Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review

Association of dietary patterns with osteoporosis risk: a meta-analysis of observational studies

BACKGROUND

Dietary patterns play a crucial role in osteoporosis prevention and management. Patients with osteoporosis need to select a dietary pattern for prevention. This meta-analysis aims to examine the influence of eight distinct dietary patterns on the risk of osteoporosis, including dietary inflammatory index (DII), Western/unhealthful dietary pattern, dietary approaches to stop hypertension (DASH), prudent/healthful dietary pattern, aquatic dietary pattern, plant-based diet index (PDI), healthful PDI, and unhealthful PDI.

METHODS

Embase, Web of Science, PubMed, and Cochrane Library were systematically searched for observational studies up to April 10, 2025. Meta-analysis was conducted using random-effect models. Heterogeneity was evaluated by subgroup analyses and publication bias was assessed by Egger's test. If there was a risk of bias, the sensitivity analysis and trim-and-fill analysis were conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) were combined to compare the lowest and highest dietary pattern categories.

RESULTS

A total of 2,620 studies were retrieved, among which 2,600 were excluded. 20 observational studies, involving 8 dietary patterns were included, with 426,292 participants. The highest DII (OR: 1.82; 95% CI: 1.39, 2.37; P < 0.001) and the high adherence of unhealthful PDI (OR: 1.37; 95% CI: 1.11, 1.68; P = 0.003) were correlated with an increased risk of osteoporosis. Conversely, the highest category of the prudent/healthful dietary pattern (OR: 0.66; 95% CI: 0.53, 0.83; P < 0.001) presented a low osteoporosis risk. The Western/unhealthful dietary pattern, DASH, aquatic dietary pattern, and high adherence to PDI and healthy PDI dietary patterns were not associated with osteoporosis risk (All P > 0.05).

CONCLUSION

High DII or unhealthy PDI scores were associated with an increased risk of osteoporosis, while high adherence to prudent/healthy dietary patterns reduced the risk of osteoporosis.

TRIAL REGISTRATION

This paper was registered with PROSPERO (CRD42024585588).

Nutrition and Physical Activity in Musculoskeletal Health

A balanced diet and regular physical activity are essential for maintaining musculoskeletal health. Key nutrients such as calcium, vitamin D, and protein are especially important for preventing falls and fractures. While the benefits of these nutrients are well-established, other dietary components have not been studied as extensively. For instance, vegetables, which are rich in nutrients vital for muscle and bone health, play a crucial role in preventing falls and fractures. Over recent decades, a great emphasis has been given to the combinations of nutrients and foods in dietary patterns that may have synergistic or antagonistic effects. Despite the challenges in researching the impact of nutrition and physical activity on musculoskeletal health due to the extensive heterogeneity of the results, healthcare professionals should continue to promote healthy eating and regular physical activity, and these principles should be emphasized in public health initiatives. Ultimately, a sufficient and balanced diet, abundant in plant-based foods and low in processed or discretionary foods, along with consistent physical activity, remains the most effective strategy for the prevention of musculoskeletal issues. This article aims to review the updated literature of recent years on the links between nutrition and physical activity with bone and skeletal muscle health.

Comparison of Nutrient Intake Across Different Dietary Patterns in Brazilian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Dietary patterns are able to capture the complexity of the diet. The present study aimed to compare the nutrient intake across different dietary patterns in Brazilian community-dwelling older adults.

METHODS

Dietary patterns from 295 (predominantly women, 85%) of Brazilian community-dwelling older adults were identified using principal component analysis, based on a 24 h dietary recall (24HR). The following patterns were identified: the "traditional" pattern (consisting of in natura or minimally processed food); the "modified" pattern (consisting of processed foods, confectionery), and the "snack" pattern (composed of coffee, whole milk, bread, toast, butter, or margarine). Participants were divided into three tertiles according to their scores in each pattern. A comparison of energy and nutrient intake across the tertiles of the three patterns was analyzed using the Kruskal-Wallis rank sum test. Then, the intake of energy and macro and micronutrients were analyzed.

