Public Health Nutrition

Research Paper

Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men

Timothy J Keya1 c1, Paul N Applebya1, Elizabeth A Spencera1, Andrew W Roddama1, Rachel E Nealea2 and Naomi E Allena1

a1 Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK

a2 Viertel Centre for Research in Cancer Control, Queensland Cancer Fund, PO Box 201, Spring Hill, Queensland 4006, Australia


Objective The risk factors for fractures are incompletely understood. An outstanding question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture.

Design We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospective cohort study. Nutrient intakes were estimated using a semi-quantitative food-frequency questionnaire administered at recruitment.

Setting The UK.

Participants A total of 26 749 women and 7947 men aged 20–89 years.

Results Over an average of 5.2 years of follow-up, 1555 women and 343 men reported one or more fractures, 72% of these resulting from a fall. Among women, fracture risk was higher at lower calcium intakes, with a relative risk of 1.75 (95% confidence interval (CI) 1.33–2.29) among women with a calcium intake of < 525 mg day− 1 compared with women with a calcium intake of at least 1200 mg day− 1 (test for linear trend, P < 0.001). The association of dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above. Dietary calcium intake was not associated with fracture risk in men. Fracture risk was not related to the dietary intake of any other nutrient examined.

Conclusion In this population, women with a low dietary calcium intake had an increased risk of bone fracture, and this association was more marked among younger women than among older women.

(Received August 29 2006)

(Accepted January 18 2007)

(Online publication March 19 2007)


c1 Corresponding author: Email