Young Army Women: Indications for Further Research,”
Military Medicine (1992) 157:334.

8. Grisso, J.A. et al. “Risk Factors for Hip Fracture in Men. Hip Fracture Study Group,”
American Journal of Epidemiology (1997) 145:786.

9. Hoidrup, S. et al. “Tobacco Smoking and Risk of Hip Fracture in Men and Women,”
International Journal of Epidemiology (2000) 29:253.

10. Huopio, J. et al. “Risk Factors for Perimenopausal Fractures: A Prospective Study,”
Osteoporosis International (2000) 11:219.

11. Jenkins, M.R. and A.V. Denison. “Smoking Status as a Predictor of Hip Fracture Risk in Postmenopausal Women of Northwest Texas,”
Preventing Chronic Disease (2008) 5:A09.

12. Johansson, C. et al. “Prevalence of Fracture Among 10,000 Women from the 1900 to 1940 Birth Cohorts Resident in Gothenburg,”
Maturitas (1991) 14:65.

13. Johansson, C. and D. Mellstrom. “An Earlier Fracture as a Risk Factor for New Fracture and Its Association with Smoking and Menopausal Age in Women,”
Maturitas (1996) 24:97.

14. Johnston, P. et al. “Smoking and Hip Fracture: A Study of 3617 Cases,”
Injury (2006) 37:152.

15. Jones, I.E. et al. “Associations of Birth Weight and Length, Childhood Size, and Smoking with Bone Fractures During Growth: Evidence from a Birth Cohort Study,”
American Journal of Epidemiology (2004) 159:343.

16. Kanis, J.A. et al. “Smoking and Fracture Risk: A Meta-Analysis,”
Osteoporosis International (2005) 16:155.

17. Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

18. Kelsey, J.L. et al. “Risk Factors for Fracture of the Shafts of the Tibia and Fibula in Older Individuals,”
Osteoporosis International (2006) 17:143.

19. Kelsey, J.L. et al. “Risk Factors for Pelvis Fracture in Older Persons,”
American Journal of Epidemiology (2005) 162:879.

20. Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fractures in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

21. Lau, E.M. et al. “Risk Factors for Hip Fracture in Asian Men and Women: The Asian Osteoporosis Study,”
Journal of Bone and Mineral Research (2001) 16:572.

22. LaVecchia, C. et al. “Cigarette Smoking, Body Mass and Other Risk Factors for Fractures of the Hip in Women,”
International Journal of Epidemiology (1991) 20:671.

23. Melhus, H. et al. “Smoking, Antioxidant Vitamins, and the Risk of Hip Fracture,”
Journal of Bone and Mineral Research (1999) 14:129.

24. Meyer, H.E. et al. “Risk Factors of Femoral Neck Fractures in Oslo,”
Tidssskr. Nor. Laegeforen [Norwegian journal] (1996) 116:2656.

25. Meyer, H.E. et al. “Risk Factors for Hip Fracture in Middle-Aged Norwegian Women and Men,”
American Journal of Epidemiology (1993) 137:1203.

26. Michaelsson, K. et al. “Diet and Hip Fracture Risk: A Case-Control Study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment,”
International Journal of Epidemiology (1995) 24:771.

27. Michaelsson, K. et al. “Differences in Risk Factor Patterns Between Cervical and Trochanteric Hip Fractures. Swedish Hip Fracture Study Group,”
Osteoporosis International (1999) 10:487.

28. Olofsson, H. et al. “Smoking and the Risk of Fracture in Older Men,”
Journal of Bone and Mineral Research (2005) 20:1208.

29. Paganini-Hill, A. et al. “Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study,”
Epidemiology (1991) 2:16.

30. Paganini-Hill, A. et al. “Menopausal Estrogen Therapy and Hip Fractures,”
Annals of Internal Medicine (1981) 95:28.

31. Peel, N.M. et al. “Health-Protective Behaviors and Risk of Fall-Related Hip Fractures: A Population-Based Case-Control Study,”
Age and Ageing (2006) 35:491.

32. Pfister, A.K. et al. “Hip Fracture Outcomes and their Prevention in Kanawha County, West Virginia,”
West Virginia Medical Journal (1999) 95:170.

33. Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

34. Scane, A.C. et al. “Case-Control Study of the Pathogenesis and Sequelae of Symptomatic Vertebral Fractures in Men,”
Osteoporosis International (1999) 9:91.

35. Stewart, A. et al. “Prevalence of Hip Fracture Risk Factors in Women Aged 70 Years and Over,”
QJM (2000) 93:677.

36. Vander Klift, M. et al. “Risk Factors for Incident Vertabral Fractures in Men and Women: The Rotterdam Study,”
Journal of Bone and Mineral Research (2004) 19:1172.

37. Vestergaard, P. and L. Mosekilde. “Fracture Risk Associated with Smoking: A Meta-Analysis,”
Journal of Internal Medicine (2003) 254:572.