RESULTS

Older adults with higher scores for the "traditional" pattern had significantly higher intakes of total energy, all macronutrients, beta-carotene, vitamin C, E and K, thiamine, pyridoxine, and total folate (p < 0.05). Participants with higher scores for the "modified" pattern had significantly higher intakes of total energy, added sugar, total and animal protein, leucine, arginine, monounsaturated fat, cholesterol, niacin, and pyridoxine; the second tertile had lower vitamin A than the first tertile (p < 0.05). Finally, older adults with higher scores for the "snack" pattern had significantly lower intakes of total and insoluble fiber, animal and vegetable proteins, vitamins (A, E, and K), niacin, and pyridoxine (p < 0.05). The "Traditional" pattern exhibited the most appropriate dietary pattern regarding the availability of essential nutrients, resulting in a better quality of habitual intake and outcomes that are related to health promotion and reduction in the risk of non-chronic issues.

CONCLUSIONS

The results reinforce the importance of public policies that encourage the maintenance of the traditional Brazilian dietary pattern, which is in alignment with Brazilian Dietary Guidelines, especially in the older population.

The Relationship of Certain Diseases and Dietary Inflammatory Index in Older Adults: A Narrative Review

PURPOSE OF REVIEW

One of the important markers affecting aging processes is the increase in inflammatory markers. Many chronic diseases are associated with inflammation and chronic inflammation increases with aging. Inflammation can change with dietary components. Foods, compounds and nutrients that have anti-inflammatory or proinflammatory properties attract attention. According to the Dietary Inflammatory Index, positive scores are obtained if the nutrient has a proinflammatory effect on cytokines, and negative scores are obtained if it has an anti-inflammatory effect.

RECENT FINDINGS

A higher proinflammatory diet is associated with cardiometabolic diseases, neurodegenerative disease, cancers and musculoskeletal health and related mortality. In this study, its relationship with type 2 diabetes mellitus, obesity, metabolic syndrome, musculoskeletal diseases, dementia, depression and cancer, which are more common in older adults and known to be associated with inflammation, was examined. Although studies involving under 65 years old are more prevalent, research involving older adults and Dietary Inflammatory Index (DII) is more limited. It is known that chronic inflammation increases with aging. Diet is one of the factors affecting inflammation. In the light of these investigations, the topics of anti-inflammatory nutrition and DII for the treatment of inflammation-related diseases in older adults are strong and open to development topics of discussion. Despite the significant interest in the potential positive effects of anti-inflammatory nutrition on diseases, contributing to clearer evidence of its protective effects on health necessitates further randomized controlled trials, in vivo, in vitro, cell, animal, human and case-control studies for better risk assessment.

Associations of different dietary patterns, bone mineral density, and fracture risk among elderly women: the China Osteoporosis Prevalence Study

Objective

Despite the fact that China amounts to one-fifth of the world's population, has a higher proportion of the elderly, and has a higher prevalence of osteoporosis and fracture, limited studies have investigated the association between dietary patterns and bone mineral density (BMD) as well as fracture risk among the elderly Chinese population. We aimed to investigate the association between different dietary patterns and BMD as well as the risk of fractures, and this association may vary between elderly women and men.

Methods

Building upon the China Osteoporosis Prevalence Study, we included 17,489 subjects aged ≥40 years old randomly sampled across 44 counties/districts of 11 provinces or municipalities in China who completed a food frequency questionnaire. BMD was measured by dual x-ray absorptiometry. Vertebral fracture was defined based on lateral spine radiographs using the semi-quantitative technique of Genant.

