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Meta-Analysis
. 2025 May 30;20(1):551.
doi: 10.1186/s13018-025-05896-9.

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

Bing Tan  1 , HongWei Su  2 , LanYa Wei  3 , Min Liang  4
Affiliations
Meta-Analysis

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

Bing Tan et al. J Orthop Surg Res. .

Abstract

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).

Keywords: Bone mineral density; Dietary patterns; Meta-analysis; Osteoporosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of literature selection
Fig. 2
Fig. 2
Forest plot of the association between DII with osteoporosis risk
Fig. 3
Fig. 3
Forest plot of the association between Western/unhealthy dietary patterns and osteoporosis risk
Fig. 4
Fig. 4
Forest plot of the association between three dietary patterns and osteoporosis risk. a: DASH; b: Prudent/Healthful dietary pattern; c: Aquatic dietary pattern
Fig. 5
Fig. 5
Forest plots of the association between three plant-based diet indexes and osteoporosis risk. a: healthful PDI; b: unhealthful PDI; c: overall PDI
Fig. 6
Fig. 6
Sensitivity analysis chart of DII and osteoporosis risk
Fig. 7
Fig. 7
Sensitivity analysis chart of PDI and osteoporosis risk
See this image and copyright information in PMC

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