38. Ward, K.D. and R.C. Klesges. “A Meta-Analysis of the Effects of Cigarettes Smoking on Bone Mineral Density,”
Calcified Tissues International (2001) 68:259.

39. White, S.C. et al. “Risk Factors for Fractures in Older Men and Women: The Leisure World Cohort Study,”
Gender Medicine (2006) 3:110.

40. Williams, A.R. et al. “Effect of Weight Smoking, and Estrogen Use on the Risk of Hip and Forearm Fractures in Postmenopausal Women,”
Obstetrics and Gynecology (1982) 60:695.

41. Woods, N.F. et al. “Frailty: Emergence and Consequences in Women Ages 65 and Older in the Women’s Health Initiative Observational Study,”
Journal of the American Geriatrics Society (2005) 53:1321,

42. Zhang, J. et al. “Antioxidant Intake and Risk of Osteoporotic Hip Fracture in Utah: An Effect Modified by Smoking Status,”
American Journal of Epidemiology (2006) 163:9.

The four studies showing that smoking has inconclusive effects on fracture risk:

1. Center, J.R. et al. “Risk of Subsequent Fracture After Low-Trauma Fracture in Men and Women,”
Journal of the American Medical Association (2007) 297:387.

2. Holmberg, A.H. et al. “Risk Factors for Fragility Fracture in Middle Age. A Prospective Population-Based Study of 33,000 Men and Women,”
Osteoporosis International (2006) 17:1065.

3. Jacqmin-Gadda, H. et al. “Risk Factors for Fractures in the Elderly,”
Epidemiology (1998) 9:417.

4. Vander Voort, D.J. et al. “Risk Factors for Osteoporosis Related to Their Outcome: Fractures,”
Osteoporosis International (2001) 12:630.

The fifteen studies showing that smoking has no effect on fracture risk:

1. Albrand, G. et al. “Independent Predictors of All Osteoporosis-Related Fractures in Healthy Postmenopausal Women: The OFELY Study,”
Bone (2003) 32:78.

2. Clark, P. et al. “Risk Factors for Osteoporotic Fractures in Mexicans,”
Archives of Medical Research (1998) 29:253.

3. DiPietro, L. et al. “Body Mass and Risk of Hip Fracture Among a National Cohort of Postmenopausal Women: A Re-Analysis,”
Obesity Research (1993) 1:357.

4. Elliot, J.R. et al. “A Comparison of Elderly Patients with Proximal Femoral Fractures and Normal Elderly Population: A Case-Control Study,”
New Zealand Medical Journal (1992) 105:420.

5. Hagino, H. et al. “Case-Control Study of Risk Factors for Fractures of the Distal Radius and Proximal Humerus Among the Japanese Population,”
Osteoporosis International (2004) 15:226.

6. Hemenway, D. et al. “Fractures and Lifestyle: Effect of Cigarette Smoking, Alcohol Intake, and Relative Weight on the Risk of Hip Fractures in Middle-Aged Women,”
American Journal of Public Health (1988) 78:1554.

7. Hemenway, D. et al. “Risk Factors for Wrist Fracture: Effect of Age, Cigarettes, Body Height, Relative Weight, and Handedness on the Risk for Distal Forearm Fractures in Men,”
American Journal of Epidemiology (1994) 140:361.

8. Johnell, O. et al. “Risk Factors for Hip Fracture in European Women: The MEDOS Study. Mediterranean Osteoporosis Study,”
Journal of Bone and Mineral Research (1995) 10:1802.

9. Kiel, D.P. et al. “Smoking Eliminates the Protective Effect of Oral Estrogens on the Risk for Hip Fracture Among Women,”
Annals of Internal Medicine (1992) 116:716.

10. Kleerkoper, M. et al. “Identification of Women at Risk for Developing Postmenopausal Osteoporosis with Vertebral Fractures: Role of History and Single Photon Absorptiometry,”
Bone Minerals (1989) 7:171.

11. Mallmin, H. et al. “Risk Factors for Fractures of the Distal Forearm: A Population-Based Case-Control Study,”
Osteoporosis International (1994) 4:298.

12. Mussolino, M.E. et al. “Risk Factors for Hip Fracture in White Men: the NHANES I Epidemiologic Follow-Up Study,”
Journal of Bone and Mineral Research (1998) 13:918.

13. O’Neill, T.W. et al. “Risk Factors, Falls, and Fracture of the Distal Forearm in Manchester, U.K.,”
Journal of Epidemiology and Community Health (1996) 50:288.

14. Roy, D.K. et al. “Determinants of Incident Vertebral Fracture in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS),”
Osteoporosis International (2003) 14:19.

15. Tuppurainen, M. et al. “Risks of Perimenopausal Fractures: A Prospective Population-Based Study,”
Acta Obstetrica et Gynecologica Scandinavia (1995) 74:624.

Studies showing that after quitting smoking, fracture risk remains high for ten years:

Cornuz, J. et al. “Smoking, Smoking Cessation and Risk of Hip Fracture in Women,”
American Journal of Medicine (1999) 106:311.

