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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

References

    1. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, Shamliyan T, Cooney TG, Cross JT Jr, Fitterman N, Lin JS, Maroto M, Obley AJ, Tice JA, Tufte JE. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med. 2023;176(2):224–38. - PMC - PubMed
    1. Marques ALÓ, da Silva JA. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int. 2015;26(11):2623–30. - PubMed
    1. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1):136. - PMC - PubMed
    1. Xiao PL, Cui AY, Hsu CJ, Peng R, Jiang N, Xu XH, Ma YG, Liu D, Lu HD. Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: a systematic review and meta-analysis. Osteoporos Int. 2022;33(10):2137–53. - PubMed
    1. Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, Bosco-Levy P, Bradbury BD, Chan AHY, Chandran M, Cooper C, de Ridder M, Doyon CY, Droz-Perroteau C, Ganesan G, Hartikainen S, Ilomaki J, Jeong HE, Kiel DP, Kubota K, Lai EC, Lange JL, Lewiecki EM, Lin J, Liu J, Maskell J, de Abreu MM, O'Kelly J, Ooba N, Pedersen AB, Prats-Uribe A, Prieto-Alhambra D, Qin SX, Shin JY, Sørensen HT, Tan KB, Thomas T, Tolppanen AM, Verhamme KMC, Wang GH, Watcharathanakij S, Wood SJ, Cheung CL, Wong ICK. Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality. J Bone Miner Res. 2023;38(8):1064–75. - PubMed

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