Results

A diet rich in "carnivorous", "vegetarian", "dairy, fruit, and egg" was significantly associated with higher BMD at total hip (TH), femoral neck (FN), and lumbar spine 1-4 (L1-4). Yet, a diet rich in "beverage and fried food" was associated with a lower BMD at the FN and L1-4. High quartiles of the carnivorous diet were associated with 34%-39% reduced risk of clinical fracture in the past 5 years and vertebral fracture. Stronger associations were observed among women. Sensitivity analysis among postmenopausal women presented even stronger positive associations between carnivorous and vegetarian diets and high BMD, as well as between carnivorous diet and reduced risk of fractures.

Conclusions

Our study suggested that a diet rich in meat, vegetables, and dairy, fruit, and eggs might be associated with greater BMD and a lower fracture risk, while beverage and fried foods may be associated with a lower BMD at L1-4, especially among elderly women. These findings are relevant to provide recommendations on dietary nutrition regarding the elderly population at high risk of osteoporosis and fractures, especially postmenopausal women.

Association between adherence to the Nordic diet and frailty in older adults: A systematic review of observational studies

BACKGROUND

The Nordic or Baltic Sea diet is a healthy plant-based dietary pattern composed of foods originating from Nordic countries, closely related to the Mediterranean diet. Adherence to the Mediterranean diet has been found to be associated with a reduced risk of frailty. Although adherence to the Nordic diet has been associated with health benefits, little is known about its association with frailty.

OBJECTIVES

To investigate the evidence from observational studies regarding the association between the Nordic/Baltic Sea diet and frailty among older adults.

DESIGN

Systematic review.

METHODS

Three databases (Medline/Ovid, Embase/Ovid, and Scopus) were systematically searched in February 2023 for observational studies examining the association between adherence to the Nordic diet and frailty among adults ≥60 years. The two authors independently assessed the full text of the papers for eligibility of studies and risk of bias.

RESULTS

Three studies (the results of which were reported across 6 papers) met the inclusion criteria, among which one study (2 papers) included only women. Greater adherence to the Nordic diet was associated with a reduced risk of frailty measured by modified Fried criteria in women (one study). Moreover, greater adherence to the Nordic diet was associated with improved muscle (handgrip/leg) strength (one study) and physical performance (two studies), but these differences were seen only in women, with no significant results in men in two studies. Greater adherence to the Nordic diet was also associated with a lower risk of mobility limitations and improved ability to carry out self-care tasks (one study) and a borderline non-significant difference in Activities of Daily Living (one study). A meta-analysis was not performed due to heterogenous outcomes. Although all studies were of good quality, the results should be carefully interpreted due to methodological limitations.

CONCLUSIONS

Adherence to the Nordic diet could be promising in reducing frailty risk, but more robust studies with equal gender representation and frailty-specific outcomes are needed.

Prevalence and Risk Factors of Osteoporosis in a Chinese Population: A Cross-Sectional Study in Xi'an, Shaanxi Province, China

BACKGROUND Osteoporosis is a systemic chronic disease characterized by bone mineral density (BMD) reduction. This study aimed to assess the prevalence of osteoporosis and fracture risks in northwestern China and investigate the related anthropometric risk factors. MATERIAL AND METHODS Between July 2022 and August 2022, 1429 participants (1295 females, 134 males) with measured BMD were recruited to participate in this cross-sectional study. Data on height, weight, and T score were collected. Spearman's correlation and multiple linear regression analysis were used to investigate the relationships between various demographic factors and BMD and the 10-year risk of major osteoporotic fracture (MO) and hip fracture (HP). RESULTS The overall prevalence of osteoporosis in northwest China was 42.34%, with 44.56% in females and 20.90% in males. Age negatively affects females' T scores (r=-0.304, P<0.05), and height positively influences both sexes' T scores (r=0.059 P<0.05). Age (r=0.148, P<0.05) and height were positive predictors of MO (r=0.027, P<0.05), while weight was a negative predictor (r=-0.035, P<0.05). The conclusion for HP was consistent with that of MO, except for the T score, which was a positive predictor of HP (r=0.014, P<0.05). CONCLUSIONS The prevalence of osteoporosis in northeast China is high. The association between anthropometric parameters and osteoporosis in adults in northwest China is different between sexes.