Forsen, L. et al. “Ex-Smokers and Risk of Hip Fracture,”
American Journal of Public Health (1998) 88:1481.

Jenkins, M.R. and A.V. Denison. “Smoking Status as a Predictor of Hip Fracture Risk in Postmenopausal Women of Northwest Texas,”
Preventing Chronic Disease (2008) 5:A09.

Vestergaard, P. and L. Mosekilde. “Fracture Risk Associated with Smoking: A Meta-Analysis,”
Journal of Internal Medicine (2003) 254:572.

Studies showing that smoking-related free radicals (oxidative stress) damage bone, and that antioxidant nutrients reduce this damage:

Melhus, H. et al. “Smoking, Antioxidant Vitamins, and the Risk of Hip Fracture,”
Journal of Bone and Mineral Research (1999) 14:129.

Zhang, J. et al. “Antioxidant Intake and Risk of Osteoporotic Hip Fracture in Utah: An Effect Modified by Smoking Status,”
American Journal of Epidemiology (2006) 163:9.

Studies showing that depression increases fracture risk:

Chu, S.P. et al. “Risk Factors for Proximal Humerus Fracture,”
American Journal of Epidemiology (2004) 160:360.

Greendale, G.A. et al. “The Relation Between Cortisol Excretion and Fractures in Healthy Older People: Results from the McArthur Study,”
Journal of the American Geriatric Society (1999) 47:799.

Jacqmin-Gadda, H. et al. “Risk Factors for Fractures in the Elderly,”
Epidemiology (1998) 9:17.

Mussolino, M.E. “Depression and Hip Fracture Risk: the NHANES I Epidemiologic Follow-Up Study,”
Public Health Reports (2005) 120:71.

Richards, J.B. et al. “Effect of Selective Serotonin Reuptake Inhibitors on the Risk of Fracture,”
Archives of Internal Medicine (2007) 167:188.

Schneeweiss, S. and P.S. Wang. “Association Between SSRI Use and Hip Fractures and the Effect of Residual Confounding Bias in Claims Database Studies,”
Journal of Clinical Psychopharmacology (2004) 24:632.

Silverman, S.L. et al. “Prevalence of Depressive Symptoms in Postmenopausal Women with Low Bone Mineral Density and/or Prevalent Vertebral Fracture: Results from the Multiple Outcomes of Raloxifene Evaluation (MORE) Study,”
Rheumatology (2007) 34:140.

Spector, W. et al. “Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications,”
Journal of the American Geriatrics Society (2007) 55:327.

Stalenhoef, P.A. et al. “A Risk Model for the Prediction of Recurrent Falls in Community-Dwelling Elderly: A Prospective Cohort Study,”
Journal of Clinical Epidemiology (2002) 55:1088.

Whooley, M.A. et al. “Depression, Falls, and Risk of Fracture in Older Women. Study of Osteoporotic Fractures Research Group,”
Archives of Internal Medicine (1999) 159:484.

Woods, N.F. et al. “Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women’s Health Initiative Observational Study,”
Journal of the American Geriatrics Society (2005) 53:1321.

Studies showing that proton pump inhibitors prescribed to treat heartburn increase risk of fractures:

Vestergaard, P.et al. “Proton Pump Inhibitors, Histamine H2 Receptors Antagonists, and Other Antacid Medication and the Risk of Fracture,”
Calcified Tissues International (2006) 79:76.

Wright, M.J. et al. “Proton Pump-Inhibiting Drugs, Calcium Homeostasis, and Bone Health,”
Nutrition Reviews (2008) 66:103.

Yang, Y.X. et al. “LongTerm Proton Pump Inhibitor Therapy and Risk of Hip Fracture,”
Journal of the American Medical Association (2006) 296:2947.

Studies showing that Valium and other tranquilizers and sedatives increase fracture risk:

Coutino, Ed Eda S. and S.D. Silva. “Medication as a Risk Factor for Falls Resulting in Severe Fractures in the Elderly,”
Cad. Suade Publica. [Brazilian journal] (2002) 18:1359.

Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women. Study of Osteoporotic Fractures Research Group,”

Jacqmin-Gadda, H. et al. “Risk Factors for Fractures in the Elderly,”
Epidemiology (1998) 9:17.

Lau, E.M. et al. “Risk Factors for Hip Fracture in Asian Men and Women: The Asian Osteoporosis Study,”
Journal of Bone and Mineral Research (1002) 16:572.

Scheeweiss, S. and P.S. Wang, “Claims Data Studies of Sedative-Hypnotics and Hip Fractures in Older People: Exploring Residual Confounding Using Survey Information,”
Journal of the American Geriatric Society (2005) 53:948.

Studies showing that the diabetes drugs Avandia and Actos increase fracture risk:

Benvenuti, S. et al. “Rosiglitazone Stimulates Adipogenesis and Decreases Osteoblastogenesis in Human Mesenchumal Stem Cells,”
Journal of Endocrinology Investigation (2007) 30:RC26.

