​albert.​nl) Carrefour Protein Tyrosine Kinase (www.​carrefour.​fr) ICA (www.​ica.​se) CBS Statistics Netherlands, INSEE Statistics France, IOF International Osteoporosis Foundation, SCB Statistics

Sweden a http://​www.​nationaalkompas.​nl b http://​www.​cbs.​nl c http://​www.​inseee.​fr d http://​www.​scb.​se eCorresponding to an extra 650 mg calcium per day; September 2010 prices fSummed over the eight distinguished age categories Main outcomes With a distinction according to age class, Fig. 2 shows the PIF, indicating the number of hip fractures that could potentially be prevented each year with additional calcium intake. All age classes taken together, the PIF is highest in French women (1,565), followed by Swedish women (307). Across all age classes, the PIF number was relatively low in The Netherlands (103), compared with France and Sweden. Fig. 2 Potential impact fraction (absolute numbers) The prevented mortality is relatively low for all three countries: all age classes and both sexes taken together, the number of deaths prevented per 10,000 persons experiencing a hip fracture is 5.1 (Sweden), 2.4 (France), and 0.4 (The Netherlands), respectively. This can be explained by the fact that the PAF (i.e. the percentage of hip fractures attributed to low calcium Salubrinal mw intake) is rather low (The Netherlands, 0.8 %; France,

3.1 %; and Sweden, 2.2 %). Figure 3 shows the yearly number of DALYs lost, representing the burden of hip fractures due to low calcium intake. In all countries, the number of DALYs lost appears to increase with age. In total, the yearly societal burden of hip fractures due to low calcium intake appeared to be 6,263 DALYs for France, 1,246 DALYs for Sweden, and 374 DALYs for The Netherlands. Fig. 3 DALYs lost, representing the burden of hip fractures in relation to low calcium intake Figure 4

shows the total costs that can potentially be avoided when the risk of hip fractures is decreased by the additional consumption of dairy foods. These discounted costs (which are actually savings) represent the difference between the costs of treating hip fractures second and the costs of extra dairy foods. The potential savings on the costs of treating hip fractures exceeded the costs of extra dairy foods in all age classes in all three countries. The total costs potentially avoided were largest in women in France (€ 100,311,274) followed by women in Sweden (€ 23,912,460) and The Netherlands (€ 5,121,041). The main part of these costs can be prevented in the older age categories, i.e. from 70 years onwards. Fig. 4 Costs avoided (first and subsequent years after hip fracture) through improved dairy foods consumption Sensitivity analyses We varied the PAF by changing the risk factor for a hip fracture associated with low calcium intake (using the 95 % confidence interval of 1.02 to 1.16) [37], as well as by changing the proportion of people with a low calcium intake. Both outcomes of the model (i.e.