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Meta-Analysis
. 2019 Mar 1;10(2):219-236.
doi: 10.1093/advances/nmy073.

Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis

Roberto Fabiani  1 , Giulia Naldini  2 , Manuela Chiavarini  3
Affiliations
Meta-Analysis

Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis

Roberto Fabiani et al. Adv Nutr. .

Abstract

Low bone mineral density (BMD) and osteoporosis-related fractures constitute a considerable public health burden. Several studies have demonstrated the association between diet and bone health. We performed a systematic review to provide an estimate of the association between different dietary patterns defined through the use of a posteriori methods and fracture or low BMD risk. A literature search on PubMed, Web of Science, and Scopus databases, up to March 2018, was performed to identify all eligible case-control, prospective, or cross-sectional studies involving subjects of both sexes and any age. Random-effects models were used. Heterogeneity and publication bias were evaluated. Stratified analyses were conducted on study characteristics. The meta-analysis includes 20 studies and identifies 3 prevalent dietary patterns: "Healthy," "Milk/dairy," and "Meat/Western." From the 10 studies on fracture, adherence to the "Healthy" pattern reduced the risk, particularly in older people (OR: 0.79; 95% CI: 0.66, 0.95; P = 0.011) and in Eastern countries (OR: 0.64; 95% CI: 0.43, 0.97; P = 0.037), whereas the risk increased with the "Meat/Western" pattern, especially for older people (OR: 1.11; 95% CI: 1.04, 1.18, P = 0.001), in those with hip fractures (OR: 1.15; 95% CI: 1.05, 1.25; P = 0.002), and in Western countries (OR: 1.10; 95% CI: 1.07, 1.14; P < 0.0001). Analyses on low BMD showed a reduced risk in the "Healthy" pattern, particularly for younger people (OR: 0.62; 95% CI: 0.44, 0.89; P = 0.009). The "Meat/Western" pattern increased low BMD risk, especially in older people (OR: 1.31; 95% CI: 1.05, 1.64; P = 0.015). The "Milk/dairy" pattern resulted in the strongest reduction in low BMD risk; when stratifying, this effect remained significant (e.g., older women-OR: 0.57; 95% CI: 0.46, 0.70; P < 0.0001). Nutrition is an important modifiable factor affecting bone health. The "Healthy" and "Milk/dairy" patterns are associated with a reduced risk of low BMD and fracture. In contrast, the "Western" pattern is inversely associated.

Keywords: bone fracture; bone mineral density; dietary pattern; meta-analysis; systematic review.

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Figures

FIGURE 1
FIGURE 1
Flow diagram of the systematic literature search on dietary patterns and bone fracture and low BMD risk. BMD, bone mineral density.
FIGURE 2
FIGURE 2
Forest plots of the association between “Healthy” (A) and “Meat/Western” (B) dietary patterns and fracture risk. ES, effect size.
FIGURE 3
FIGURE 3
Forest plots of the association between “Healthy” (A), “Meat/Western” (B), and “Milk-dairy” (C) dietary patterns and low BMD risk. BMD, bone mineral density; ES, effect size.
See this image and copyright information in PMC

Comment in

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