Grey, A. “Sekeltal Consequences of Thiazolidenedione Therapy,”
Osteoporosis International (2008) 19:129.

Meier, C. et al. “Use of Thiazolidenediones and Fracture Risk,”
Archives of Internal Medicine (2008) 168:820.

Monami, M. et al. “Bone Fractures and Hypoglycemic Treatment in Type 2 Diabetic Patients: A Case-Control Study,”
Diabetes Care (2008) 31:199.

Murphy, C.E. and P.T. Rodgers. “Effects of Thiazolidenediones on Bone Loss and Fractures,”
Annals of Pharmacotherapy (2007) 41:2014.

Reports documenting that steroid anti-inflammatory drugs (prednisone etc.) increase fracture risk:

Anonymous. “Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis: 2001 Update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis,”
Arthritis and Rheumatism (2001) 44:1496.

DeGregorio, L.H. et al. “Glucocorticoid-Induced Osteoporosis,”
Arg. Bras. Endocrinol. Metabol. [Brazilian journal] (2006) 50:793.

DeVries, F. et al. “Fracture Risk with Intermittent High-Dose Oral Glucocorticoid Therapy,”
Arthritis and Rheumatism (2007) 56:2089.

Henderson, N.K. and P.N. Sambrook. “Relationship Between Osteoporosis and Arthritis and Effect of Corticosteroids and Other Drugs on Bone,”
Current Opinion in Rheumatology (1996) 8:365.

Hiwatashi, A. and P.L. Westesson. “Patients with Osteoporosis on Steroid Medication Tend to Sustain Subsequent Fractures,”
American Journal of Neuroradiology (2007) 28:1055.

Lane, N.E. “An Update on Glucocorticoid-Induced Osteoporosis,”
Rheumatological Disease Clinics of North America (2001) 27:235.

Lappe, J.M. et al. “The Impact of Lifestyle Factors on Stress Fractures in Female Army Recruits,”
Osteoporosis International (2001) 12:35.

Paganini-Hill, A. et al. “Menopausal Estrogen Therapy and Hip Fractures,”
Annals of Internal Medicine (1981) 95:28.

Robbins, J. et al. “Factors Associated with 5-Year Risk of Hip Fracture in Postmenopausal Women,”
Journal of the American Medical Association (2007) 298:2389.

VanStaa, T.P. et al. “A Simple Score For Estimating the Long-Term Risk of Fracture in Patients Using Oral Glucocorticoids,”
QJM (2005) 98:191.

VanStaa, T.P. et al. “Clinical Assessment of the Long-Term Risk of Fracture in Patients with Rheumatoid Arthritis,”
Arthritis and Rheumatism (2006) 54:3104.

Studies showing that anticonvulsant drugs increase fracture risk:

Chu, S.P. et al. “Risk Factors for Proximal Humerus Fracture,”
American Journal of Epidemiology (2004) 160:360.

Cummings, S.R. et al. “Risk Factors for Hip Fracture in White Women. Study of Osteoporotic Fractures Research Group,”
New England Journal of Medicine (1995) 332:767.

Kanis, J. et al. “Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study. Mediterranean Osteoporosis Study,”
Osteoporosis International (1999) 9:45.

Scane, A.C. et al. “Case-Control Study of the Pathogenesis and Sequelae of Symptomatic Vertebral Fractures in Men,”
Osteoporosis International (1999) 9:91.

Spector, W. et al. “Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications,” Journal of the American Geriatric Society (2007) 55:327.


Chapter 16
SHOULD YOU TAKE OSTEOPOROSIS DRUGS?


Sources for the material on HRT:

Grady, D. et al. “Cardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-Up (HERS-II),”
Journal of the American Medical Association (2002) 288:49.

Heiss, G. et al. “Health Risks and Benefits Three Years After Stopping Randomized Treatment with Estrogen and Progestin,”
Journal of the American Medical Association (2008) 299:1036.

Hulley, S. et al. “Noncardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-Up (HERS-II),”
Journal of the American Medical Association (2002) 288:58.

Hulley, S. et al. “Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group,”
Journal of the American Medical Association (1998) 280:605.

Majumdar, S.R. et al. “Promotion and Prescribing of Hormone Therapy After Report of Harm by the Women’s Health Initiative,”
Journal of the American Medical Association (2004) 292:1983.

Matthews, K.A. et al. “Prior to Use of Estrogen Replacement Therapy, Are Users Healthier Than Nonusers?”
American Journal of Epidemiology (1996) 143:971.

Rodriguez, C. et al. “Estrogen Replacement Therapy and Ovarian Cancer Mortality in a Large Prospective Study of U.S. Women,”
Journal of the American Medical Association (2001) 285:1460.

Rossouw, J.E. et al. “Risks and Benefits of Estrogen Plus Progestin in Health Postmenopausal Women: Principal Results from the Women’s Health Initiative Randomized Controlled Trial,”
Journal of the American Medical Association (2002) 288:321.

