British Journal of Nutrition

Research Article

Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies

Liangzhi Xua1 c1, Patrick McElduffa1 p1, Catherine D'Estea1 and John Attiaa1

a1 Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Population Health Sciences, Faculty Health, The University of Newcastle, Australia


It is generally accepted that supplemental Ca and/or vitamin D is effective in reducing the incidence of bone fractures; this is supported by numerous randomised controlled trials and meta-analyses. However, a question that has received much less attention is whether dietary Ca, i.e. Ca in physiological doses in normal food intake, also affects bone fracture risk. The present study aims to review the effect of dietary Ca on bone fractures at the hip, spine and radius in women >35 years old, and to compare these results with previous meta-analyses. MEDLINE (1966–1999) and reference lists in papers were searched for observational dietary Ca studies. Data were extracted in duplicate and separately. Heterogeneity and publication bias were tested. Observational studies failed to show any association between dietary Ca intake and risk of hip fracture (risk ratio 1·01, 95% CI 0·96, 1·07 for each increment of 300mg dietary Ca intake/d). There is a suggestion that either extremely low Ca intake may increase fracture risk, or that East Asian women may respond differently to increasing Ca intake.

(Received June 06 2003)

(Revised November 24 2003)

(Accepted December 06 2003)


c1 *Corresponding author: Dr Liangzhi Xu, present address: Department of Obstetrics and Gynaecology, The Second West China Hospital, Sichuan University, Chengdu, China, fax +86 28 8555 9065, email

p1 The Medical School, The University of Manchester, Oxford Road, Manchester M13 9PT, UK