Milk drinking and fractures in children - Head Start Programs

Nutrition Research Newsletter, March, 2004

Bone fractures are a frequent problem for children. Low bone density and high body weight increase fracture risk during growth. Adequate absorption of dietary calcium is important for optimal bone growth, Sustained milk avoidance during growth may therefore jeopardize bone health unless appropriate substitute calcium-rich foods are consumed.

In a recent study, Some researchers from New Zealand observed a group of children who had avoided drinking cow's milk for prolonged periods; they obtained information about any possible fractures and compared their observed fracture frequencies with those expected in children of similar age and sex.

The full fracture histories of 50 children (30 girls and 20 boys) aged 3 yrs to 13 yrs, who had avoided drinking cow's milk for prolonged periods, were compared with those in a birth cohort of more than 1,000 children from the same city. Children's height and weight were measured and BMI was determined. Current dietary calcium intake was estimated and information concerning the reasons for milk avoidance, the duration of this, and the use of high-calcium substitute foods was collected. The children were re-interviewed two years later to record detailed information about any fractures occurring and trauma severity.

Forty-six subjects attended the follow-up interview. Baseline data concerning fractures were used for the other four children. Twenty-two fractures were confirmed, all of them occurring before puberty. Eighteen of the 22 were associated with only slight trauma (minor trips or falls incurred during normal play). Twelve children broke one bone; four children broke multiple bones. Children who avoided milk did not use calcium-rich food substitutes appropriately, and had low dietary calcium intakes and low bone mineral density values. Significantly, more of the children who avoided milk reported fractures (16 observed vs. 6 expected). They also experienced more total fractures than the birth cohort population (22 observed vs. 8 expected). Reasons for children avoiding milk included dislike of the taste, cost reasons or because their families chose not to supply this food regularly.

Previous studies have shown that children who habitually avoid milk have low calcium intakes and poor skeletons, but this study is the first to demonstrate that young children who avoid milk sustain more fractures than community controls of similar age and sex. Low physical activity levels may have contributed to the adiposity and the poor skeletal growth of the study children, since overweight children are frequently inactive. An intervention is needed to educate children and their parents about the dangers of milk avoidance and the benefits of non-dairy calcium rich foods or drinks, vitamin and mineral supplements, and regular exercise with regard to bone density and fractures.

Ailssa Goulding, Jennifer E. P. Rockell, Ruth E. Black, et al. Children who avoid drinking cow's milk are at increased risk for prepubertal bone fractures. JADA 104(2):250-253 (February 2004) [Address correspondence to: Professor Ailssa Goulding, PhD, FACN, Department of Medical and Surgical Sciences, 9th Floor, Dunedin Hospital, University of Otago, PO Box 913, Great King Street, Dunedin, New Zealand. E-mail: ailsa.goulding@stonebow.otago.ac.nz]