Vastag, B. “Hormone Replacement Therapy Falls Out of Favor with Expert Committee,”
Journal of the American Medical Association (2002) 287:1923.

Viscoli, C.M. et al. “A Clinical Trial of Estrogen Replacement Therapy After Ischemic Stroke,”
New England Journal of Medicine (2001) 345:1243.

Warren, M.P. and J. Kulak. “Benefits and Drawbacks of Hormone Replacement Therapy,”
Women’s Health in Primary Care, (1999) 2:21.

Writing Group for the PEPI Trial. “Effects of Estrogen or Estrogen/Progestin Regimens on Heart Disease Risk Factors in Postmenopausal Women. The Postmenopausal Estrogen/Progestin Intervention (PEPI) Trial,”
Journal of the American Medical Association (1995) 273:199.

The study showing that bisphosphonates are less effective in real life than in the clinical trials that led to their approval:

Adami, S. et al. “Fracture Incidence and Characterization in Patients on Osteoporosis Treatment: The ICARO Study,”
Journal of Bone and Mineral Research (2006) 21:1565.

The nine meta-analyses of Fosamax (alendronate) efectiveness:
1. Boonen, S. et al. “Effect of Osteoporosis Treatments on Risk of Non-Vertebral Fractures: Review and Meta-Analysis of Intention-to-Treat Studies,” Osteoporosis International (2005) 16:1291.

2. Cranney, A. et al. “Meta-Analyses of Therapies for Postmenopausal Osteoporosis. II. Meta-Analysis of Alendronate for the Treatment of Postmenopausal Women,”
Endocrine Review (2002) 23:508.

3. Karpf, D.B. et al. “Prevention of Nonvertebral Fractures by Alendronate. A Meta-Analysis. Alendronate Osteoporosis Treatment Study Group,”
Journal of the American Medical Association (1997) 277:1159.

4. Liberman, U.A. et al. “Hip and Non-Spine Fracture Risk Reductions Differ Among Antiresorptive Agents: Evidence from Randomised Controlled Trials,”
International Journal of Clinical Practice (2006) 60:1394.

5. MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

6. Papapoulos, S.E. et al. “Meta-Analysis of the Efficacy of Alendronate for the Prevention of Hip Fractures in Postmenopausal Women,”
Osteoporosis International (2005) 16:468.

7. Sawka, A.M. et al. “Does Alendronate Reduce the Risk of Fracture in Men? A Meta-Analysis Incorporating Prior Knowledge of Anti-Fracture Efficacy in Women,”
BMC Musculoskeletal Disorders (2005) 6:39.

8. Stevenson, M. et al. “A Systematic Review and Economic Evaluation of Alendronate, Etidronate, Risedronate, Raloxifine, and Teriparatide for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Health Technology Assessment (2005) 9:1.

9. Wells, G.A. et al. “Alendronate for the Primary and Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women,”
Cochrane Database Systematic Reviews (2008) CD001155.

The six meta-analyses of Actonel (risedronate) effectiveness:

1. Boonen, S. et al. “Effect of Osteoporosis Treatments on Risk of Non-Vertebral Fractures: Review and Meta-Analysis of Intention-to-Treat Studies,”
Osteoporosis International (2005) 16:1291.

2. Cranney, A. et al. “Meta-Analyses of Therapies for Postmenopausal Osteoporosis. II. Meta-Analysis of Risedronate for the Treatment of Postmenopausal Women,” Endocrine Review (2002) 23:517.

3. Liberman, U.A. et al. “Hip and Non-Spine Fracture Risk Reductions Differ Among Antiresorptive Agents: Evidence from Randomised Controlled Trials,”
International Journal of Clinical Practice (2006) 60:1394.

4. MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

5. Stevenson, M. et al. “A Systematic Review and Economic Evaluation of Alendronate, Etidronate, Risedronate, Raloxifine, and Teriparatide for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Health Technology Assessment (2005) 9:1.3.

6. Wells, G. et al. “Risedronate for the Primary and Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women,”
Cochrane Database Systematic Reviews (2008) CD004523.

The four meta-analyses of Didronel (etidronate) effectiveness:

1. Cranney, A. et al. “A Meta-Analysis of Etidronate for the Treatment of Postmenopausal Osteoporosis,”
Osteoporosis International (2001) 12:140.

2. MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

3. Stevenson, M. et al. “A Systematic Review and Economic Evaluation of Alendronate, Etidronate, Risedronate, Raloxifine, and Teriparatide for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Health Technology Assessment (2005) 9:1.3.

4. Wells, G.A. et al. “Etidronate for the Primary and Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women,”
Cochrane Database Systematic Review (2008) CD003376.

