Table 8Association between lactose intolerance and bone outcomes

ExposureNumber of Studies/PatientsBone Mineral
Density (BMD)or Content (BMC)
Level of EvidenceNumber of Studies/PatientsFractures, Osteoporosis or OsteopeniaLevel of Evidence
Children
Diet7 RCTs/1,207 children (mean age range 7–11 years old)
Chan, 1995103
Bonjour, 1997105
Cadogan, 1997104
Lau, 2004101
Gibbons, 2004102
Chevalley, 2005106
Cheng, 2005107
Inconsistent increase in BMC of lumbar spine and femoral neck at 12, and 18 months after increased dairy intake. Results did not persist at 24 months of followupModerate2/100, New Zealand
Black, 200276
Goulding, 200489
Milk avoiders had increase in adjusted odds by 259 (OR 3.59, 95% CI 1.77; 7.29)- 313% (OR 4.13, 95% CI 1.61; 10.56)Low
4/940
Parsons, 199795
Du, 200296
Black, 200276
Rockell, 200597
BMC
Inconsistent reduction in BMC among milk avoiders
Low
3/745
Du, 200296
Black, 200276
Rockell, 200597
BMD
Consistent reduction in milk avoiders
Low
Dairy Ca++1/152
Vatanparast, 2005160
For every additional 1 mg Ca++ for boys, 0.017 g increase in total body BMC
NS for girls
Low1/50
Goulding, 200489
NSLow
Lactose malabsorption1/291
Matlik, 200799
Inconsistent reduction in BMCLow
Lactose intolerance2/310
Stallings, 199498
Matlik, 200799
Inconsistent reduction in BMCLow1/50
Goulding, 200489
NS among those milk avoiders with perceived LI vs. no symptoms of LILow
Genotype1/358
19168163
During the transition to young adulthood men but not women with C/C genotype tended to have greater bone lossLow
Adult women
Diet2 RCTs/496 adult women (mean age range 28–35 years old)
Woo, 200762
Baran, 199063
Short term increase (6 months) in total spine BMD in young women with high adherence to increased lactose diet.
Reduced decline in vertebral BMD in pre-menopausal women.
Low9/111,485
Kelsey, 199277
Nieves, 199278
Wyshak, 198979
Tavani, 199581
Johnell, 199582
Feskanich, 199784
Turner, 199885
Johansson, 200487
Kalkwarf, 200386
Inconsistent evidence that low lifetime milk intake is associated with increased odds of fractureLow
Dairy Ca++1/960
Tavani, 199581
NSLow
Vegan diet2/443
Lau, 1998171
Chiu, 199793
BMD in Asian women
NS
Low1/26, 749
Appleby, 200790
NSLow
1/258
Chiu, 199793
Osteopenia Increased in adjusted odds by 294% (OR 3.94, 95% CI 1.21; 12.82)Low
Lactose malabsorption1/80
Goulding, 199971
BMC
NS
Low3/11761
Honkanen, 1997167
Wheadon, 1991164
Harma, 1988170
Inconsistent increase in crude and adjusted oddsLow
4/13,748
Honkanen, 1997167
Honkanen, 1996166
Corazza, 1995169
Horowitz, 198772
BMD
Inconsistent reduction
Low2/124
Finkenstedt, 1986168
Corazza, 1995169
Osteoporosis Inconsistent increase in crude oddsLow
Lactose intolerance1/58
Corazza, 1995169
BMD
NS
Low1/564
Enattah, 200529
NSLow
2/124
Finkenstedt, 1986168
Corazza, 1995169
Osteoporosis Inconsistent increase in crude oddsLow
Genetic polymorphism2/331
Obermayer-Pietsch, 200468
Obermayer-Pietsch, 200769
BMD
Consistent reduction among individuals with C/C genotype
Low3/895
Obermayer-Pietsch, 200468
Obermayer-Pietsch, 200769
Enattah, 200529
Inconsistent evidence that women with C/C genotype had increased crude odds of fractureLow
2/637
Enattah, 200529
Obermayer-Pietsch, 200769
Osteoporosis
NS
Low
Adults
Diet1/367
Kull, 200967
BMD
Significant reduction in low milk consumers
Low3/44,552
Cumming, 199480
Fujiwara, 199783
Kanis, 200588
Inconsistent increase in odds of lifetime or osteoporotic fracture in those with low lifetime or childhood milk intakeLow
1/404
Shaw, 1993163
Osteoporosis NS in those with low milk intakeLow
Dairy Ca++1/4342
Looker, 1993174
NSLow
Vegan Diet1/34,696
Appleby, 200790
Increase in adjusted relative risk by 30% (RR 1.30, 95% CI 1.02; 1.66)Low
Lactose malabsorption1/103
Di Stefano, 20025
BMC
NS
Low1/218
Kudlacek, 200292
Increase in crude odds of overall factures by 163% (OR 2.63, 95% CI 1.52; 4.54) and crude odds of verterbral fracture by 262% (OR 3.62, 95% CI 1.93; 6.79) in those with severe LMLow
3/350
Di Stefano, 20025
Alhava, 1977162
Kudlacek, 200292
BMD
NS
Low1/103
Di Stefano, 20025
Osteopenia Increase in crude odds by 677 (OR 7.77, 95% CI 2.20; 27.44)-959 (OR 10.59, 95% CI 2.66; 42.20) in LM with LI symptoms
Lactose intolerance1/103
Di Stefano, 20025
Reduction in BMCLow2/585
Kudlacek, 200292
Kull, 200967
Increased in crude odds by 96% (OR 1.96 95% CI 1.11; 3.48)169% (OR 2.69, 95% CI 1.25; 5.78)Low
3/536
DiStefano, 20025
Kull, 200967
Segal, 2003100
BMD
Consistent reduction
Low1/32
Birge, 196794
Osteoporosis Increase in crude odds by 656% (OR 7.56, 95% CI 1.30; 43.98)Low
Genetic polymorphism1/367
Kull, 200967
BMD
NS
Low1/601
Enattah, 200565
Elderly with C/C genotype had 322% increase in crude odds (OR 4.22, 95% CI 2.17; 8.33)Low
Adult males
Diet1/15,825
Kanis, 200588
NSLow
1/404
Shaw, 1993163
Osteoporosis NS in men with low milk intakeLow
Vegan diet1/7,947
Appleby, 200790
NSLow
Genetic polymorphism1/234
Enattah, 200457
BMC
NS
Low1/239
Gugatschka, 200791
NSLow
1/234
Enattah, 200457
BMD
NS
Low

Bold = statistically significant

From: 3, Results

Cover of Lactose Intolerance and Health
Lactose Intolerance and Health.
Evidence Reports/Technology Assessments, No. 192.
Wilt TJ, Shaukat A, Shamliyan T, et al.

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