The three meta-analyses of Boniva (ibandronate) effectiveness:

1. Harris, S.T. et al. “Ibandronate and the Risk of Non-Vertebral and Clinical Fractures in Women with Postmenopausal Osteoporosis: Results of a Meta-Analysis of Phase III Studies,”
Current Medical Research and Opinion (2008) 24:237.

2. Liberman, U.A. et al. “Hip and Non-Spine Fracture Risk Reductions Differ Among Antiresorptive Agents: Evidence from Randomised Controlled Trials,”
International Journal of Clinical Practice (2006) 60:1394.

3. MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

The three studies of Zometa or Reclast (zoledronic acid) effectiveness:

1. Black, D.M. et al. “Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis,”
New England Journal of Medicine (2007) 356:1809.

2. Geusens, P.P. and W.F. Lems. “Fracture Prevention in Postmenopausal Women with Osteoporosis by an Annual Infusion of Zoeldronic Acid,”
Ned. Tijdschr. Geneeskd. [Dutch journal] (2007) 151:1445.

3. Lyles, K.W. et al. “Zoledronic Acid and Clinical Fractures and Mortality After Hip Fracture,”
New England Journal of Medicine (2007) 357:1799.

The one study of Aredia (pamidronate) effectiveness:

Brumsen, C. et al. “Daily Oral Pamidronate in Women and Men with Osteoporosis: A 3-Year Randomized Placebo-Controlled Clinical Trial with a 2-Year Open Extension,”
Journal of Bone and Mineral Research (2002) 17:1057.

The two meta-analyses and other studies of Forteo (teriparatide) effectiveness:

Gallagher, J.C. et al. “Teriparatide Reduces the Fracture Risk Associated with Increasing Number and Severity of Osteoporotic Fractures,”
Journal of Clinical Endocrinology and Metabolism (2005) 90:1583.

Kaufman, J.M. et al. “Teriparatide Effects on Vertebral Fractures and Bone Mineral Density in Men with Osteoporosis: Treatment and Discontinuation of Therapy,”
Osteoporosis International (2005) 16:510.

MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

Neer, R.M. et al. “Effect of Parathyroid Hormone (1-34) on Fractures and Bone Mineral Density in Postmenopausal Women with Osteoporosis,”
New England Journal of Medicine (2001) 344:1434.

Stevenson, M. et al. “A Systematic Review and Economic Evaluation of Alendronate, Etidronate, Risedronate, Raloxifene, and Teriparatide for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Health Technology Assessment (2005) 9:1.

Five meta-analyses of Evista (raloxifine) efectiveness:

1. Cranney, A. et al. “Meta-Analyses of Therapies for Postmenopausal Osteoporosis. IV. Meta-Analysis of Raloxifene for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Endocrine Review (2002) 23:524.

2. Ettinger, B. et al. “Reduction of Vertebral Fracture Risk in Postmenopausal Women with Osteoporosis Treated with Raloxifene: Results from a 3-Year Randomized Clinical Trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators,”
Journal of the American Medical Association (1999) 282:637.

3. MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

4. Seeman, E. et al. “Anti-vertebral Fracture Efficacy of Raloxifene: A Meta-Analysis,”
Osteoporosis International (2006) 17:313.

5. Stevenson, M. et al. “A Systematic Review and Economic Evaluation of Alendronate, Etidronate, Risedronate, Raloxifene, and Teriparatide for the Prevention and Treatment of Postmenopausal Osteoporosis,”
Health Technology Assessment (2005) 9:1.

The three meta-analyses of Miacalcin/Fortical (calcitonin) effectiveness:

Cranney, A. et al. “Meta-Analyses of Therapies for Postmenopausal Osteoporosis. VI. Meta-Analyses of Calcitonin for the Treatment of Postmenopausal Osteoporosis,”
Endocrine Review (2002) 23:540.

Kanis, J.A and E.V. McCloskey. “Effect of Calcitonin on Vertebral and Other Fractures,”
QJM [formerly Quarterly Journal of Medicine] (1999) 92:143.

MacLean, C. et al. “Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis,”
Annals of Internal Medicine (2008) 148:197.

Studies documenting high rates of noncompliance with osteoporosis medications:

Brookhart, M.A. et al. “Gaps in Treatment Among Users of Osteoporosis Medications: The Dynamics of Noncompliance,”
American Journal of Medicine (2007) 120:251.

Cramer, J.A. et al. “A Systematic Review of Persistence and Compliance with Bisphosphonates for Osteoporosis,”
Osteoporosis International (2007) 18:1023.

Cramer, J.A. et al. “Compliance and Persistence with Bisphosphonate Dosing Regimens Among Women with Postmenopausal Osteoporosis,”
Current Medical Research and Opinion (2005) 21:1453.

Curtis, J.R. et al. “Channeling and Adherence with Alendronate and Risedronate Among Chronic Glucocorticoid Users,”
Osteoporosis International (2006) 17:1268.

Downey, T.W. et al. “Adherence and Persistence Associated with the Pharmacologic Treatment of Osteoporosis in A Managed Care Setting,”
Southern Medical Journal (2006) 99:570.

Lo, J.C. et al. “Persistence with Weekly Alendronate Therapy Among Postmenopausal Women,” Osteoporosis International (2006) 17:922.

Penning-Van Beest, F.J. et al. “Determinants of Persistence with Bisphosphonates: A Study in Women with Postmenopausal Osteoporosis,”
Clinical Therapy (2006) 28:236.

Siris, E.S. et al. “Adherence to Bisphosphonate Therapy and Fracture Rates in Osteoporoti Women: Relationship to Vertebral and Nonvertebral Fractures from Two U.S. Claims Databases,”
Mayo Clinic Proceedings (2006) 81:1013.

The study showing that only about half of people taking osteoporosis drugs take calcium and vitamin D as they should:

Rush, D.N. et al. “Evaluation of Calcium and Vitamin D Supplementation in Bisphosphonate Therapy,”
Journal of the American Pharmaceutical Association (2007) 47:725.

Studies showing that thiazide diuretics reduce calcium in urine:

Hodler, J. et al. “Short-Term Effects of Thiazides on Magnesium and Calcium Metabolism and Secondarily on that of Phosphorus, Uric Acid, Oxalate, and Cyclic AMP,”
Nephrologie (1983) 4:60.

Yendt, E.R. and M. Cohanim. “Prevention of Calcium Stones with Thiazides,”
Kidney International (1978) 13:397.

The twelve studies showing that thiazide diuretics reduce fracture risk by about 30 percent:

1. Cauley, J.A. et al. “Effects of Thiazide Diuretic Therapy on Bone Mass, Fractures, and Falls. The Study of Osteoporotic Fractures Research Group,”
Annals of Internal Medicine (1993) 118:666.

2. Coutinho, E. et al. “Medication as a Risk Factor for Falls Resulting in Severe Fractures in the Elderly,”
Cad. Saude. Publica. [Brazilian journal in Portuguese] (2002) 18:1359.

3. Feskanich, D. et al. “A Prospective Study of Thiazide Use and Fractures in Women,”
Osteoporosis International (1997) 7:79.

4. Jones, G. et al. “Thiazide Diuretics and Fractures: Can Meta-Analysis Help?”
Journal of Bone and Mineral Research (1995) 10:106.

5. Kelsey, J.L. et al. “Risk Factors for Fracture of the Shafts of the Tibia and Fibula in Older Individuals,”
Osteoporosis International (2006) 17:143.

6. LaCroix, A.Z. et al. “Thiazide Diuretic Agents and the Incidence of Hip Fracture,”
New England Journal of Medicine (1990) 322:286.

7. Nguyen, T.V. et al. “Risk Factors for Osteoporotic Fractures in Elderly Men,”
American Journal of Epidemiology (1996) 144:255.

8. Ray, W.A. et al. “Long-Term Use of Thiazide Diuretics and Risk of Hip Fracture,”
Lancet (1989) 1(8640):687.

9. Rejnmark, L. et al. “Reduced Fracture Risk in Users of Thiazide Diuretics,”
Calcified Tissues International (2005) 76:167.

10. Schlienger, R.G. et al. “Use of Beta-Blockers and Risk of Fractures,”
Journal of the American Medical Association (2004) 292:1326.

11. Schoofs, M.W. et al. “Thiazide Diuretics and the Risk of Hip Fracture,”
Annals of Internal Medicine (2003) 139:476.

12. Wiens, M. et al. “Effects of Antihypertensive Drug Treatments on Fracture Outcome: A Meta-Analysis of Observational Studies,”
Journal of Internal Medicine (2006) 1260:350.

The two studies showing that thiazide diuretics have no impact on fracture risk:

1. Cumming, R.G. and R.J. Klineberg. “Psychotropics, Thiazide Diuretics, and Hip Fractures in the Elderly,”
Medical Journal of Australia (1993) 158:414.

2. Guo, Z. et al. “Cognitive Impairment, Drug Use, and the Risk of Hip Fracture in Persons Over 75 Years Old: A Community-Based Prospective Study,”
American Journal of Epidemiology (1998) 148:887.

Studies showing that statins reduce biochemical markers of bone loss:

Berthold, H.K. et al. “Age-Dependent Effects of Atorvastatin on Biochemical Bone Turnover Markers: A Randomized Controlled Trial in Postmenopausal Women,”
Osteoporosis International (2004) 15:459.

Jadhav, S.B. and G.K. Jain. “Statins and Osteoporosis: New Role for Old Drugs,”
Journal of Pharmacy and Pharmacology (2006) 58:3.

Majima, T. et al. “Short-Term Effects of Atorvastatin on Bone Turnover in Male Patients with Hypercholesterolemia,”
Endocrine Journal (2007) 54:145.

The thirteen studies showing that statins reduce fracture risk:

1. Chan, K.A. et al. “Inhibitors of Hydroxymethylglutaryl-Coenzyme A Reductase and Risk of Fracture Among Older Women,”
Lancet (2000) 355(9222(:2185.

2. DeVries, F. et al. “Reanalysis of Two Studies with Contrasting Results on the Association Betwseen Statin Use and Fracture Risk: The General Practice Research Database,”
International Journal of Epidemiology (2006) 35:1301.

3. Meier, C.R. et al. “HMG-CoA Reductase Inhibitors and the Risk of Fractures,”
Journal of the American Medical Association (2000) 283:3205.

4. Nguyen, N.D. et al. “On the Association Between Stating and Fracture: A Bayesian Consideration,”
Bone (2007) 40:813.

5. Nichols, R. et al. “Statins Are Associated with a Reduced Risk of Bone Fracture in Hemodialysis Patients,”
Hemodialysis International (2008) 12:275.

6. Pasco, J.A. et al. “Statin Use, Bone Mineral Density, and Fracture Risk: Geelong Osteoporosis Study,”
Archives of Internal Medicine (2002) 162:537.

7. Ray, W.A. et al. “Lipid-Lowering Agents and the Risk of Hip Fracture in a Medicaid Population,”
Injury Prevention (2002) 8:276.

8. Rejnmark, L. et al. “Hip Fracture Risk in Statin Users: A Population-Based Danish Case-Control Study,”
Osteoporosis International (2004) 15:452.

9. Rejnmark, L. et al. “Statin But Not Non-Statin Lipid-Lowering Drugs Decrease Fracture Risk: A Nation-Wide Case-Control Study,”
Calcified Tissues International (2006) 79:27.

10. Schoofs, M.W. et al. “HMG-CoA Reductase Inhibitors and the Risk of Vertebral Fracture,”
Journal of Bone and Mineral Research (2004) 19:1525.

11. Scranton, R.E. et al. “Statin Use and Fracture Risk: Study of a U.S. Veterans Population,”
Archives of Internal Medicine (2005) 165:2007.

12. Toh, S. and S. Hernandez-Diaz. “Statins and Fracture Risk: A Systematic Review,”
Pharmacoepidemiological Drug Safety (2007) 16:627.

13. Wang, P.S. et al. “HMG-CoA Reductase Inhibitors and the Risk of Hip Fractures in Elderly Patients,”
Journal of the American Medical Association (2000) 283:3211.

The one study that’s inconclusive on statins for fracture prevention:

Bauer, D.C. et al. “Use of Statins and Fracture: Results of Four Prospective Studies and Cumulative Meta-Analysis of Observational Studies and Controlled Trials,”
Archives of Internal Medicine (2004) 164:146.

The four trials showing that statins have no effect on fracture risk:

1. LaCroix, A.Z. et al. “Statin Use, Clinical Fracture, and Bone Density in Postmenopausal Women: Results from the Women’s Health Initiative Observational Study,”
Annals of Internal Medicine (2003) 139:97.

2. Reid, I.R. et al. “Comparison of the Effects of Pravastatin and Atorvastatin on Fracture Incidence in the PROVE IT-TIMI 22 Trial: Secondary Analysis of a Randomized Controlled Trial,”
Bone (2005) 37:190.

3. Reid, I.R. et al. “Effect of Pravastatin on Frequency of Fracture in the LIPID Study: Secondary Analysis of a Randomized Controlled Trial. Long-Term Intervention with Pravastatin in Ischemic Disease,”
Lancet (2001) 357(9255):509.

4. VanStaa, T.P. et al. “Use of Statins and Risk of Fractures,”
Journal of the American Medical Association (2001) 285:1850.

Studies showing that compliance rates for thiazide diuretics and statins are around 75 percent:

Evans, J.G. “Diuretics for Elderly Patients,”
Journal of Hypertension (1990) 8(Suppl):S33.

Gislason, G.H. et al. “Long-Term Compliance with Beta-Blockers, Angiotensin-Converting Enzyme Inhibitors, and Statins After Acute Myocardial Infarction,”
European Heart Journal (2006) 27:1153.

Oelzner, S. et al. “Correlations Between Subjective Compliance, Objective Compliance, and Factors Determining Compliance in Geriatric Hypertensive Patients Treating with Triamterene and Hydrochlorothiazide,”
International Journal of Clinical Pharmacology and Therapeutics (1996) 34:236.

Smith, C.S. et al. “Early Initiation of Lipid-Lowering Therapy for Acute Coronary Syndromes Improves Compliance with Guideline Recommendations: Observations from the Orbofiban in Patients with Unstable Coronary Syndromes (OPUS-TIMI 16) Trial,”
American Heart Journal (2005) 149:444.

Yilmaz, M.B. et al. “Being Well-Informed About Statins is Associated with Continuous Adherence and Reaching Targets,” Cardiovascular Drugs and Therapeutics (2005) 19:437.

Chapter 17
Save Your Bones, Save the Planet

United Nations Food and Agriculture Organization. “Livestock’s Long Shadow: Environmental Issues and Options,” 2006.